Moneo writes: Show us the money before Mecs model is set in stone
There has been a lot of talk recently about Mecs systems throughout the country and the word on the street seems to be that this is the way we should all be going. I read somewhere that with yet another year of stagnation on the NHS fee Mecs afforded us the opportunity to find a way around the parlous figure paid for NHS sight testing.
It seems that it is all speed full ahead at Locsu on this topic. As you will know from my previous columns Moneo is very pro ‘clinical optometry’ and therefore you would expect me to welcome these sort of initiatives with open arms. However, I wish to sound a very loud note of concern at the outset of this new era in optometry.
When the NHS began the leaders of our profession negotiated us into a system that would eternally damn high quality eye healthcare in this country. For over 50 years we have accepted uneconomic fees for our work and that has irretrievably held back clinical optometry and led to a reliance on our spectacle selling role. Over that time optometry has developed and matured into what some would call a quasi-medical profession.
We now possess skills that the average GP could never hope to acquire throughout their working life. It therefore makes total sense that optometry should be the first port of call for all matters pertaining to the care and welfare of sight. But the same could have been said of ophthalmic optics and its role in refraction and basic health care at the outset of the NHS.
My fear is that we are about to see, once again, the same mistakes made by our leaders and negotiators as those who made such a terrible mistake at the start of the NHS. There must not be a single Mecs scheme negotiated throughout this country that is not economically standalone viable. It is vital these schemes are costed out so that there is no dependency whatsoever on other means of income to subsidise losses made by offering Mecs services.
In costing these services all factors need to be taken into account and the scheme needs to be able to demonstrate that if only Mecs were on offer in an establishment the fees would be economically viable. Now I know there are those that say it does not matter if the fee is not economic because the person, and their family are likely to come back to you and then they will buy glasses and this in the end will make this viable. That argument is just nonsense. Can you imagine going into a bank manager for a business loan with a tale like that? You would get shown the door pretty quick.
Do we have reason to be worried? I believe the answer is categorically ‘yes’. Recently when NICE issued new guidelines on AMD one professional body was very quick to issue advice on how to comply with these guidelines even though this would have meant its members doing far more work, taking on far more responsibility all to bale out overworked eye clinics but for absolutely no extra payment at all. Such advice would have been music to the ears of NICE but could so easily spell financial ruin to the business owners.
Admittedly the advice changed rapidly in the face of the minor storm that followed but this time the advice said you should do this extra work but only if it is funded.
Personally I feel the advice should have been: under no circumstances will we countenance doing this new work until it is funded properly and until then continue in the old way while we seek urgent talks to ensure funding. So, yes, I am worried because this latest debacle highlights how naive, to put it kindly, those that negotiate on our behalf and represent us and are supposed to protect us actually are.
My local Mecs scheme is uneconomic and I am told the fees are representative of other schemes across the country. This can only mean that all these schemes are being set up on the basis that optometry will bail out the NHS because it wants to. I would say to those setting up or negotiating terms for these schemes that practices are not charities. We need to be remunerated economically. Schemes which are set up using an uneconomic funding model, just to get them up and running are a sign of weakness and inability to negotiate properly.
I would rather see no Mecs schemes set up than schemes set up that put practitioners at financial risk. I look forward to seeing the financial modelling that has taken place at Locsu and elsewhere to show whether the funding being negotiated is economically viable. If this viability cannot be demonstrated then I would be very interested to know why these models of care are being brought to the table.
We are already hamstrung by the NHS sight test fee. Please do not let the same mistakes happen again with Mecs services.