Verum has treated us to a polemic that questioned the actuality or need for conflict between what s/he deemed the two sectors of the optical industry. Although superficially even-handed it comes across as ‘methinks the lady doth protest too much’.
First, there is evidence of what can happen when the pure professionals get together across independent and multiple sectors without malevolent influence. This is Scotland. Although the Scottish National Party does not have a lot to crow about it has continued the pioneering new GOS contract introduced under the first devolved administration (Liberal/Labour coalition).
For those too young to remember, the profession made its case through the collegiate working of Donald Cameron, Frank Munro and Hal Rollason. The different sectors; independent, multiple, College, AOP and FODO came together and the rest is, well, not history, it is embedded. These bodies put aside their differences and made the case for change. There is control over the scope of practice, reward (intellectual and financial) for doing a decent job and a sea change in capability via Independent Prescribing. The evidence is of a revolution the Royal College of Ophthalmologists has lately been calling for to manage the state of ophthalmic services across the UK.
Unfortunately Verum’s commentary rapidly devolves into a ‘chip on the shoulder’ that the multiple sector is unfairly denigrated by a holier than thou, independent sector. There are a number of flaws to this argument. For example, Verum states: ‘...multiple... practitioners are rewarded not for their clinical skills but for the numbers of spectacles that they can sell. But surely all practices have to make a profit in order to continue to exist.’ But profit does not have to come from product sales, it can come from other sources such as properly funded professional fees that reflect the cost of provision.
It is a stark and glaring anomaly belying this argument that the multiple sector, in general, and specifically one large group, expects their practices and franchisees not to charge for professional time, except the loss leader of the sight test. Of course, through fear and a lack of confidence many independants also succumb to this mentality.
Clearly, NHS England does not view optometry as a valued clinical discipline sufficient to alter the GOS contract nationally. Thus optometrists have no means of payment for services other than to cross-subsidise from product sales, charge the patient or contract locally commissioned enhanced schemes. It is this more than anything else that differentiates the practitioner or practice and it straddles the two sectors, perhaps not equally. Personally I feel it is dishonest and unethical to cross-subsidise for services outside the legal minimum of a sight test.
Failing to charge has a number of serious consequences. First it will pressure the practitioner to maintain a low threshold for referral which has a direct consequence in the attitude of the public, but more importantly, the ophthalmologist. Any optometrist who has worked in the HES or sat in on casualty knows the embarrassment of seeing a wholly inadequate referral because the referring optometrist has not investigated properly, and within their capability, because their business owner does not permit it.
Secondly, it has led directly to the sclerotic nature of entry-level optometric education such that competence has not risen with the need for better primary eye care. Thirdly it places immediate conversion pressure on the entire team if the optometrist does want to exercise their professional duty to examine further (dilation), or repeat tests (tonometry and fields). Finally it places time pressure on the examination, even with pre-screening and even Verum concedes there is a difference in the sectors.
Using a professional model for fees is not unique to the independent sector but it is much less common in the multiple sector with one or two notable exceptions such as Leightons. It is, however, defining of professionalism. It also underlies the development of properly funded enhanced services and it is definitely the case that this led the independent sector into being at the forefront of developing such services. Perhaps here lies the displeasure at the infamous Mr Perkins letter inviting independent practitioners to climb on board his brave new world.
Finally we must nail one completely inaccurate assertion by Verum. Namely that ‘multiple practices led the way with new technologies to the mainstream of optometric practices.’ Quite frankly this is utterly laughable. The surge in digital imaging and in particular in OCT and Scanning Laser Ophthalmoscopes has come through the independent sector and despite these instruments being around for 10 years the multiple presence is minimal.
Possibly, dare I say it because of the very reasons outlined above, those practices, independent or multiple, with an inadequate business model that sees no earnings from professional services are the very ones that have not invested in modern technology. I believe there is a very small window of opportunity before one or other of the major players invests in the next levels of technology now that the independent sector has proved it viable. Once that happens all bets are off.