I will start this month’s column with a quote from Mr Wilkins Micawber from Charles Dickens’ novel David Copperfield: ‘Annual income 20 pounds, annual expenditure 19 pounds, 19 shillings and six pence, result happiness. Annual income 20 pounds, annual expenditure 20 pounds nought and six, result misery.’
I have been moved to remind everyone of these words of financial wisdom because of what I have seen from our professional organisations on the subject in the optical journals. I had seriously hoped I would not need to return to this subject so soon, but I suspect some of the comments from these organisations should fill us all with fear and trepidation.
Many business owners are having to come to terms with some crippling financial announcements from the chancellor, Rachel Reeves, in the recent budget and it now appears they are at risk of being taken down a path of financial ruin by some misguided doctrine from those who are supposed to be there to help and protect us.
In the first edition of Optician this year, an article was run entitled ‘On the cards for 2025’, in which various leaders were asked to comment on the prospects for the coming year. In their comments, I could see little or nothing that alluded to the need for financially viable NHS services.
Yes, there were quotes such as ‘rising bills and the National Insurance increase will put pressure on operating costs, especially for independents’. However, there were no caveats that we must therefore ensure everything we do for the NHS comes with viable fees.
Paul Carrol, chair of the Optometric Fees Negotiating Committee (OFNC), commented: ‘The OFNC will continue collaborating with its primary care partners to support the government’s three big shifts.’ The most important being to shift care from hospitals to primary care, with high street optometry as a prime example of where change can be achieved. Nowhere is there mention of only doing this if it is economically viable.
In the same article, Emma Rawlings from SightCare stated: ‘Managing cash flow and finding ways to reinvest in growth will likely be difficult for many.’ She also emphasised: ‘Practices that embrace innovation and stay on top of the industry trends have a real opportunity to thrive.’
Yet, there was no mention of only doing this with realistic funding. Specsavers reaffirmed its commitment ‘to upskilling colleagues through CPD and funding for higher qualifications’. All of this may sound wonderful but underpinning everything is the fact that anything we do within NHS contracts is loss making.
Fast forward one week and the January 17 issue’s News section published the headline ‘OFNC concerns over special schools fee’. We then learn that the OFNC has been doing what it does best, complaining about NHS England because it has introduced a new NHS service which, albeit essential, was going to be grossly underfunded.
OFNC said: ‘The newly proposed fee was insufficient to provide the unique, ongoing care that was required. We fear that this will mean that either a huge, underfunded burden will be placed on those delivering the service, making it unsustainable, or the service as delivered will not match that which was intended’.
In the Viewpoint page of the same issue, we read the headline quote from the director of professional services at Specsavers saying: ‘Studying for higher qualifications, such as the professional certificate in glaucoma, all help in day-to-day patient care and will future-proof our profession as it looks to enhanced services.’
While I agree it may help patients, if those glaucoma services are not funded appropriately by the NHS then the services will not be viable and the risk is that many practices will not be viable. Mr Micawber knew what he was talking about, but our professional bodies do not seem to have heeded those words of wisdom.
The first new service of 2025 comes with no financially viable funding. Should we be surprised? Absolutely not. We all know well the history of the NHS attitude towards our profession.
We must stop pandering to the NHS now and fight for equitable funding from the outset. Those that deal with our professional bodies within the Department of Health have a long history of disrespecting our negotiators.
I strongly suspect this will not change, especially if they see us as willing to do the work at any costs just to further our reputation. If I worked in the Department of Health, my attitude would be ‘bring ’em on’. They are the easy ones to knock around; they don’t have the fight of the GPs, dentists or pharmacists.
I would love to see the results of a survey asking if you would be willing to work for an NHS service that will cause you to lose money. I think we all know what the result would be. The only surprise is why that survey has never been done.
If these professional bodies cannot get an undertaking of financial viability, at the very least, then we should have the courage to walk away before they sleepwalk us into financial ruin.
History speaks for itself. We’ve been taken there countless times before, please don’t take us there again.
