The NHS is now celebrating 70 years of its existence. At the same time we see the announcement from the government of a massive spending increase for the NHS. Does this signal anything of importance for us in optometry? Categorically ‘yes’.

Just over 70 years ago our negotiators were arguing for our role in the NHS. It is their efforts at that time that have largely given us what we know as the General Ophthalmic Services today. In fact it seems that when the rules were changed in 1989 the impact on the clinical side of our job was largely unchanged and so what we know as the GOS is largely what was agreed on in 1948. Possibly one of the largest errors was to give up our right to an NHS pension.

Why this was done I will never understand. What I do know is that most people I speak to nowadays agree that GOS is totally unfit for purpose in a modern healthcare system. If we were designing an eye healthcare service for the modern age it would look radically different from the clumsy system we currently have.

I believe the time is right to look at where the NHS will go from here and how it will restructure to make the most of the new monies coming its way. What we should be doing as a profession is starting a debate on a complete re-structuring of GOS making it fit for purpose for a modern age. I believe we need to be radical enough to completely scrap the existing system and start with a fresh blank piece of paper and design the service from scratch.

This new service needs to be economically viable, already a massive departure from where we are now, but it also needs to be innovative and make use of the skills that a modern optometrist possesses. So much of what happens in the secondary sector, at much greater cost, could well be done in the primary care sector by optometrists and optometric clinical assistants.

With modern IT systems transfer of data is so much more possible. One example that comes to mind is the screening of hydroxychloroquine users. As has come to be expected, as soon as the RCOphth decides to publish guidelines on this activity it just as surely says this work can only be done in a hospital setting. This is nonsense and just shows more signs of protectionism. Optometry is clearly better placed to provide all these types of services going forward. We need a debate on what we all see as the way forward for optometry in the coming years.

So who should be at the forefront of this exercise? I would suggest that the last people who should be involved in this process are those who have got us to where we are now. It is thanks to successive weak negotiators that we are in the position where we are now. I would suggest this debate needs to start in the universities and in the arena of the newly qualified optometrists.

It is their future that will be decided in any root and branch redesign of services. Already I can hear the great and the good saying these people are not sufficiently experienced to cope with things like this, that these people do not understand how these things work, that they do not understand how government works.

The arguments are legion but I come back to the fact that this current lot of negotiators and highly experienced officers have got us to the position we are now, namely working under a contract that is totally unfit for purpose in a modern healthcare service.

I believe the time has come to rewrite how optometry functions in a modern system and that those best placed to do it are those who will have to work with the new system. That is what happened 70 years ago. However, this time we should start with the benefit of hindsight. We should not let the same mistakes be made a second time around.

I have great faith in our newly qualified generation of optometrists. They are so much more skilled than my cohort ever were when just qualified. I really believe the time is now to redesign our future and that future should be handed to these new young clinicians initially to have their say.

I would like to see the universities grasp this initiative and take it forward. These students are paying over £27,000 to train as optometrists and it is incumbent upon the universities who are taking this money from them to ensure they send these new young professionals out into a profession that is fit for purpose and can assimilate them into its ranks.

The future for optometry needs to be rewritten now and renegotiated now but how that future looks is currently an exciting blank sheet. Let us all grasp the opportunity that now exists and let us ask the future practitioners of optometry to decide the future of optometry.