It was with a sense of impending déjà-vu that I read the other day of the government’s intention to restructure the NHS. However, as I read on it became clear there was some really excellent logic behind the move this time as it would appear the grave errors of previous restructures have now come home to roost. If anything good can come out of this pandemic, it is the recognition of what the NHS can do well and the recognition of just how much has been put in place by recent reforms to stifle that good.

This latest restructuring should recognise the vital need to make the NHS fit for purpose in a new health environment and give us in the eye care sector, the biggest opportunity we have had since eye care services were negotiated and set up in 1958 and the debacle of the restructure in 1989. The opportunity, that is, to design and lobby for a modern eye health care service that, for once, actually provides a service fit for purpose and works to preserve sight, as opposed to the current outdated, outmoded service so many of us have said for years is just not fit for purpose.

History has been littered with examples of how the profession of optometry has sat back and done little or nothing to influence change and therefore has had change, often detrimental change, imposed upon it. For years this profession, much to its shame, allowed the onward march of those with retail influences at their core to have the upper hand. This has led to a gradual downgrading, in the public’s mind, of eye care services. Today, many people will go to their GP as their first port of call if they have an eye problem and following the GP their pharmacist. In many cases the ‘glasses seller’ still comes a poor third. The time has come, and the Covid pandemic has demonstrated this, to move optometry to where it belongs in a modern healthcare system – at the front of clinical care. Retailing and shopkeeping has had its turn at trying to change a once revered eye health service into a retail trade and now, as those clinicians who stepped up in the current crisis have shown, optometry stands ready to deliver a new eye health service truly fit for modern times, embracing all the modern concepts of eye health available to us now.

The General Ophthalmic Services are not fit for purpose and have not been for a long while. The Opticians Act is way out of date and both of these have probably been responsible over the years for many a person’s sight loss because of their outdated, outmoded stances. We have supported those bits of legislation and many, fearful of the loss of their monopolies, have not just supported but also defended them. This stance is no longer acceptable in a new restructured NHS. It is very clear to all that optometry is a hybrid of public and private services with the NHS subsidising spectacles obtained from the private sector. It is also clear the moves envisaged for the new NHS will distance it from association with private sector dealings. With spectacles now readily available online at prices way below current NHS voucher values it does not take a genius to see the writing is on the wall for NHS support for the retail side of NHS eye services. These online companies have been growing fast in recent years and with the pandemic these services have increased markedly. Many in optometry have long called for deregulation of refraction and a move away from overt retailing. Surely now is the time, if ever there was a time. There are many in our professions who think optometrists have a divine right to refraction. It worries me when they are surprised to learn that anyone can carry out a refraction. It is not a regulated function. What is regulated is the issue of the prescription emanating from that refraction. Optometrists do not need to refract and should be looking towards our ‘vision preservation’ clinical role going forwards.

We need to be designing the modern clinical eye care services that will fit into a new NHS. The last thing we need to do is to sit back and wait to see what a bunch of civil servants come up with and then moan about it, which is what we have always done.

I have said this before, but it is absolutely right to repeat it here: we need leaders who are visionaries. People who can see beyond our past and who are willing to design a new ship, not just shuffle the deckchairs on the clapped-out old tub we sail at the moment. My fear is that so many people in positions of so-called influence at present are so entrenched in the old mindset that little will be done to drive change. Please convince me and the rest of the profession that I am wrong.