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I survived, and so did my patients, opening a new practice in the City of London in 1974, a branch in South London in 1981, before selling in 1988. A sabbatical followed by five years as a sole Specsavers franchisee in Bedfordshire and then an eight-year part-time locum run-down to 2003 completed my professional CV.
I have seen it all. I began with fan and block and a full-aperture trial case and ended with an automated Nidek refractor and electronic gizmos. I was on the AOP council when for the second time in 15 years the title 'Association of Optometrists' was rejected an indication of the organisation's mind-set. I was active in local AOP matters and was an unsuccessful candidate for the GOC in the mid-90s. I contributed to Optician and the national press from the early 1970s, mostly on opto-political affairs, generally from a minority point of view.
From the late 1970s opticians and the 'exorbitant' prices of spectacles were regularly castigated in the press. An article 'The great frame up' in the London Evening Standard was the turning point in a campaign to unwind the protectionism built into the profession and the supply of glasses since 1958. Advertising was an offence, the pricing of frames visible to the passing public forbidden supply of optical appliances including ready-readers except by registered practitioners prohibited. In the early 1970s credit-card stickers on shop doors were even banned. The article was followed by considerable TV and press coverage, with similar attacks by leading ophthalmologists. Political events led Margaret Thatcher's government to pass the controversial Health and Medicines Act in 1988. The AOP was tooth and nail against it. My article in the Daily Telegraph (October 18, 1988) on the morning of the final debate in the House of Commons 'Why furious opticians are short-sighted' was quoted by the secretary of state for health in support and ridiculed by AOP general secretary Ian Hunter in Optometry Today.
Twenty years on I feel the profession lost a golden opportunity to 'go private'. An NHS exam fee of just under £10 in 1988 has increased now to £19.32 in line with the increase in RPI, while national average earnings have increased by 250 per cent. Currently employed optometrists earn on average £35-£55k, yet 30 years ago £10K p/a was common, £25k 20 years ago and £60k just 10 years ago. How has such a catastrophic loss of earnings happened? There really is no mystery. The prime purpose of most trade and professional unions is to further the interests of their members. Not so the AOP. In its earliest negotiations with government over 50 years ago its prime recommendations,1 'as were made were primarily for the benefit of the public'. It has been argued that ever-increasing numbers on the register have no difficulty finding employment, thanks to the numbers of female part-timers. Perhaps, but isn't the real answer the necessity of accepting low wages in preference to unemployment? It seems remarkable that notwithstanding universities' independence, the number of optical undergraduates was allowed to expand with virtually (in public at least) no sustained reasoned opposition from the AOP or College.
The duplicity of optical organisations was enhanced with the introduction of voluntary CET when former College president Gwyneth Morgan wrote in Optician 1996: 'The non-compulsion argument supports the right of this minority [those opposed to compulsion] potentially to endanger the public and spoil the profession's responsible and caring reputation' (My brackets). There were no statistics then to support that argument and optometry is arguably to this day the most honest and disciplined profession operating under those allied to medicine regulations. But a mind-set of kowtowing to government is part of the optical personality.
The GOC has boasted of its tightening of public protection with the unsaid caveat that the individual practitioner stands an ever-increasing chance of being asked to explain his/her actions from a public which has been brainwashed to suspect all professionals.
Has the public benefited over the changes of the last 10 and 20 years? Certainly the earlier diagnosis of chronic simple glaucoma and other conditions aided by sophisticated electronics paid for by the practice is a genuine health benefit and gift to government and patient alike. On the still common complaint of cost of spectacles it seems this will never go away, irrespective of how cheap the item is at the bottom end of the market. And for the OO? Shared care, the nirvana of some, is here, but at what price? Over-zealous monitoring officials, uneconomic fees and increased risk of prosecution from over-protective watchdog organisations. For some practitioners for whom optometry was often a second-choice profession a small price to pay for the kudos of a 'white coat'. But the decline of the entrepreneurial self-employed independent practitioner is a catastrophe. Like the independent pharmacist he won't become extinct but will survive in limited habitats protected from the advance of the retail green giant. Imagine a situation where more than half of all restaurants were fast-food chains and one sees the optical situation today okay for simple tastes but lacking in variation and little service element.
The OO had the opportunity in 1988 to re-affirm his capability as the expert for the healthy eye - a function that had been performed with honour and status by and prior to Messrs Newton, Franklin and Dollond. That opportunity was rejected!
Thankfully 'ophthalmic optician' has finally joined the apothecary in the linguistic coffin. And for the individual OO? She is underpaid, overworked and over-managed, doesn't aspire to self-employed independent practice and will retire from full-time practice in her 40s. For all the above whom must one thank? I leave it to you.
Reference
- A History of the AOP, by Peter A Smith, 1996.