So the Department of Health has announced a 2.5 per cent increase in the sight test fee, the domiciliary fee, CET allowance and pre-reg training grant. Of course, if the backdated cash amounting to the rise had been appropriately invested by the DoH’s bean-counters over the past nine months, a large chunk of the small 2.5 per cent rise could potentially have been paid for out of the interest accrued.
While we all await the GOS Review, I would advise a degree of realism and caution in the level of expectation. It looks like the profession is doomed to yet another year of supplementing the cost of providing the NHS sight test via the private charges for the same and for specs. Increasingly I hear from colleagues and internet discussion boards that, as margins are squeezed by the likes of the internet suppliers, this cannot go on. Well, it will go on but only as long as we allow it. Hell will freeze over before the DoH voluntarily pays anything resembling an appropriate rate for the time, resource and investment expended in providing the service, unless it is forced to do so. That will only happen if patients start to find it difficult to book an NHS appointment.
The NHS sight test is unrecognisable from that envisaged in 1948. Patients are getting a vastly superior yet subsidised service, using a higher level of equipment and delivered by a more highly educated optometrist. I cannot, however, attach any of these superlatives to the increases in the level of fees we are paid. We need to draw a line as to what we are prepared to provide in return for the NHS sight fee (at level 1, in recognition of the proposed three-level service model).
Apart from professional altruism disguised as wanting to provide increasingly excellent patient care, when and why did we agree to beef up the NHS sight test content to the extent it is now? The bubble of cross-subsidy, if not yet burst, has a more than a slow puncture.
Unless we restrict access to the NHS test and in the absence of DoH payment, anything over a basic level of content should be chargeable as an enhanced or level 2 service. Then the patient will have a choice of paying privately or being referred into secondary care. The ‘South Derbyshire Protocol’ of a few years ago, in a way, attempted to suggest that, but was quickly and effectively silenced.
Of course, the choice to the patient of paying for anything over a basic level 1 service or face being referred, will inevitably result in a significant increase in referrals into secondary care. I know that will be a difficult choice for practitioners and many will feel extremely uncomfortable at taking a ‘work to rule’ stance. However, doing nothing only serves to help the likes of James Murray Wells.
Many of my colleagues are suggesting the use of the NHS sight test as a ‘voucher’ or part-payment towards the true cost of providing the bespoke service. If the patient will not pay then we will have no choice but to refer the patient into secondary care to receive the enhanced services they may need but we can no longer afford to provide pro bono. I do not remember registering as a charity
Our negotiators feel they have got the best deal they can with the DoH and are happy they have managed to retain the GOS budget and payments for domiciliary services at a central level (with the domiciliary services within level 2), but it appears that this is as far as the DoH is prepared to go. A centrally held budget will increasingly stand out as all other budgets are devolved. It will come under close scrutiny in the future.
At some point soon after the GOS Review we will need to consider how we move forward. This may involve getting ‘heavy’ with the DoH. I bet they are trembling.