So what is this brave new world we are busy signing up to, this world of enhanced services in Optometry? I am not using the term EOS (enhanced optical services) because there is precious little ‘optical’ in any of them and in fact it rather perpetuates the myth that ‘opticians’ are all about things optical which is, of course, partly the reason we are where we are.
This brave new world will have many things we are not used to. Budgets. Even the much-lauded Scottish contract has started to sweat as the civil servants in Edinburgh strive to continue what is in effect an open-ended non-cash-limited service. Given the national basis there are clearly savings being made by closing remote A&Es and letting the optometrists run primary eye care, treating and directing accordingly. Nevertheless, the question has to be asked when will the inflation-busting costs of clinical practice start to fall back against the availability of funds?
All over the country there is a sense of simultaneous optimism and foreboding – and I am not talking about the referendum – as new possibilities open up. Meanwhile, the grouping of CCGs starts to look at what existing contracts and service level agreements set up in the heady days of PCTs might be ripe for modification, pruning or elimination. So we might see the pre-cataract referral scheme of Upton Snodsbury CCG be dropped in favour Greater Westchester’s evidence based Pears, while Rutlebury buys every optometrist a pachymeter.
We might need some caution on this route and possibly a plan B to support our businesses clinically. Yes its the obvious route to clinical fulfilment enabling optometry to take its place with other health care providers but you will join the world of budget restraints and NHS practice. I believe it is already the case that some CCGs are seeking to invoke cash limits on active schemes and clearly practices will need to be alert to potential risks that might arise from schemes running out of money. Perhaps we’ll be given monthly numbers you can’t exceed. The net effect of which might be that you are in week seven of a quarter and you can’t do any more cataract referrals or post-op aftercares until week one of the next quarter. That would send postcode rationing one step further down the food chain. One would hate to invoke the spectre of the Irish maternity hospital with an 11-month waiting list but you get my drift.
Of course the spectre that haunts many optometrists who have worked hard to develop enhanced clinical services is that the Department of Health (DH) might nationally, or perhaps more likely, regionally, seek to award a contract to a single large provider working behind the scenes with all the powers of a big multinational. Clearly the profession would like to behave as one voice; difficult, some might say impossible and certainly historically unusual (apart from the 1989 privatisation). Once again Scotland is the mirror where all sectors joined up and worked together. Three things mitigate against this in England, sowing seeds of distrust, first the requirement for large contracts over €300,000 to be put out to open tender, second our recent experience of the DVLA visual assessment contract and third the feeling that they are really one of us, aren’t they? If I were that big business and in a position to exercise muscle driving patients into my practices would my instincts cause me to pull back?
I think it is interesting to look at other models developing in our sector. For a start our surgical colleagues have become much more entrepreneurial and are actively seeking patients, less so maybe for old hat procedures like laser but much more into the lucrative area of cataract and clear lens extraction. While there will always be the die hard public servant NHS ophthalmologist it’s not impossible to conceive of an entirely new approach where cataract surgery (the most common surgical procedure anyone will undertake) is voucherised. Where will optometrists sit with that? Have you developed co-management relationships or is it a one-way street?
Perhaps now is the time to have another dig at the DH, which I think we work in spite of rather than because of. Take for example the engagement of Capita to run the GOS. Right at the time we all thought we might move to electronic claiming of GOS, up pops Capita. Not for nothing do they have a different name in Private Eye.
Already we have seen payment dates shift a little and forms go out of print along with competence and understanding going out of the window. So why, if it is sensible to go national with Capita is it somehow madness for optometrists to be granted a national contract for an extension to GOS instead of wanting to have their cake (GOS as a heath check) and eat it (policing it mercilessly to contract).
The bottom line is that in our sector the NHS, even an enhanced NHS, is not a panacea for all the ills, some of our own making. We are, by and large, practitioners in business and you need a plan B.
