Against the backdrop of the current Covid-19 pandemic that has forced many of England’s optical practices to close and undertake emergency appointments at significant health risk to staff, the government’s decision to impose a freeze on GOS fees for the fifth year in a row will come as a body blow.
The Department of Health and Social Care (DHSC) said it was a ‘difficult decision’ and reflected ‘the lack of available evidence about any impact on NHS sight test numbers or optical businesses’ as a result of fees being frozen since 2016. In response, the Optometric Fees Negotiating Committee (OFNC) said the government’s decision would have to be imposed without the OFNC’s agreement.
The relationship between the OFNC and the DHSC looks to have become increasingly strained, highlighted by OFNC’s forthright letter in response to the government’s decision. OFNC secretary Tony Stafford said the government’s statement regarding evidence on the impact of a potential freeze in fees was ‘inaccurate and misleading,’ and the OFNC was worried that ministers had not fully understood the GOS system.
‘We put forward all the evidence requested as we have done many times before and this does not reflect the substance or tone of our discussions with NHS England,’ Stafford wrote in the letter.
The OFNC said the NHS could call upon its own limited data to see that the number of sight tests per optometrist had reduced over time. In its bid, the committee explained that this was because as the population aged, test times and associated costs increased. ‘With our population growing older this is set to continue, putting further pressure on practices as the GOS test remains grossly underfunded,’ said the OFNC.
Gap in evidence
According to the OFNC, early discussions covered how a gap in useful evidence had been created after the NHS decided to terminate the agreed data collection surveys which informed past fee negotiations in 2005. Despite repeated offers from the OFNC to work with NHS England to address this lack of data, none have been accepted. ‘This short-sighted approach continues to endanger the viability of GOS services for patients and the public,’ said Stafford.
Ahead of the next round of negotiations later this year, the OFNC said ministers had specifically asked the sector to consider the impact of the ongoing freeze in fees, particularly on smaller providers, and to provide evidence to back this. ‘We are concerned that ministers may have misunderstood the situation,’ said Stafford.
‘As we explained at our meeting in December, many providers, of all sizes, are under pressure and we would welcome a collaborative approach from NHS England to restart the data collection process to evidence that.
‘It would be meaningless in this context to single out one type of practice; practices of all kinds operate in a competitive market and are all suffering from the underfunding of fees across the whole sector,’ he added.
OFNC chair Paul Carroll said the strong response was necessary because the government’s letter outlining the decision did not bear any relation to discussions the OFNC had with NHS England. ‘The OFNC made absolutely clear to NHS England that the ongoing freeze in GOS fees is not in patients’ best long-term interests, with an even greater risk that NHS eye care will be unviable for some communities,’ he said.
Carroll warned that the trust and goodwill of a loyal workforce had been further eroded.
The Association of Independent Optometrists and Dispensing Opticians (AIO) also said there was a lack of knowledge within the NHS, with ‘minimal understanding within the health service and the wider community of the work that optometrists do, the contribution that they make today and the unrealised potential that exists to revolutionise eye care and save the NHS a fortune.’
An AIO spokesperson said: ‘It is a sad indictment on our profession and those that represent it (and AIO includes itself in this criticism) that this situation has remained unchanged for many years. Notably, dentists and pharmacists are far more effective in getting their voice heard and their professions recognised appropriately. Now is the time for a complete rethink and some radical action.’