A new survey commissioned by the General Optical Council focusing exclusively on business registrants has found high levels of innovation throughout the profession.
Research agency Impact Health carried out the survey between December 7, 2023 and January 31, 2024 and was completed by 214 registered businesses. The majority of businesses were based in England (83%) with 8% in Wales, 7% in Scotland, 4% in Northern Ireland and 1% outside of the UK.
Businesses were predominately based in towns (72%), rural locations (27%) or in a city (25%), and have been providing services for over 10 years (80%), five to 10 years (8%) or two to five years (9%). Staff size was significantly associated with business structure as independents were more likely to have nine or fewer staff (79%) whereas multiples were more likely to have 10 or more (76%).
There was a relatively even split between the options for annual turnover in the past 12 months; less than £250k (19%), £250k to <£500k (23%), £500k to <£1m (25%), and more than £1m (32%), with 75% of independents likely to have annual turnover of less than £500k and 92% of multiples likely to have a turnover of over £500k.
Steve Brooker, GOC director of regulatory strategy, said: ‘We carried out this survey to understand more about the businesses we regulate and the issues they face. The results will help us see how regulation may need to adapt to support businesses meet the needs of patients in a changing landscape, and contribute towards a review of business regulation we are currently undertaking.
‘It is positive to see so many businesses introducing new services, innovating in service delivery and planning to use new technologies over the coming years, and we will continue to support them to innovate in a responsible way.
‘However, we are alert to concerns, with businesses telling us they have problems recruiting staff and many expecting difficult times ahead for the industry.’
Brooker thanked respondents and said the GOC intended to carry out the survey on an annual basis to inform its work and see how trends developed over time.
Increased innovation
The survey said registered businesses commonly innovated with new services and there was increased uptake of digital technologies, from websites to artificial intelligence (AI).
When asked about innovation in clinical services, 73% had introduced a new or improved clinical service to patients over the past three years. Of these respondents, 79% introduced a service that was only new to their business and 28% introduced a service that was new to the market.
The most common reason given by businesses for deciding to innovate was improving customer experience (99%) and 92% said patient demand for new services was another reason for doing so. Other drivers of innovation were availability of new technology (97%), NHS or government commissioning (76%), and 68% said GOC regulations.
Barriers to introducing innovations included the UK economy (74%), cost of innovation (69%), cost of finance (66%), and lack of NHS IT connectivity to ophthalmology (76%).
Benefits cited by businesses included adding services had attracted new patients (68%), increased revenue from existing patients (52%), 48% had faster referrals and 34% have experienced better IT communications with ophthalmology and GPs.
Servicing solutions
In relation to the types of services and technology offered, 74% used social media and 89% had a website. The GOC highlighted that only 44% of those that had a website, published prices for sight tests and eye examinations online.
Planned usage of glaucoma monitoring was expected to rise from 33% to 68% over the next two years and independent prescribing would rise from 20% to 53%. Pre- and post-operative cataract services were offered by 90% of respondents and could increase by 5% in the next two years, while myopia management could rise by 7% from 85%.
Paediatric myopia control was currently offered by 73% and could rise to 84% in the next two years, while dry eye could rise from 72% to 88%. The GOC said adoption of technology was expected to grow in the next two years with 27% of respondents planning to use AI, rising from 5% currently.
Over the next two years, the use of live chat or virtual assistants would rise from 11% to 26%, websites with interactive features would rise from 58% to 77%, practice management systems (PMS) and electronic patient records would rise from 75% to 89%.
Multiples were more likely than independents to use interactive websites (92% vs 34%), autorefractors (83% vs 40%) and live chat or virtual assistants (18% vs 6%). Optical coherence tomography (OCT) and PMS/electronic patient records were the most widely used technologies, being used by over three in four registered businesses.
The use of Optomap was expected to rise over the next two years from 11% to 30%, OCT from 82% to 91%, remote sight testing from 5% to 11% and autorefractor from 58% to 63%.
Challenging climate
When asked about business performance, 51% of respondents experienced growth last year and 55% anticipated further growth in the next 12 months.
The GOC highlighted that 50% of independent practices expected to grow in the next 12 months in comparison with 61% of multiples, with 60% of multiples experiencing growth in the last 12 months compared to 44% of independents. Survey respondents also noted that workforce pressures were a key business challenge and there was concern about the future of primary eye care.
Rising costs due to economic conditions was noted as quite or very challenging by 89% of businesses, as was increasing wage pressures (88%) and government funding of sight tests (79%). Recruiting staff was a difficulty for 67% of respondents and 76% have used locums at least ‘occasionally’ over the past year with an additional 35% that used them ‘most’ or ‘all of the time’.
Furthermore, 63% disagreed that they could easily recruit an optometrist and 51% disagreed that they could easily recruit a dispensing optician. Reasons for using locums varied between multiples and independents with 33% of multiples using them as a positive choice to fit the business model compared to 48% of independents.
Fifty-two percent of multiples used locums due to difficulties recruiting and retaining staff, compared to 33% of independents. Other challenges included the impact of the cost of living crisis on patients (76%) and competition from online businesses (56%). Forty percent agreed or strongly agreed with the statement ‘I am optimistic about the future of primary eye care’, while 32% disagreed or strongly disagreed. 72% expected difficult times for the industry in the future.
The next generation
Other areas the GOC surveyed registered businesses about included placements for optical students, which was more prevalent among multiples (50%) than independents (11%).
Around a quarter (27%) of registered businesses currently have arrangements with universities or the College of Optometrists to offer placements. Of those that do not currently offer placements, 27% planned to offer them in the next two years with this again higher among multiples (47%) than independents (19%).
Perceived benefits of offering placements were future-facing, the GOC noted, such as supporting a new generation of optical professionals and increasing the pipeline of future employees rather than immediate benefits to the workplace. Barriers to offering placements included time constraints and a lack of available consulting rooms, as well as regulatory, financial and resource-based barriers.
However, the GOC highlighted the likelihood of an independent offering a placement was more about a lack of perceived benefits rather than experiencing barriers to offering them. Although independents were more likely than multiples to cite these barriers. Around a third (36%) of registered businesses have employed a newly qualified optometrist or dispensing optician in the past two years, which was again more common among multiples.
Businesses believed leadership and management was the area most in need of improvement for newly qualified optometrists, with 49% of respondents that said they had not met this outcome compared to 39% that did. Survey respondents also reported substantial improvements in performance for newly qualified professionals compared to when they started work, particularly for newly qualified optometrists.
Unreasonable fees
When asked about the GOC’s registration fees, most businesses said they were not reasonable and also disagreed that annual compliance costs were reasonable, particularly independents.
The GOC’s annual renewal fee for optometrists, dispensing opticians and businesses was £405 for 2024-25, which rose from £380 in 2023-24. The ongoing compliance costs most likely to be considered unreasonable were NHS commissioning requirements, data protection requirements and professional indemnity insurance.
A majority of respondents agreed that the GOC’s standards for optical businesses were easy to comply with and helped ensure the quality of patient care. However, there was uncertainty about whether they were easy to understand and the GOC identified an opportunity to improve the comprehensibility of the standards.
Ten percent of registered businesses have had an OCCS complaint considered against them in the past 12 months, with the proportion being substantially higher among multiples than independent practices.