Last month I wrote about the need to dismantle the current General Ophthalmic Services (GOS) format and renegotiate it completely as the only sensible way ahead for NHS services. Little did I realise that within a few days an announcement would be confirmed that seriously jeopardises the future of an NHS contract in any form for a very large number of optometric outlets. What is more worrying is that those charged with negotiating with the NHS on our behalf seem not only to be happy with this development but seem to consider their role in it as a significant victory for the profession.

For those of you who have not yet realised that your GOS contract might be in serious jeopardy let me explain why this is the case. Currently, the contract is controlled at a national level and if you apply for one you will, provided your practice meets criteria, be granted one to carry out NHS sight testing at your practice. Effectively, there is no rationing of contract availability.

As from April 2022 control of the GOS contract management functions will be devolved from NHS England at a national level to new Integrated Care Boards (ICB) at a regional level. The Optometric Fees Negotiating Committee (OFNC) seem very happy with this outcome, and more-so because they feel they have scored a victory by keeping the fee settlement, grant settlements and contract terms as a nationally agreed function. These payments will then be imposed on the ICBs who will have to fit them within their financial frameworks and administer the contracts. In a press release from the OFNC, its chairman states: ‘This is the most efficient model for both the NHS and contractors and means there will be no material changes for GOS contractors or practitioners.’

How the OFNC arrives at this conclusion is a mystery and their acceptance of the outcome is why the situation is potentially so grave. In reality the new ICBs will not be able to control the budget for GOS services and therefore show a potential black hole within their annual budgets for this service. Further costs will come in administering the contract throughout numerous outlets. The biggest potential for

controlling GOS contract costs for ICBs comes from controlling the number of contracts available in their area and hence controlling the management costs behind those contracts. Is this likely to happen?

One look at what happened to the DVLA contract for driver vision screening will give you an immediate answer. The view of the DVLA was that the costs of administering so many individual contracts were prohibitive and the need for so many contracts was unnecessary, hence the obvious solution was to streamline the service and restrict the contract to a smaller number of providers. You do not need to have got 10 A*s in your GCSEs to realise what the first steps will be for some ICBs. And when some start restricting the availability of the GOS contract, others will very quickly follow.

The argument that NHS services will suffer is spurious in that it is clear that there are a large number of practices with NHS sight tests available on the same day throughout the UK, which suggests cutting the number of outlets where GOS sight tests can be obtained will not be detrimental to patients. Just look around your own towns and see how many optometric outlets there are holding NHS contracts. Ask yourself, are they all really necessary? In pharmacy, contract restrictions have been in place for years, optometry will, without doubt, follow in the months ahead. The DVLA has shown ICBs the way forward and they will surely follow. The question is are you ready to run your practice outside of the NHS Contract?

The biggest worry in all of this is why our professional bodies and especially the OFNC could not see this inevitable outcome. They have effectively signed this profession up to a future of contract restriction that will see many of you adapting to work outside the NHS in just the same way as you had to adapt when you lost your vision screening contract with the DVLA. However, this latest development stands to have a massive negative impact on practice incomes. How many times must we let our negotiators land us in these positions? The difference with this time is the effects could be terminal for many practices.

Possibly one glimmer of hope is the arrival of a new CEO at the Association of Optometrists (AOP). Reading his welcome notes, I was heartened to see we now have at the AOP someone who genuinely seems to understand the commercial threats that are pressing down on us. Some in this profession have been warning of these threats for well over 20 years. Maybe, at last, the AOP will start to take them seriously. Sadly, the threat from the inevitable loss of the NHS contract for many may mean it is already too late for them. This is the most dangerous situation optometry has found itself in since the inception of the GOS.