The other day I was reading an email thread about contracts with Clinical Commissioning Groups (CCGs) for local enhanced services. Fifteen years ago this month, at its annual conference, the Association of Optometrists launched its first Primary Care Commissioning Toolkit. At the time, as reported in Optician, this was hailed by the then director general as ‘sensational’. The toolkit allowed practitioners to negotiate contracts with their Primary Care Trusts (PCTs) – later to morph into Clinical Commissioning Groups (CCGs) – aimed at moving choked secondary care services into the primary care sector. The purpose of the toolkit was to enable practitioners to present a business case to PCTs that can be adapted to suit local needs. It was envisaged the toolkit would enable optometrists to engage with commissioners, expand traditional roles and engage with other primary care providers. The speaker made the comment, ‘We’ve got to become negotiators and make sure primary care is understood by the Department of Health, otherwise we won’t get involved.’

So, fast forward 15 years and where are we now? The Local Optical Committee Support Unit (Locsu) may well jump to say that because of its organisation things have moved on massively, and in some ways it may well be right. However, listening to a number of optometrists and reading this thread I have to wonder whether this is really the case at the sharp end. Increasing numbers of optometrists currently running Primary Eyecare Acute Referral Scheme (Pears) or Minor Eye Conditions Service (Mecs) schemes are beginning to ask themselves whether it is really worth the bother. This is borne out by the thread I read. It would appear that a request from a local CCG to make an annual renewal of a local enhanced scheme contract now requires the practice to produce a copy of their business contingency plan on top of everything else. A one-year contract seems a short span for any contract but, of course, it allows the CCG to move the goalposts every year in their favour. In another instance a CCG sets up a Covid-19 Urgent Eye Care Service (Cues) which requires the optometrist to provide a ‘same day’ service for the patient or for that practice, if they cannot provide a same day service, to search round and find somewhere that can at their own cost thus effectively allowing the CCG to control the practice diary or, at the least, hold the practice to ransom. Most practitioners I have spoken to complain these systems are uneconomical and place an impossible burden on the practice. It is therefore no surprise that more and more practices are now refusing to sign up to these local schemes or are not renewing their existing contracts.

What then happened to the ‘sensational’ aspirations of the Primary Care Commissioning Toolkit? There can be no doubt that at the time, as the NHS underwent great changes, there were massive opportunities for optometry. The sad fact is that very few people could be bothered to get involved and were happy to sit back and let others do the work. The result was a mish-mash of services with no set funding structure and differing rules and requirements always slanted well in favour of the CCG. Sadly, in the early days many jumped at the chance to demonstrate their clinical willingness to be recognised on a higher footing to their colleagues, and many of those soon found they had been taken for a ride by their local commissioners and were regretting their hastiness.

The arrival of Locsu, on the back of this problem, promised a more stable and uniform approach to the problems that were arising. While there can be no doubt Locsu have made some inroads into matters, many still complain that the contracts negotiated on their behalf are onerous, one-sided and not remotely economically viable. In this Covid-19 era staying afloat is difficult enough without having to manage uneconomical contracts. Locsu is currently sitting on a massive surplus of funds as reported in its last annual report and elsewhere in the optical press. While the annual report sets out a large number of things it intends to do in the coming year, at no point does it show how it will measure its success on the issues and therefor be held accountable.

It is vital that Locsu and the LOCs now start to work, not just to achieve outcomes that look good in an annual report, but are actually good and economically viable for those who will have to implement them. As things stand I fear that the coming year will see the collapse of many Mecs, Pears, and Cues schemes unless they become more viable for operators.

Locsu has now built up the financial clout and says it has the expertise to make this happen. It is very apparent that there is great dissatisfaction on the front line from those attempting to deliver good quality services. Locsu, along with the other professional bodies, has one year to turn this potential collapse around or I truly fear for the future of optometric primary care services in the community and all that was described as ‘sensational’ amid great optimism at its launch 15 years ago.