Presentations on commercialising clinical practice and a panel discussion about going private were two of the highlight sessions at Independents Day 2023 conference and exhibition on July 3.
Nick Atkins, director at event organisers Proven Track Record, welcomed 95 delegates to the National Conference Centre in Birmingham.
Discussing the theme of the day, profitable practice post-pandemic, he told attendees to consider what the pandemic did to their practices and to reflect on the promises they made about their businesses during that time.
Atkins highlighted that now was the time to focus on securing additional revenue from clinical services and noted business owners in attendance could make use of the profitability research report provided by Insight Marketing Group.
The first presentation of the day was made by Professor Nick Rumney, optometrist and chair at BBR Optometry in Hereford, who discussed industrialising optometric practice.
Rumney explained that his presentation was not about sales and instead focused on moving from one business pattern to another. He said industrialisation in optometry terms meant transforming the economy of a practice from predominantly retail sales to include a substantial clinical component that provided a return on investment.
Rumney explained this meant providing the whole clinical package and optometric practices could not divorce themselves from the end result of vision correction.
He discussed how his practice in Hereford created a sustainable business model by utilising a knowledge transfer partnership associate.
Rumney outlined how the practice grew by mapping the pathway, analysing costs, looking at fee structures and creating a marketing plan.
However, Rumney noted how time and money were the elephants in the room in this discussion. He showcased a graph that plotted appointment time versus fee at his practice, which highlighted what services were making money.
Lastly, Rumney said his practice evaluated price elevation every two years and that any business that had not looked at their pricing in five years was going backwards.
Looking and feeling private
Optometrist Dr Martin Smith then shared his experience of dropping the general ophthalmic services (GOS) contract and moving to a fully private clinical services model.
During 'Going private: Is it the answer?', Smith explored the how and why of adopting this model at his Lincoln-based practice where he made the switch during the pandemic.
He said it had been ‘an incredibly positive experience’ but noted it was not the answer for every practice. However, he said going through the process of going private was useful regardless of whether a practice made the leap or not.
The key elements to going private Smith highlighted were having your own practice, additional qualifications, equipment, specialist clinics and subscription models.
Smith said an existing subscription service made going private easier but all of the criteria was useless unless it was wrapped in strong customer services. ‘It needs to look and feel private,’ he said.
When Smith took over the practice, he invested in OCT and started a doctorate and charged for providing these services as part of a two-tier model.
As part of his doctorate, Smith gained independent prescribing (IP) capabilities, which he said switched his thinking about what services could and should be. The pandemic then afforded him time to reflect on his business model.
Smith said NHS patients were not willing to pay for a service as they did not value them and although some patients will leave when going private, they should be allowed to.
Those considering whether ditching GOS was ethical, should consider what the consequences were for patients receiving care in a cross-subsidy system and what freedom of GOS meant for the practice, he said.
Smith said NHS eye care was fiction because it was subsidised by spectacles sales that patients pay for and GOS forced a two-tier system of care, which created risk for patients and liability risk to practitioners.
A private practice with realistic clinical fees was a more honest system and private practices were not depriving patients access to GOS as those providers still existed, he noted.
Concluding, he said healthcare was currently a priority for people so now was a good time to switch and the profession had been waiting too long for reforms.
Charging for services
Continuing the discussion on privatisation was a panel of practice owners who had gone private, which included Dr Smith, Anthony Josephson, Keyur Patel, Sophie Taylor-West and Keval Sejpar.
The panel was chaired by Trevor Rowley who said he was one of the first practices to go private in 2004. By show of hands, he surveyed the room and the vast majority were open to going private and some already had.
Taylor-West said the only time she experienced GOS was during her pre-reg. After qualifying, she worked at a private independent practice and when she opened her own practice, she decided against GOS because of the associated red tape.
Josephson offered some private services pre-Covid but during the pandemic he decided he wanted a more efficient option and to be clinically valued by patients.
