The start of a new year should always be a time for optimism. Admittedly there are still clouds upon us now and on the horizon from the Covid-19 pandemic, but those clouds should be a reason for diligent planning of the year ahead.

Last year saw a growing realisation, often brought about because of Covid-19, that the existing model of sight testing under an NHS GOS contract may no longer be the way of guaranteeing thorough and safe eye care in the UK. At the end of last year both the Association of Optometrists’ journal and the College of Optometrists’ Acuity journal ran articles featuring optometrists who had chosen to leave the NHS model of care behind. The reasons cited for this move included the desire to move away from a reliance on retail sales, and the major desire to be able to offer a far more thorough comprehensive level of eye care to patients.

Conspicuous by its absence was the realisation by the professional bodies that the reason so many had found themselves making this decision was that the remuneration for delivering the NHS level of care was not financially sustainable without a retailer style existence and that level of care was just not acceptable in a modern healthcare system. This is something that the dental profession realised decades ago, and we are now at last beginning to realise as well.

The fact that the NHS fee is so paltry lies in many decades of weak negotiating by our profession. Unlike many other parts of the NHS our negotiators have not been prepared to stand up to the NHS negotiating teams. There has been a plethora of excuses from our negotiators over the years, but the simple fact is that little has been achieved while traditional areas of the NHS team, such as nurses and junior doctors have been prepared to fight for what they believe in.

While I do not wish to make a string of predictions for the coming year, the two I can be pretty sure of are, firstly we will get little or no increase in NHS fees this year, and any increase will be well below inflation, and secondly our negotiators will again tell us they are not happy but find some reason to suggest they have had another successful year. Maybe though, none of that matters.

There is clearly a groundswell of clinicians who know the NHS will never offer a route to comprehensive safe primary eye care in this country. They know that we will never negotiate a fee structure that can make this happen. They watch with growing concern as we bolt on more clinical rooms to a house that has been built on sand and that is showing signs of collapsing under the weight of financial chaos. This is not the way forward in their eyes.

Some say there will be casualties in the new private approach. However, having listened to their reasoning I can’t agree. I find it strange when people say that everyone should be entitled to NHS services free at the point of need and abandoning GOS stops this right. Everyone knows that primary NHS eye care services are far from free at that point. The patient who comes in with flashes and floaters just is not entitled to primary NHS eye care services because assessing such major potential sight threatening symptoms does not constitute an NHS sight test.

So, let’s not kid ourselves that by going private we are abandoning the morals underpinning our professional ethic. Far from it. Others say that by introducing charging there will be those who cannot afford to visit an optometrist and this could therefore be detrimental to their eye care. Those who use this argument are choosing to ignore one very obvious fact proven by research by RNIB in the past – literally thousands of people do not visit an optometrist currently because of the fear of the cost of the spectacles they may have to buy. By choosing, over the years, to cross subsidise the paltry NHS fee by artificially inflating the cost of products that are sold in an optical outlet we have priced out literally thousands of ordinary people. It is probably that, more than anything, that has added to preventable sight loss in this country.

Those who have chosen to leave the NHS behind have seen this and recognised charging properly for their professional time delivering high quality eye healthcare, they can end their dependence on this cross-subsidy therefore making spectacles affordable once again. This is the thinking that will drive the move to reducing preventable sight loss in this
country.

I believe 2022 will see many optometrists re-evaluating their worth and seeing that they can deliver a far more comprehensive system of primary eye healthcare outside the NHS. Business planning will show what can be achieved and, as we move forward, managing Covid-19, what better time to undertake such a
re-appraisal?

I wish you all a very happy and successful 2022.