Talking to colleagues recently I have become aware that more of them know of patients buying their spectacles from online suppliers. I also noted the other night while watching television that a mainstream television series was sponsored by one such online company. Providing this sponsorship suggests their revenue streams can’t be bad. I also note the regular adverts from these companies on commercial TV channels.

All this demonstrates that, while market penetration may currently be small, there is an inexorable move by the consumer to source ever cheaper spectacles from online sellers. It would appear this move by consumers to purchase their spectacles from sources other than the high street optometrist will only increase in the months and years ahead. Such a move presents a serious challenge to optometry as a whole.

Many years ago this profession was warned that the dispensing retail function, what was termed at the time ‘the jewel in the crown of optometry’ would one day be plucked from that crown and the main revenue stream for optometry would be lost. As is typical for this profession the warning was ignored amongst cries of ‘it will never happen!’ At the time this warning was made with the exhortation that we had to get our house in order and start charging economically viable consultation fees and move away from our reliance on overtly retail income.

These warnings fell on deaf ears. The upshot was that optometry was taken down a different route. Far from repositioning itself as a clinically based profession with realistic fees for its clinical work we saw the rise of those who saw the chance of making a quick buck who took optometry down an ever more retail route.

Theirs was the quest to offer clinical services for as little as possible and in many cases give the clinical services away free of charge. These people were happy to see optometry as a means to make money from retail sales like any other shopkeeper at the expense of our true clinical standing. It is those people who have brought optometry to the potential crisis we now find ourselves facing.

It is now very clear that the ‘jewel in the crown’ is in very serious danger of being lost. Where does that leave optometry looking ahead? It leaves us with a situation where we are left with a loss-making revenue stream. To the eternal shame of those who were prepared to sell out this profession over the years we have come to this point where it may well be too late for some to change.

Of course there are those who heeded this warning from years ago and have moved to sensible cost-effective charging for their clinical time and they are now the ones who are best placed going forwards and I congratulate them albeit they are the vast minority.

Possibly the biggest problem we face is the continual annual farce known as the NHS fee ‘negotiations’. For years our so called negotiators, another group of people who always think they know best, have failed to make any impression on the Department of Health (DoH) meaning that year on year we have seen the real worth of what we are paid for our clinical services fall ever lower.

Never has this august body bothered to canvass the profession or seek a powerful mandate to challenge the DoH. Why would they? They have always known better than anyone else. This now leaves us, as we look ahead, with the real possibility that, as we relentlessly lose the income stream from dispensing, we just will not be able to offer NHS sight test services at the price the government wants to pay.

In the past we have shrugged our shoulders and just passed the test fee loss on to product sales. Now, however, that is becoming less feasible in the light of the competition from online retailers. If we are to try to compete with them the cross subsidy has to cease or there will be many who will face bankruptcy.

While there are many in this profession who are directly to blame for this current crisis by cashing in on the retail side over the years we now all face the same dilemma. For optometry to continue to provide sight testing services to the NHS we must be paid a realistic fee. The government has been allowed to get away with underpaying us for years, partly because of those who would give our services away for free, but mainly because our negotiation stance has been so inept.

Our negotiators must seek a powerful mandate from this profession and must make it clear to government that we can no longer cross subsidise their underpayment. If the government will not listen we have to be prepared to take action to withdraw our NHS services until realistic fees are paid. If we do not we will be left with only loss-making services and bankrupt optometrists do not do NHS sight tests. It is time for our negotiators to step up.