Moneo writes

A discussion on the cost of providing an eye examination has been taking place on the optometry mail-base. This is in the light of the contention in the Bosanquet Report that it costs £37. I do not intend here to argue the merits of what the actual fee is, but I would like to consider what arises out of this discussion in terms of an optometrist's understanding of what we will get paid for by the NHS in future.

A useful starting point is what we think we should charge for an eye examination. According to the latest edition of Optics At A Glance issued by FODO there is still almost no difference at all between what the government pays for a sight test and what, when given the freedom to charge, the profession chooses to charge.

Why on earth should the government pay us more than we think we are worth? It is a good question that this profession has never answered satisfactorily.

The next point to consider is just what will an NHS sight test consist of in a new GOS contract. It is clear that our professional bodies have argued that there should be different tiers of service provided under new GOS. This has been made apparent by the College of Optometrists' submission to the government and this approach has been welcomed with open arms by the Department of Health.

The reason for this is simple. If we have a basic eye test as now, ie refraction plus a basic inspection of the eye to determine presence or absence of disease or abnormality, this may only be worth a small amount of money, or part of the £37. The rest of our work, which we all continually say we do, will be considered as enhanced services that will attract the remainder of the £37.

This money, I strongly suspect from the evidence of other new contracts with NHS contractors will be devolved to PCTs to use as they see fit in developing services. So when we see talk of £37 for an eye examination that may or may not be the right figure, but I would be very surprised if we see it as a lump sum paid for every NHS sight test performed in the future.

When Scotland pays its optometrists their new increased fee, the argument that optometrists have to use spectacle prices to cover losses made on sight tests will disappear. The retail price of spectacles should plummet. If it does not, they should expect to be pilloried by consumer organisations for gross profiteering.

Of course if the prices do plummet, optometrists near the border in England  can expect to see patients leave their practices in droves to buy their very much cheaper spectacles in Scotland. This could spell disaster for many practices. Such is the price of progress and open competition.