Where is the profession of optometry going to be in 10 years’ time? This is something that our professional organisations seem to be trying to address. However, sadly I have to say that what I have read so far has given me a crushing sense of déjà vu.

At the outset of any consideration of the future we need to be brutally frank about where we are in our relationship with the NHS and then base our thinking upon that current situation. Bluntly we have been propping up the NHS eye services for decades and we have been abused for doing that by the Department of Health. We have let this happen with toothless negotiations year upon year.

Therefore, everyone needs to be quite clear that if we do not enter into new negotiations with a markedly different stance aimed at radically changing this situation we will get nowhere. Having read the AOP strategy my big fear is that it is just too mealy mouthed. Yes, it is full of nice words and, yes, it probably alludes to where we would want to get to in the future, but frankly I was left with the impression of an optometric Oliver holding out his empty bowl crying ‘please sir can I have some more?’ Right at the end the strategy makes a small reference to some practitioners now not partaking in GOS: ‘More and more practices are considering reducing the times they offer NHS sight tests and some are considering withdrawal from GOS completely.’ These words have a very hollow ring to them. There are just no teeth in the document anywhere. To be frank, if I was in the Department of Health and I read that document I would merely smile and remember to pat the negotiators on the head the next time I saw them. The one thing I would not be in the slightest is concerned that I might have a battle on my hands.

Built on sand

One of the biggest problems is that the current GOS contract is like a house built on sand. We all know it is unsafe and unworkable but what seems to be the intent now is to accept that this house, although being in a dangerous state of disrepair, is the only one we’ve got so we must make do with it and try and build some more floors on it to make it look better. I have to ask you, who in their right minds would even consider such a stupid act?

If we are truly to develop modern eye health care services in this country our starting point has to be the abolition of the GOS contract and modernisation of the Opticians Act. If we are not going to do either of these then there is absolutely no point in doing anything. Both the contract and the Act are hopelessly out of date and not fit for purpose. They are the sand we have built our house upon. Our starting point must be to tear down this existing house and build a new modern one fit for purpose in its place established on a sound base of a meaningful Opticians Act and a proper modern NHS contract that is fit for purpose. There can be no other meaningful start point than to withdraw from the GOS contract. Those that believe this current GOC contract and the Opticians Act as it exists are a good place to be are deluding themselves, as more and more optometrists are beginning to realise. The words in the AOP strategy are weak and, if they are designed to carry a threat to the DoH then they miss by a country mile.

What is also of concern in all of this, and has been for years, is the silence on the matter from the regulator, the GOC. Of course, we would probably get the stock response that these things are not their concern, but I would suggest that argument shows a total misunderstanding of their role as a regulator. First and foremost, their role is to ensure the protection of the public in matters of eye care. However, over the years the members of the GOC have all known of the inadequacies of the Opticians Act and the GOS contract. They have known that optometrists have had to inflate the price of goods to offset the losses made on NHS clinical care. They have known this inflation has been a disincentive for people to attend for eye care. They know this has resulted in preventable damage to people’s eyesight occurring. It is scandalous that the GOC has taken no action, even expressed an opinion to government or attempted to have the Act modernised to fit with modern demands over the years.

If we are truly to move forward and to have a meaningful strategy that truly will develop eye care in the years ahead, we need to start from a strong united and radical position that leaves the DoH in no doubt that we are here to fight and we mean business.