David Challinor reviews the historic GOS contract north of the border
The agreement in Scotland on the GOS contract must be viewed as a leap of imagination by ministers and government officials. Can England and for that matter Northern Ireland follow suit? One can only hope so. For Scotland's new deal is every bit as favourable as the profession's representatives north of the border insisted when the news broke last week (News, October 28).
Optometry Scotland chairman Hal Rollason, who was involved in negotiating the new contract with the Scottish Executive, commented that the deal represents the most momentous change in legislation in the country for 60 years, and 'a launch pad for a world-leading service'.
But what does this mean to the 1,020 optometrists within Scotland's 15 NHS health boards? Well, from April 2006 they can claim significantly more than previously, with all patients entitled to the new NHS exam, so for professionals there will be no need to check for exempt groups status.
The new fee will be £28.50, with a secondary fee of £18, and well-placed sources state that the authorities will not be displeased if one in five patients return for this secondary check. From April 2007 the primary exam will rise to £36, with a secondary fee of £21.
There are limits. There is a cap of 20 NHS patients a day per practitioner and if abuse of the new system is evident, a local optometric adviser will look at record cards so professionals cannot carry out the same level of work to earn 50 per cent more.
A grant of £8,000 for equipment is available, paid by April 2006, to every practice irrespective of the number of consulting rooms or professionals employed. The new contract requires a practice to have a slit lamp, VFA, contact tonometer and volk lens. The grant can be claimed retrospectively, but there is no agreement for future years, so those in-the-know will no doubt get their claims in quick.
Discussions have already started as to how an equipment grant of some sort can be achieved beyond 2008, with a £45 NHS contract fee for eye exams being discussed for new technology in practice, although no agreement has yet been reached.
The details have left many wondering how Scotland can be so generous. To understand why the Scottish Executive is so anxious to keep optometrists on its side, you need to look no further than the future demographics of Scotland's population, now totalling five million.
For 2005 it is estimated that 80 per cent of the population who have serious eye problems are over 65, and one in five of the over-75 population is registerable as blind or partially sighted. However, by 2020 the birth rate is expected to have fallen and the population will be in decline, although the number of people over-60 will increase by 1,388,396 and 488,817 people will be over the age of 75.
Significantly, in 15 years' time the incidence of conditions such as AMD, glaucoma, diabetes and cataract is expected to increase by 40-80 per cent. Little wonder the Scottish government realises it needs the services of optical practitioners. Nevertheless, there has already been an early acknowledgement from the profession that the investment in the new contract must deliver results.
Writing in the AOP's Blink newsletter Donald Cameron, chairman of the Association's Scottish Council, said: 'If the profession grasps the opportunities and adapts to the new structure sensibly then, at the end of two years, we will have audited results which will convince the Scottish Executive of the contribution that optometrists make to health gain in the community. '
Clinical details of the contract reveal that an agreement has been reached for practitioners to carry out a dilated exam on patients aged over 60 as part of the primary exam, for the right to see patients annually - rather than every two years - so optometrists do not have to alter codes on the forms.
Other details include patients who are in their 70s are expected to be dilated as a matter of routine - with the volk-type exam carried out on all dilated patients - with slit lamp tests used on every patient.
Further details, including information for clinical policies in the future, are available from the Scottish Executive's interim report on eye care services (www.scotland.gov.uk/Publications/2005/10/21111455/14557).
A chief aim of the changes, said the Scottish Executive's deputy health minister Lewis Macdonald, is to prevent unnecessary duplication of appointments, and make better use of the professionals Scotland employs, with optometrists taking the lead.
Optometry Scotland's Rollason said: 'This is a defining moment for optometry in Scotland. Optometry must rise and embrace this challenge.'
As to the negotiating process, he revealed: 'Although our colleagues at the Scottish Executive Health Department fought their corner hard, I must give them my gratitude.
They have kept an open mind, they have listened to the profession, and together we have delivered a new contract for optometry that will provide the cornerstone for eye care in Scotland.'