The Association for Independent Optometrists and Dispensing Opticians (AIO) has written to the Secretary of State for Health and Social Care, Sajid Javid, to ask for a meeting to clarify why ‘it is vital that long term reforms to the provisions of eye care in the UK, and in particular England, are progressed urgently.’
In the letter, the AIO took aim at the slow pace of eye health care reform, the General Optical Services (GOS) fee and its effects on private practice, and the Opticians Act.
Speaking to Optician, AIO chair Dr Christian French explained why the Association felt compelled to contact the government: ‘The pandemic has put additional strain on secondary care and we find ourselves in an almost now-or-never position to introduce meaningful reform.
'For years our profession has hankered for sweeping reform that would enable full utilisation of primary care optometry’s unique skillset; but there seems to be an inertia, which means these discussions never progress beyond mutual agreement that it’s a good idea.’
GOS concerns
The AIO’s letter stated: ‘The GOS regime in England requires a total overhaul in order to prevent a wholesale abandonment of the NHS contract by optical practices up and down the country, which will seriously impair the delivery of basic eye testing for the most disadvantaged in society.’
It goes on to highlight that those from lower socio-economic backgrounds were the most reliant on NHS eye care services and presented a higher-risk of eye health issues.
‘If they can’t access GOS-funded services, there will be a steady increase of untreated and undiagnosed cases of serious eye disease leading to sight loss and blindness’, added the AIO, explaining that this would cost the NHS more when these patients presented to ophthalmologists.
‘The financial implications of reducing sight loss and blindness are commensurately substantial; in other words, it is not just a matter of improving eye health, but also of saving taxpayers money.’
Another contention raised concerned the exploitation of the GOS fee by some retailers: ‘The current GOS regime offers extremely poor value for taxpayers and is abused by some commercial interests as a mechanism to upsell eyewear to unsuspecting consumers that is not necessary.’
The effects of commercial interests are mentioned again when the letter criticises the Optometric Fees Negotiation Committee (OFNC) as ‘primarily funded by large commercial interests that wish to protect the status quo.’
Dr French said that funding for the OFNC required ‘a complete rethink’.
He added: ‘Primary care optometry is woefully underfunded at present, and those who offer NHS contracts can only do so by shoring up the loss-leading model through sale of spectacles.
'No other sector of healthcare is underpaid to such an extent that businesses would simply have to close if they relied solely on NHS fees.’
Modernising the Act
The AIO also made clear that it desired reform to the Opticians Act in its appeal to the Secretary, calling many provisions of the Act ‘redundant and inappropriate in today’s world.’
It said that the meeting it has requested with Javid was partially necessary because the Act ‘does not take account of the significant developments in the use of sophisticated technology in eye health diagnosis, nor the extraordinary opportunity that now exists to place community optometry at the heart of the nation’s eye care.’
The Opticians Act was most recently updated in 2005, before which it saw another update in 1989.
It was established in 1958, and Dr French said the increasing prevalence of diagnostic technology since then warranted a rethink: ‘Fundus photography and OCT imaging have enabled clinicians to undertake clinical exams of a far superior level of detail than ever before.
'These, and other instruments, were historically only used in hospitals, but with more primary care practices investing in such technology, there is a far greater scope to help monitor and co-manage cases with the hospital eye service.’
The AIO’s letter closed with an appeal to what the government should do to safeguard the public’s sight: ‘The current lack of progress in the world of optics is simply unacceptable; proposals for embedding primary eye care in community optometry have been in place for over seven years. The public deserve more radical action to save eye sight and optimise the use of taxpayer money.’