Stakeholder views

The process for identifying national priority localities was described earlier. Through this process localities are identified as high, medium or low priorities for either Core VOS or VOS IA. The localities are identified by the VOS National Advisory Committee based on advice received from the state and Northern Territory VOS reference groups. To contribute to the decision making process, information held by the Optometrists Association of Australia has been utilised, which outlines where existing optometry practices have been established.

Many stakeholders consulted (including some who participated in the process) did not understand and could not see an explicit rationale for the priority localities identified, including the allocation between Core VOS or VOS IA. Specific comments made included:
    • Assessment of need should take into account the average population size of communities, the age structure and other information such as the number of people known to have diabetes as recorded in the local health clinic records.
    • There are specific communities that seem to be under or over serviced, and these imbalances did not seem to be addressed when the priority locations list was developed.
    • Local service providers should be given an opportunity to provide input into identifying priority locations and the number of visits required to identified communities.
    • The scheme should give more priority to outreach services for Aboriginal and Torres Strait Islander people living in regional areas and be expanded to include Aboriginal and Torres Strait Islander people living in urban areas.
    • There is a lack of recognition that while there may be local optometrists practicing in a locality, Aboriginal and Torres Strait people may not be comfortable accessing these services. Consequently, a visiting services based in an AMS may be justified.
    • It was also pointed out that while local optometrists may be willing to provide outreach services to a local AMS, typically they will not be eligible to receive VOS funding. While these optometrists will not face travel costs, they will bear costs in providing the service, such as the lower level of Medicare billing they may achieve in the AMS setting and the costs of maintaining the base practice. This sometimes leads to situations where out of area optometrists received VOS support to provider services in AMSs (at a relatively high subsidy), but local optometrists are ineligible despite being potentially the most cost effective option available.
A small number of examples were given of newly approved services going to communities that were already supported by a visiting VOS service.
The Optometrists Association of Australia was broadly supportive of the current methods but argued that these need to be more widely understood. The Association argued the current principles articulated in section 5 of the VOS program guidelines should continue to apply. However, it was argued that the guidelines should be enhanced to allow approval of services where there is already a local optometrist, but there is a need for need of additional optometry services because of high demand or the local optometrists being unable to establish a good working relationship with a local AMS.

Evaluation findings

While it is recognised the current approach to identifying needs and priorities is a generally consultative process, there are some opportunities to improve the steps involved in identifying priorities and planning services.

The current approach is focussed on identifying specific locations requiring outreach optometry services, that is, locations without local optometry services. The feedback we received from optometrists delivering services in remote Australian was that the approach does not adequately take into account the level of outreach service provision required for these locations (e.g. with the size or age profile of the population how many visits would typically be required). It also is not able to adequately address issues for localities where there may be local optometrists providing services (or a branch), but that the level of service provision is inadequate to address the needs of the community. Another problem is that the current approach does not deal with the logistical issues of service provision in very remote areas. In these areas the planned level of service provision (number of visits) often falls short of actual services. This is a systemic issue and should be built into planning of service provision. Another issue is that the focus on individual locations detracts from understanding how these are likely to form a part of a network or circuit. Finally, there is a case for allowing for public comment on priority locations prior to finalising decisions, in order to obtain wider input, including from local health and optometry service providers. Ways of addressing these issues are as follows:
    • Create a comprehensive database for planning services by integrating the Medicare data analysis with VOS program data and information, from the Optometrists Association of Australia on localities where optometrists are in practice. The data base should include:
        • analysis of Medicare data on provision of optometry and ophthalmology services (at the SLA level)
        • VOS and MSOAP (ophthalmology) program data and information
        • admitted patient hospital episodes per 1,000 population (age adjusted) for specific ophthalmology related surgery (e.g. cataract procedures), based on the Admitted Patient Care NMDS
        • data from the Optometrists Association of Australia on localities where optometrists are in practice.
    • Use routine analysis of Medicare data to identify the extent to which specific localities/regions (e.g. SLA or equivalent) fall short in terms of access to optometry services and the level of eye examinations. Routine analysis can also be used with the voluntary Indigenous identifier to estimate the level of provision for Aboriginal and Torres Strait Islander people across localities/regions. Key tables required at the SLA or equivalent level should include:
        • services per 1,000 population (age adjusted) for optometry services
        • services per 1,000 population for non-hospital ophthalmology services
        • services per 1,000 population for specific ophthalmology related surgery (e.g. cataract procedures)
        • proportion of people (aged 50+ and total) who have had at least one optometry or ophthalmology service in the last two years and the last five years
        • proportion of Aboriginal and Torres Strait Islander people (based on the voluntary Indigenous identified) (aged 50+ and total) who have had at least one optometry or ophthalmology service in the last two years and the last five years.
    • Set VOS planning benchmarks that reflect the level of outreach service provision considered appropriate for localities of different population sizes. These benchmarks should take into account the higher likelihood of outreach service disruptions in very remote areas, for example, due to cultural and community issues and the weather.
    • Where appropriate, cluster localities into groups, reflecting likely or existing circuits. This will not always be appropriate and in some instances it will be appropriate to deal with localities individually. Set priorities in relation to circuits or localities, depending on the agreed approach, and advertise for proposals related to the circuits or localities.
    • Based on planning benchmarks, identify the required number of visits/circuits for each priority circuit/locality.
    • Publicly release and invite public comment on the proposed priority circuits/localities and proposed annual number of visits/circuits. Consider feedback prior to finalising the agreed priorities.
These steps need to be undertaken well before the call for VOS proposals, which should be issued more than three months before the end of each VOS funding agreement period. The steps need to be undertaken through a consultative process involving the VOS National Advisory Committee, state/Northern Territory reference groups and the proposed joint state/Northern Territory eye health planning committee. The following recommendations suggest how this might be achieved.

Recommendations - Assessment of need

39. DoHA initiate steps to create a comprehensive database for planning VOS and other eye services by integrating the relevant data at the SLA (or equivalent) and/or locality level, as described in the report.
40. DoHA establish a system for generating reports annually from Medicare data that provides key tables on eye health services at the SLA (or equivalent) level, as described in the report.
41. Based on analysis of the planning database the VOS National Advisory Committee specify planning benchmarks for the provision of outreach optometry services for localities of different population sizes. These benchmarks should take into account (a) the gap in access to optometry services for remote and very remote locations (b) the current impact of VOS (c) the extent to which current gaps can be addressed with available (including addition) VOS funding; and (d) the higher likelihood of outreach service disruptions in very remote areas, e.g. due to cultural and community issues and the weather.
42. VOS state reference groups/joint eye health planning committees be provided with analyses of planning data discussed above and be requested to provide advice on priority localities/circuits. The joint eye health committees should be requested to advise on:
    a. The number of visits required for each locality per year, based on the planning benchmarks proposed in the previous recommendation and other information available locally to the committee.
    b. The priority to be accorded a particular locality.
    c. Whether and how the locality should be grouped with other localities in advertising for VOS service proposals, and if so the priority for the circuit as a whole.
43. Following consideration of advice from joint eye health planning committees, the VOS National Advisory Committee develop recommendations on a national list of
priority localities including an indicative number of outreach visits require per year for each locality, and the potential grouping of the location into a circuit. The recommendations should be released publicly seeking comments from the public and other stakeholders. The VOS National Advisory Committee should consider feedback on the proposed priorities prior to providing its final recommendations to the Minister’s delegate.Top of page