I share the concerns of Optician editor, Simon Jones, when, a couple of weeks ago, he raised the issue of our professional bodies urging practices to sign up for the Optometry First scheme.

For years I have campaigned for services traditionally delivered in secondary care to be available in a primary care setting. I have argued these services are well within the scope of our core competencies and I have designed systems for the delivery of these services as well as developed commissioning pathways with NHS commissioners to allow this to happen. For those reasons alone it will come as no surprise to learn that, in principle, I welcome these latest developments. There is, however, a slight irony in that the bodies now recommending involvement were less than willing to support these measures when I and others first proposed them.

The big issue that remains is, as always, that of equitable funding. Simon points out there is already a growing exodus of practices from the GOS because of its ongoing lack of funding. GOS is the foundation upon which other NHS primary eye care services will be developed. For years I have described GOS as a house built on sand. We now run the risk of extending this house upwards and outwards when it is already showing major signs of cracking, collapsing and falling apart altogether. For many this will be a risk too far.

It exasperates me that, after all these years, our professional bodies adopt a stance that, without the promise of adequate funding, will risk the livelihoods of many of their members if adopted. No one running a proper business would enter negotiations to supply goods or services without securing adequate funding for those goods or services as part of the negotiations. But, yet again, when it comes to our professional bodies, whether their members get paid adequately or not does not really seem to matter to them. Just so long at they get recognition for ‘enhancing the profession’.

But the professional bodies need to realise that negotiating to deliver a system that leaves the providers severely compromised financially is not enhancing the profession, just a demonstration of a complete lack of understanding of how businesses function. In fact, there is a high possibility that many will choose not to sign up to this scheme, giving the impression to others outside optometry that the profession is unwilling to take on the roles envisaged within Optometry First. Therefore, far from enhancing the profession, they will have played a major role in portraying optometry as a profession unwilling to assist in solving the eye healthcare problems of the nation.

This is a sorry state of affairs that should never have been allowed to happen. There is enough evidence from history that the NHS is happy to take, take, take and offer little in return when it comes to primary eye care. This is not surprising because we have repeatedly been willing to give, give, give in the false belief that we will somehow gain the respect of NHS mandarins. This belief is one that, for some obscure reason, is held by our professional bodies, but certainly not by those who have to carry the can on the front line.

The one saving grace in all of this is that we should now be seeking a firm assurance that the NHS is willing to step up and accept the role we can play going forward and acknowledge that the role requires proper financially viable funding if it is to succeed. I would like to think that the level of remuneration required for this to be financially viable has already been worked out by the professional bodies and, as in other NHS funding, there will be a baseline with a regional adjustment tariff to take into account the differing financial pressures in different regions. If this has not been done there is an urgent need to do it before any other moves are made by the professional bodies to sign the profession up to Optometry First. This remuneration figure needs to be agreed by the profession to give the negotiators a mandate to proceed. If not, we must very sadly walk away, a situation that would have been caused by the inadequacies of our professional bodies.

The first sign of the willingness of the NHS to take a proper reasoned approach to this whole funding issue will be the upcoming offer for an increased GOS fee. If the NHS is really serious about the aims of Optometry First and it acknowledges the fundamental role optometry is able to play in rebuilding eye care services I would expect to see, for the first time, a realistic increase in the GOS fee. I would expect our negotiators to have been all over this and to be saying that, without a realistic increase in the GOS fee for coming years we cannot sign up to any new mechanisms. We need to see that commitment from the NHS. The question is, do our negotiators have the necessary abilities to be able to do that? This year the Optometric Fees Negotiating Committee has an immensely powerful lever. Does it have the ability to use it?