Recently I listened to Doug Perkins giving his thoughts on the way optometry needed to move forward to meet the challenges ahead. It is clear there are a lot of challenges and I have spoken about some of them in the past. What I found disappointing about his whole approach was just how unimaginative it was. Most times when this profession looks at changing how we do things the approach at best could be described as minimalist tinkering. What I heard from Doug could be classified as radical tinkering. The problem is it is still only tinkering.

He spoke about the threats we face from online refracting and online spectacle sales in the future. What would be the best way of combatting this? Quite simply remove optometry’s reliance on refracting and selling glasses. I would suggest therefore deregulating the refraction function. Of course this blows ‘tinkering’ out of the water and replaces it with really radical thinking. I am not surprised the head of Specsavers does not even consider dropping the refraction function as a core function from an optometrist’s arsenal. My concern is that I find it hard to believe that large companies who predicate their existence on a retail function are not already considering the whole online refracting model themselves.

If we were designing a modern eye healthcare service today from scratch I doubt anyone in their right mind would base that service on refraction and spectacle sales. In fact I would go as far as to say no one should be allowed to design a service based on that model. We should be looking to develop a double strand of service.

A strand based around retail optics whereby refraction is a deregulated function and then a clinical optometry strand utilising all the skills and equipment modern optometry brings to the table. In this new service GOS would be dismantled entirely. The money that currently is used in GOS would be re-utilised to fund the clinical optometry baseline service. Patients would actually register with their optometrist like they currently do with their GP. Optometrists would then be paid in a similar fashion to GPs namely a global sum would be paid annually on a per capita basis based on the number of patients registered.

With this system patients could access their optometrist for basic eye healthcare checks and basic visual problems. Currently someone with a problem such as flashes and floaters, contrary to the assertion by Mr Hunt that access to NHS services is free at the point of need, has to pay privately for a consultation as such a consultation does not constitute an NHS sight test. Under this new system the patient would have free access to their optometrist.

This now places the optometrist at the very centre of eye healthcare delivery, something our national bodies have been striving for for years. The optometrist is the ‘go to’ person for eye problems, not the GP. The optometrist is now also available to undertake further clinical work in the primary care arena such as stable glaucoma monitoring, diabetic screening, hydroxychloroquine screening, red eye care, etc. All of these additional monitoring and treatment scenarios being funded from additional specific pots of money as is currently the way with GPs who carry out additional services such as musculo-skeletal services for example.

Of course there will be those more complex patients who still require more in depth refraction and this will still be carried out by optometrists, or maybe dispensing opticians or orthoptists. In reality many practices will install autorefractors in their practices to be used under the dispensing optician.

There will also be those who still wish to have their optometrist carry out the refraction. This will be a private function and done at the request of the patient. Patients will have to demonstrate proof of an eye health check within a specified period before having access to a deregulated refraction. This is not difficult to administer.

The overall effect of a radically redesigned service like this will be to make refraction much more accessible. It will drive down spectacle prices, opening up access to the service to all those who currently stay away because they cannot afford the spectacles. It will drive up clinical standards within optometry simply because patients will want to register with someone they feel is ‘the best clinically’ in their locality.

Yes, this is radical thinking but it is what is really needed if we want to protect the future of optometry. There are those who feel that it is inevitable in the near future that the GOS contract will cease to be universally available to all current contractors. If we truly want to protect our future we cannot let GOS be taken over by one or two large companies. Of course the first to deny that would ever happen will be those who are probably driving such a change.

The time has come to stop tinkering and get some radical thinkers to really drive change to create an eye healthcare service that is fit for the modern era and also safeguards the future of the profession of optometry. Is there anyone out there who is up for that I wonder?