Andrew Matheson makes some good points in his letter, Postcode lottery causes confusion, and I agree that it is wholly unacceptable for the NHS to interpret the guidelines differently in different areas, the Memorandum of Understanding on Sight Test Intervals should be reviewed urgently and incontrovertible advice agreed between the Optical Confederation and Department of Health.

However I would take issue with his claim that patients choosing to pay for interim examinations would thereby forfeit their NHS entitlement, this would only be true if  private 'sight test' was undertaken. If we remember that the Opticians Act defines the sight test as investigation to see if vision correction is required and with the intention to prescribe for that purpose, then we can quite happily see our patients privately for any number of examinations (of their soft drusen or VMT or for any other reason) and simply avoid refraction, an examination to see if the eyes are healthy is not a Sight Test. Surely this is the basis of NHS England's gripe about too frequent use of GOS, but they can't have it both ways, and so it would be quite legitimate to use the GOS for the sight test when due/needed..

The problem of course with this scenario is that it penalises those who are not be able to pay for private eye examinations and adds an extra level of confusion for the public, who expect a free at the point of use NHS and cannot see the subtle differences that this requires.

I can't quite understand why our leaders are not making more of a political issue about this debacle, I'm sure that the general public would be on our side over the current mishmash of rules and interpretation. At a time when the new government wants their management of the NHS to look good we could be putting quite a lot of pressure on them. I'm sure that those 56 SNP MPs would also be making quite a lot of noise about how poor the quality of eye care south of the border is.

 John F Duffy BSc MCOptom DipTp (AS)(SP)

Director Duffy Optometrists Ltd

Chair Nottinghamshire LOC