It is rare to read a copy of any optical magazine, without seeing a reference to the inadequate level of the General Ophthalmic Services NHS sight test fee, on at least one page. The fee simply does not remunerate sufficiently for the cost of providing a sight test, and so we rely on the sight test being accompanied by the sale of spectacles, which is where an optical practice will make some money.

The economic model means that a private spectacle sale is essential for the practice to be in profit. However, patients may be entitled to NHS spectacle vouchers due to low income and if this plus the sight test fee constituted all or most of a practice’s income then we are all aware that the practice would be hard pushed to be economically viable. The main complaint then about the NHS fees is that they force practices into the position where the private sales subsidise NHS fees, which seems a little unfair on the private patient spectacle wearing population.

Another important failing of the inadequate funding is that it is not going to encourage practices to open in areas of deprivation, where there is unlikely to be the volume of private work that will allow the practice to survive and make a profit.

It is well known that the general health of populations who live in areas of deprivation will be poor in comparison to more affluent areas. The government’s public health matters website suggests that currently, in England, people living in the least deprived areas of the country live around 20 years longer in better health than people in the most deprived areas, and are likely to have around an eight year longer life expectancy. The health issues that contribute to these differences come as no great surprise; later cancer diagnosis, obesity, smoking, hypertension, diabetes, etc. We also know that many of these general health issues will be linked to eye conditions such as cataracts, AMD and sight threatening retinopathies.

The College of Optometrists report, See the gap – health inequalities, (May 2016), raised the issue of adverse eye health, including uncorrected refractive error within areas of economic deprivation, noting that the General Ophthalmic fee structure can affect viability of an optical practice in those areas. More recently research carried out by Professor David Crabb at City University found patients in areas of lower socioeconomic status had more extensive visual loss at first presentation. Professor Crabb also highlighted the connection between later presentation of eye disease and socioeconomic status.

These, and other reports over the years have considered why those living in deprived areas are more likely to have poor eye health. Awareness of the importance of a sight test and the health aspect of the sight test must be a factor. Worry about the perceived cost of spectacles will be another, to which we can add having an available and convenient optical practice to access.

So what can be done? Increasing public awareness of the importance of eye health across the board, with a focus on specific areas of deprivation, should be at the top of any action plan. Next the worry about the perceived cost of eye health and spectacles needs to be addressed. The public need to be educated that eye health is not constrained by the worry of cost, and they are likely to be entitled to a free sight test and a voucher towards the cost of spectacles. However, this still may not facilitate a visit to a practice, if there is not one that is accessible. Hence, could the government, via the NHS and public health, encourage optical practices to set up ‘outreach’ clinics in deprived areas, perhaps in community centres/ GP practices, by offering an enhanced GOS fee in such a scenario?

The ‘perfect storm’ of poor general health, leading to greater risk factors for eye disease and yet not accessing eye health leads to the clear link between those people on low incomes living in deprivation and people living with sight loss; three out of four blind or partially sighted people are living in poverty or on its margins.

Returning to the public health matters website, it suggests, ‘that we must give more attention to those who are at greatest risk of poor health if we want to make an impact’. Isn’t it a pity that this thinking has not contributed to widespread education regarding eye health and using the NHS sight test fee and voucher to enable making a difference to those with poor eye health?