Sejpar opened a practice in 2014 and immediately added eye care plans to the business before going private during the pandemic. Patel said patients used to have GOS and top up at his practice but during the pandemic the practice considered why all patients were not on a subscription service.
Panellists were asked what they charged for services and what was included. Taylor-West said she offered a £9 a month subscription that covered a one-hour eye examination that included everything, plus a discount on eyewear if required.
Josephson said he initially undercharged to get patients in but admitted he regretted that decision as he did not need to offer that incentive. Sejpar said it was important to note that a practice should only go private if its offering was better than other options locally.
When asked how eye care plans worked for children, Patel said children were an exception to the practice’s private schemes. They offered an eye exam up until the age of five and if they required more care they went on plan. He noted that patients will pay if they know they are going to need eye care.
Commercialising services 
Dr Trusit Dave, optometrist and director at EyeTech Optometrists in Coventry, then presented on the opportunities of commercialising clinical services.
In the future, Dave predicted optometrists would be viewed as specialist service providers and shared his experience of switching to offering treatment-based services.
Pre-Covid, Dave offered a tiered system of eye care but found it complex and offered limited revenue gain. Dave noted there was an ageing population and that there would be a 45% increase in over-65s from 2020-50 and a 20% increase to 2030.
This represented an opportunity in the number of people who were amenable to services offered by independent practices. Specifically, he noted an opportunity for IP optometrists to have a role in managing glaucoma patients.
He told attendees to specialise by learning and making their clinical offering the best it could be. Staff training was also key to commercialising as they needed to understand why you were offering these services.
Dave said the patient experience could be enhanced via video slit lamps that created theatre in practice and made it memorable.
At his practice, he has launched specialty micro-websites that were specific to the treatments offered. Dave also invested in Google adverts to promote services and said 60% of dry eye appointments were booked online.
Thinking small
Dr Samantha Hornberger, US optometrist and practice owner in Dearborn County, Indiana, presented on how she grew practice revenue by 23% without adding any more patients.
She explained the concept of growing big by thinking small. Hornberger clarified that thinking small did not mean small revenue but was more about growing a sustainable business by starting small and adding to it gradually.
Hornberger opened a practice from scratch in 2013 but struggled to maximise time spent with patients while developing the business.
When considering how to stay safe on reopening after Covid-19, the practice reduced the number of patients and tested on three days only, seeing one patient per hour.
Hornberger was surprised to find it did not hit revenue as expected and explained it was because she had increased value for patients and improved conversion. Now she has a locum to carry out eye examinations on two days at the practice so she can focus on business matters.
NHS debate 
The final session of the day was a debate on whether ditching the NHS in England was the future for optometry, which saw Rumney and Dave argue in favour of the NHS against Josephson and optometrist Brian Tompkins.
The debate was chaired by Atkins who asked attendees if they were in favour of ditching or keeping the NHS with roughly two-thirds of the room in favour of ditching.
Josephson said there was no viable choice for any independent to survive ever-increasing competition from multiples and that ditching the NHS was the way forward. He added that a good care plan was required to provide the best care possible for patients.
However, Rumney countered that Josephson had missed the point of the debate and said the question was about the NHS not GOS.
He said optometry needed to be part of a wider NHS team in order to be a part of to create change, adding that a multi-faceted hybrid system was already operational and a full team that worked with secondary care was required to deliver eye care services.
Tompkins said his heart was in optometry but NHS sight tests had dragged the profession down to a bureaucratic nightmare. By ditching the NHS, he said optometrists were able see the patients they wanted to.
Dave said there were implications of ditching the NHS and asked what the profession would be left with if there was no NHS? He answered that practices would be left selling beautiful spectacles and carrying out refraction.
A question from the audience asked where any practitioner in the room would be without the NHS while another attendee noted that everyone in the room was a business owner providing a service for an agreed fee and should not be ashamed of it.
A final audience vote saw a large number of people swing to keeping the NHS but the debate was still won by those in favour of ditching it.
- Independents Day will return on July 8, 2024 with the theme of commercialising dry eye services.