Last week’s news that the Department of Health (DoH) is looking to freeze the General Ophthalmic Services (GOS) fees for NHS sight testing for the second year in a row is the latest in a long line of crushing blows delivered by the government.
Ann Blackmore, of the Optometric Fees Negotiating Committee (OFNC), said the committee was still waiting on official notification from the DoH, but Optician understands that there will be no further ammendments and the DoH had in fact informed the OFNC that it wanted to impose a 6% reduction of the fee.
While the OFNC has managed to secure a freeze for the coming financial year, it was expected that more pressure on costs would be applied for the next financial year. Details of other allowances and values are expected soon.
Early reaction to a freeze at practitioner level has been mixed, with many facing up to the possibility that NHS sight test costs will no longer increase.
Abandoning GOS services has become a distinct possibility for many practices, and a recent show of hands at the Optix Software user group meeting showed that nearly a third of the audience were considering offering only private services.
Claire Ranger (pictured left), optometrist at Hammond and Dummer Opticians in Milton Keynes, was just one of those who has considered ceasing NHS work: ‘It would mean that I am paid properly for the service I provide and I also don’t have the monthly hassle of trying to work out what I have and haven’t been paid for by the NHS. There hasn’t been a month since Capita took over that the payments have been correct.
‘Stopping using the NHS could possibly have a short-term impact on my business, and it would take careful communication. I just haven’t worked out how to charge Pxs who would normally be entitled to an NHS exam. And I also want to look after children’s eye health.
‘The NHS/GOS contract is an unusual one in that the NHS will pay for everyone that is eligible if the memorandum of understanding in terms of retest intervals is adhered to. There isn’t a budget like in other services where they won’t pay once the money’s run out.
‘I know the NHS must look at keeping costs down but the current NHS fee is totally derisory for what we have to do in a sight test. I have worked out what it costs to provide a meaningful sight test and the NHS fee is only 20% of what it costs the business. The NHS is getting a bargain for their money in terms of eye tests and they should look elsewhere to cut costs.’
Optometrist Ellis Leatherbarrow of Cooper & Leatherbarrow, said he, like most of the profession, did not like the current NHS model: ‘Realistically, if you’re working on half hour eye exams which we as a practice do and then the patient doesn’t need a prescription or just requires an amendment you’re not making any money at all, but that’s just the model.
‘But the fact they’re free does increase accessibility. You definitely need some sort of encouragement and if you believe in the NHS and what it stands for, then it should be free at the point of service.’
Leatherbarrow has also considered going private. ‘When you have 70-80% of your patients which are NHS, and you communicate it well I think it could work,’ he said.
‘I would like to think we would be surprised by how many would like to come even if they have to pay. But then there’s those who just out of principle won’t pay for something they could get for free.’
Losing patients who qualify for NHS services is a concern for many practice owners, not least for Albert Road Optician proprietor and optometrist Deepak Oberai (pictured right). ‘We have considered getting rid of NHS tests but as our average client age is approximately 60, stopping NHS tests would create a barrier to entry to come into the practice for eye examinations.’
A model for the future
Practitioners such as James Bill of Bill Opticians say they now advise patients in their 70s that they only need to be seen every two years.
‘This change has understandably made many of our optometrists uncomfortable. It seems clear that the NHS is struggling to fund the GOS sight test in its current form,’ he says.
‘We are in an exciting time of change, with fundus photography, more complex field analysis, OCT and many other techniques which are not mentioned in the standard GOS sight test all at our disposal. The fundamental problem is that the very patients who could potentially benefit from these new and exciting developments, those aged over 60, are the very people who are being supplied a “standard” eye test via the GOS system. If as an industry, we believe in patient choice and believe that “standard” is not necessarily best for everyone then I can see only two options,’ he added.
‘One: the NHS can fund eye examinations for the over 60s properly and pay optometrists three times what they currently receive. This would allow more time to be given to each individual and open the door for using advanced diagnostic tools. When we look at the model used in Scotland it certainly seems to have allowed the industry to move away from excessively high volumes of patients with optometrists having no incentive to try to complete 30 eye tests a day, but instead giving a sensible amount of time to each patient.
‘Two: we means test to see if a patient, even those over 60, qualifies for a GOS help. This will allow the market to find the appropriate level for professional fees and give individual practitioners the ability to set out their clinical benefits, associated charges and prove why their particular eye examination is better, cheaper, more advanced or whatever it may be. Then the patient may choose whichever practitioner they are most comfortable with.’
Public perception
Awareness among the public around what the sight test involves is also critically lacking. ‘I believe that all eye examinations are not equal but at present the general public is still under the impression that all eye tests are the same and the standard GOS examination only serves to reinforce this,’ added Bill.
Educating the public was also on Oberai’s radar. ‘Before a decision on abandoning NHS services is taken, it would be vital for us as an industry to educate people about the importance of eye examinations. We still get people coming in “because it’s free” without realising the true cost of providing an eye examination,’ he said.
Campbell and McDearmid optometrist Faye McDearmid said the lack of awareness among the general public as to the underfunding in the profession was the most disappointing aspect of the whole debate.
‘We rely on spectacle sales to make up for loss of earnings we face by taking time to be thorough with examinations - this model is a set-up for disaster. We have people taking their prescriptions to dispense with “a better deal” - they don’t see that they get the deal of a superb eye health check in primary care which costs practices money.
‘I work in the hospital eye services and the number of referrals we are getting is increasing, but the quality of referrals is decreasing and we hear the commercial pressures on optometrists in multiples are quite frankly horrific.
‘I hope rather than focusing on the doom and gloom, which is easy to do, we can use the latest news as a platform for positive change.’
Speaking at the Optix user group last week at the Celtic Manor in South Wales, Optix managing director Trevor Rowley spoke about his experiences of going fully private at Viewpoint Opticians.
‘We had to take the leap of faith, but our practice had other revenue streams that we could fall back on should we experience a dip in revenue. We worried that we would lose all our child patients and everyone over the age of 60. What happened is that we increased our child patient base and doubled the number of over 65s.
‘Everything we expected to happen, didn’t happen. In fact, it was the complete opposite,’ said Rowley, who stressed this was his own personal experience and would not be typical of all practices.
Optometrist and proprietor of Seen Opticians in Manchester, Tareq Mustafa, said he was thankful that his practice was fully private, which it had been since it opened its doors. ‘I have a social conscience and believe in what the NHS offers, but I think it has treated our profession very unfairly.
‘However, every time I see a story about Capita issues and complaints over sight test amounts, I’m glad that the practice is isolated from it.’