No one can have failed to see the rise of the online spectacle sales companies. From nowhere we now see them sponsoring mainstream television programmes on a regular basis. It is interesting to note that these companies appear to sponsor as many programmes as one of the massive optical retail chains. This may not actually be the case but it certainly seems that way given the exposure at peak times.

I regularly come across people who have purchased their spectacles from these companies and interestingly the age group demographic is not restricted to younger people. I know there will be those that will say these companies can’t get things accurate and give stories of where patients have suffered from poorly made spectacles but let’s not kid ourselves that that is exclusive to these new types of retailers. Just as many horror stories abound within the optical sector itself. It is clear therefore that there is now a rapidly growing market outside of traditional ‘opticians’ where people happily purchase their glasses.

For many years this threat has been in the background and this profession has been warned that when it develops we will be presented with serious financial problems if we still choose to finance our existence through spectacle sales rather than economically viable consultation fees. Of course, as with other threats in the past, we have chosen to ignore those warnings. But now this threat is very real.

With this in mind I sat down to read the AOP response to the NHS consultation on developing the long term plan for the NHS. At last a chance for our professional representative body to present a radical vision for the future of eye healthcare services in the UK that moves us away from the archaic, poorly funded NHS sight test that is not only not fit for purpose but is probably, were it held up to scrutiny, responsible for much of the premature sight loss in this country. Here was the opportunity to propose a radical new approach to eye healthcare based on economically viable funding removing us from the strictures of refraction-based money-making and moving us to a true primary health care function as part of the front line primary health care team.
So what does the AOP see as the barrier to improving care and health outcomes for NHS patients? Is it viable funding for services? Is it outmoded models of care? No it is not. It is ‘the lack of interoperability between IT systems in different parts of the NHS’. In fact nowhere in the AOP response is there any mention of modernising the core function of optometry. There is a lot of talk about how optometry can extend its role in delivering preventative healthcare. There is talk of the importance of local and strategic plans including eye care.

But this is all rhetoric. This is stuff that has been rolled out time and time again in response to consultation documents and has been ignored time and time again by the mandarins at the NHS. Witness the fact that optometry does not even get a mention anywhere in the NHS document. There is much about what should be delegated to primary care optometry but there is absolutely no radical vision of what a modern eye healthcare service should look like. In fact the response is almost the opposite.

There is a lot of talk of what we can do in addition to the NHS sight test. This is almost a tacit admission that the AOP and others have given up on ever realising an economically viable NHS sight test fee and is looking to bolt on additional services to shore up the system. The problem is, as has been shown many times in the past, that attempting to extend a house whose foundations are already built on sand and is already showing signs of collapse is a recipe for total disaster. What makes matters worse is that nowhere is there any mention of how any of this ‘bolt on’ approach will be funded. True there are many examples of good practice. I suspect however that many of these examples if examined closer would show there is far from universal take up by optometry locally and some of the main reasons for this will be the lack of funding and the lack of financial support to administer and run the increased governance systems to operate these programmes.

There is no doubt that the NHS needs radically modernising. No one in their right mind, given the undoubted skills of modern optometry, would now set up a system for eye care such as is the GOS currently. As a profession we had, and I believe still have, the opportunity to ditch the current GOS contract and develop a radical new approach to eye healthcare. The only problem is that we seem wedded to a system that will lead to our financial destruction and we do not have the visionaries who can see past that approach. We must find those visionaries and quickly before the existing group do more damage.