How much should you receive for performing an NHS eye exam? Moreover, how much does it cost to cover the expenses of running a private examination? Although these questions may not have a correct or even unanimous answer, they are a catalyst for debate among optical professionals.
At present, eye care professionals in England may claim a £21.31 General Ophthalmic Services (GOS) fee for performing an NHS eye test. This price has been fixed at the same rate for two years and will remain unchanged until March when the figure will be reviewed by the government. Yet, with practice owners facing real increases to running costs – largely as a direct result of government policies – it is a valid question to ask why the GOS fee has not been increased accordingly to reflect these changes? Moreover, does the £21.31 an optician receives even cover the cost of the exam?
In order to establish the average price of a sight test in England, Optician used data from its weekly ‘Look Local’ feature which asked practices across the country about the cost of their exam fees. Taking a mean average from practices in 66 towns since February 2016, we calculated that £26.90 was found to be the cost of a basic eye exam. The most expensive fee was discovered in Marlborough, Wiltshire at £35.35, which was almost £20 more expensive than the cheapest rate (£17) found in Wigan, Greater Manchester. With a difference of almost £20 between the highest and lowest values, it was evident to see that the price of an eye exam is a complicated and personal decision influenced by several factors, such as equipment and wages.
Another aspect of the investigation that generated discussion was the difference in the costs of eye exams in the north and the south of the country. Drawing a line west from the top of the Norfolk coast, we split the country in half to examine how the price of an eye test varied depending on the location of a practice. Calculating a mean average from 27 towns across the North and Midlands, the final figure was £24.93, with the most costly test (£31) found in Stoke. In comparison, the average price of an eye exam in the South generated from a group of 39 towns came to £28.26, with the cheapest at £21 in Dover. From these results, geographical location was found to have a significant effect on how practice owners determined the price of an eye exam, with practices in the South charging their patients just over £3 more on average than their counterparts in the North.
Yet, what was most revealing about the Optician study was the difference between the national average cost of an eye exam and the GOS fee. Across England, practice owners charged just under £6 more for a private eye exam than what they receive for performing a NHS eye test. As a result, can it be said that the government is guilty of misunderstanding the cost of a sight test in England?
Christopher Saliba (pictured), owner of two practices in Hertfordshire believed that opticians should be receiving more from the NHS for performing eye exams. Saliba said the current NHS fee did not reflect the cost of running an ophthalmic clinic. ‘The sight test fees should pay for the optometrist and the upkeep of the room that the optometrist works in, including the replacement and improvement of the equipment an optometrist needs,’ he said.
The dispensing optician continued to speak about a lack of funding and agreed it had led to practice owners increasing the prices of their frames as they looked to make up the difference. He said: ‘The £25 [that I charge] doesn’t come anywhere near [to covering the cost of running an eye exam] and neither does the £21.31 [from the GOS]. It’s always been the case that the profits from the glasses subsidise the existence of the professional function of optometry. If you didn’t sell glasses, you wouldn’t be in business.’
In Scotland, practices currently receive £37 for NHS eye exams, and £24.50 for a supplementary exam. Saliba viewed this to be a closer reflection of what practices in England should be receiving from the NHS. ‘I think the Scottish level is probably about right. It’s a far more realistic figure where included in the cost of the sight test fee is an element for maintaining the function of funding the equipment and maintaining the equipment,’ he said. But, what is the actual cost of running an eye exam?
In 2006, Professor of Health Policy at Imperial College Nick Bosanquet published a report, Developing a new partnership contract for community eye care in England, in which he assessed the relationship between optical practices and the NHS. In the report, Bosanquet estimated the true cost of running an eye exam was £37. Yet, at the time of publication, the government offered eye care professionals just £18.39 for performing a test. With the NHS figure less than half of the professor’s estimated cost, he concluded that the government should pay ‘fair market price’ for services.
Despite an increase of just under £3 over a period of 12 years, the current NHS fee still fails to match Bosanquet’s original £37 estimation which, without doubt, will have risen since the study was published. In fact, over the past two years, those inside 10 Downing Street have decided to freeze the NHS sight test fee in England. This decision has been met by strong objection by the Optometric Fees Negotiating Committee (OFNC) which has expressed its concern to members in a series of letters published on its official website.
In the Committee’s most recent statement published in March of last year, OFNC chair Mike George said that the group was ‘extremely disappointed’ with the government’s decision to freeze test fees and stated that plans were not in the ‘long term interests’ of optics professionals. OFNC secretary Ann Blackmore (pictured) added to the debate, saying the government was ‘refus[ing] to recognise’ the increasing costs of running a practice and it was to their ‘members’ credit’ that practices continued to service patients ‘despite these challenges’.
Speaking with Optician, Ann Blackmore said the organisation would continue to challenge the NHS fee in the interests of both practice owners and patients.
‘Everyone needs to look after their eye health and the national NHS sight testing service remains the most cost-effective way of doing this. However, sight test fees remain disgracefully low and far below the real cost of delivering the service. They are actually lower now, in real terms, than they were in 1948. They have to be subsidised from the prices of spectacles and contact lenses to keep the service afloat which is unfair on patients who need vision correction,’ Blackmore said.
She also expressed her disapproval at the government’s decision to maintain the £21.31 fee. ‘After years of underfunding, GOS fees have been frozen for the past two years and have made inadequate allowance for the growing administrative and regulatory burdens placed upon optical businesses and practitioners. The wider economic climate makes the situation even more challenging, with CPI (inflation) running above target and actual increases to business costs running higher still. Added to which, the direct costs and hardship resulting from the Capita fiasco over the past two years have made life all but impossible for many practices,’ she said.
‘Now that the 1% pay cap has been lifted, OFNC have made a powerful case for GOS fees to increase by at least 3%. They have also called for essential investment in digital connectivity for optical practices and better commissioning of community eye services to ease the capacity crisis in hospitals and among GPs. OFNC has also called for year-on-year increases in funding of at least 3% in respect of CET, the supervisor grants for pre-registration optometrists and patient vouchers to secure the future of these essential NHS services,’ Blackmore added.
Given the government’s unwillingness to increase NHS test fees, it is no wonder an increasing number of practices in England are deciding to head down the road of private exams. However, there is an argument in which people say that practice owners and opticians should be grateful for the footfall created by free NHS sight tests.