Letters : April 14

Consensus needed on what we charge

Responding to my suggestion, that our fees are most palatable to the public when split between our ophthalmic and dispensing services (Optician, March 17), Richard Llewellyn fully agrees that the profession has a major problem.

Richard disagrees, however, with my concept of leaving the current 'cross-subsidy' in place despite the fact that this has worked very well in all but one respect; the increasing pressure on our patients to switch their custom to alternative suppliers of appliances (both spectacles and contact lenses).

As we are all aware, continuity plays a vital role in successful eye care and the responsibility for an eye examination, the resultant prescription and the selection, fitting, supply and aftercare of glasses and contact lenses should ideally rest with one practice.  It follows that one fee to cover all these services is the most sensible application and, allowing for the usually reliable and generally unvarying rate of 'no changes' and referrals, this can quite easily be calculated as a composite fee.

If we did this we could then, hand on heart, all adopt a 'full fee disclosure' apportionment for VAT purposes reducing the VAT element to the 'customer' which would help to make our charges for fees and appliances transparent, more competitive and more acceptable.

I do not believe that we can ever evolve or switch to the public paying the full fees for eye examinations alone. The true value and cost of an eye examination varies from one practice to another for the many reasons that overheads and expectations are naturally bound to do and this figure would fall between £50 and £100.  Dispensing fees could then be reduced and we would seem more competitive with 'sellers' of glasses or contact lenses who have no legitimate claim to professional fees.  Sadly, however, there would be relatively far fewer people visiting us to be given that explanation!

Even though people may value their eyesight and are aware that they should have regular eye examinations, while most of us do not work from rooms and the overwhelming majority of practices operate from high street shops selling glasses (however professionally converted) a full and proper split of the fees will always remain unacceptable.

My own experience, with 90 years of highly respected professional services behind my practice, totally supports the need to provide a fully comprehensive service and charge my fees jointly on the clinical and supply elements. Two years ago increasing my eye examination fee to a slightly more economic level for myself as head of the firm (employing 16 qualified staff and 40 people in total at one location) achieved the desired affect of halving the number of patients requesting me despite up to 42 years of undivided loyalty to me hitherto. 

This result clearly reveals the real problem where, at most just half of our patients might pay a more realistic fee for our services but most of our 'customers' as they perceive themselves to be, are prepared to pay more for tangible goods.

It is as foolish to believe that any system could totally remedy this deeply entrenched problem as it is to believe that only one system can satisfy all practitioners or the public who make up our patients and customers.

It is sad to read that Richard accuses us of overcharging for optical products when the fee that they carry properly reflects the complex nature and plurality of our optometric, ophthalmic and optical services, expressing as it does the cost of qualified staff and highly trained assistants, our expenses and overheads plus some profit.

There is only one major flaw in the current system and we have had to live with this untenable and now, increasingly unmanageable anomaly despite the fact that we have the complete answer in our hands.

The prescription must be seen to have a significant and stand-alone value if it is to be used only as a passport to look for cheaper supplies, both for contact lenses and spectacles. The examination and script part of the full composite fee for services and appliances, for which most us have clearly set ourselves up to provide, is forfeited if a meaningful charge is not permitted.

I do value my skills and services and resent that fellow practitioners (Nick Atkins, Optician, March 24) might accuse me and the many others who share my view of not being ready to charge the correct fees and not being proud to stand behind them.

On the contrary I am not just proud but more to the point, I am prepared to stand behind my convictions and have taken steps, as far as legally possible to present a transparent formula for my fees and charges.

What is needed now is consensus and a willingness to act together to stem the tide of cheap prescriptions being mindlessly handed out for embarrassingly and pitifully low gain far below cost, before it is too late.

John Sheinman
Northampton



Challenge to Specsavers