Moneo writes

Whilst we now have a timetable for the introduction of the new NHS contract there appears to be a feeling amongst all the practitioners I have spoken to that what will be offered within the new contract will be, at best, no change from now.

This is, of course, a huge disappointment to us all and I believe shows the scorn that the Department of Health shows towards eye care in England and to us as a profession. Despite the protestations of our negotiators it is clear that the government never had any intention to modernise the service and is happy to keep the parlous status quo that exists now.

To show such disregard for human health in the sixtieth year of the NHS is truly one of the greatest scandals in the history of a healthcare system that was once the envy of the world. However this terrible state of affairs does present the profession with a golden opportunity. This new contract will now formalise the expectations that the government wish us to deliver within its boundaries and as we all know this is to a very minimal standard hardly in keeping with a modern health service. Those that continue to deliver beyond those boundaries will now, in effect, be in breach of this new formalised contract.

Such action may well be seen to bring them and our profession into disrepute. It will be interesting to see how the disciplinary bodies approach deliberate breaching of the contract. For my part, and I would strongly urge you all and ask for the support from the AOP and FODO, I shall take the opportunity to point out to my patients that I am being forced by the NHS to reduce the level of care I have in the past given them in order to not be in breach of my new contract. All additional tests that I currently do to enhance my very basic NHS sight test findings will in future be carried out over and above my contract and will either have to be done by referral to the local eye clinic which will, if we all take this action, swamp the secondary sector, or will have to be paid for separately as a top up fee by the patient.

Whilst top up fees have been around for some time there has never been the opportunity to formally introduce them like the opportunity the government has presented us with in this new contract. I am also strongly considering withdrawing from the NHS altogether as it may well prove better for my patients were I to offer this service as a complete package without the need for subsidising the NHS by means of top up fees that the patient, not the government, will have to pay. It will be interesting to see what develops. I truly believe that, to not be in breach of the new contract, we have no option but to take this route.

Our professional bodies, whilst having failed to get through to this government in negotiating terms must now head this drive for practitioners to work within the strict confines of this new contract and in so doing must point out to the government how stupid it has been to take the approach it has to the nation's eyesight.