To make sure that the public can continue to access NHS-funded sight tests in England, Wales and Northern Ireland, the sight test fee must rise significantly to better reflect the actual cost of providing the test.
The sight test is a vital part of our healthcare system. It identifies vision problems which may need to be corrected, and detects serious diseases such as glaucoma and macular degeneration before the patient even notices symptoms. Optometrists recommend that most people should get their eyes tested every two years.
Around 70% of sight tests in the UK are funded by the NHS, on a flat fee basis. The NHS sight test fee in England, Wales and Northern Ireland1 has never fully reflected the costs of providing a sight test, which include equipment, premises and support staff as well as the clinician’s time and expertise. The fee has been frozen for the last three years. It is now worth considerably less in real terms than it was in 1948 when the NHS was created and NHS sight testing began.
Meanwhile, advances in peer practice and technology mean that the level of service that optometrists provide to patients when conducting sight tests has increased substantially over the years, as has the cost and sophistication of the equipment they use. For instance, the introduction of tonometers and visual field screeners has resulted in many cases of glaucoma being detected and treated earlier. These improvements to the original NHS sight test – which would be considered inadequate by current clinical standards – have been and continue to be funded by individual optical practices, not the NHS.
Therefore, optical practices make a loss on every NHS sight test they carry out – and these losses are growing over time, as optical practices’ costs increase and the NHS fee remains flat. To make up this funding gap, optical practices rely on their income from other activities, and particularly from the sale and supply of glasses and contact lenses.
While the NHS in Scotland funds sight tests for the whole population, eligibility criteria apply in the rest of the UK. People who aren’t eligible for an NHS sight test in England, Wales or Northern Ireland2 have to pay for the test themselves, and each optical practice decides what to charge for private tests. In setting the charge, each practice will take into account its own costs (including equipment, premises and staff) and competitive considerations, including the expectations of patients (who often expect the test to be NHS-funded and therefore free). Practices can, and some do, set private sight test charges that are considerably lower than the actual cost of providing the sight test, to maintain or attract custom and generate income from sales of glasses and contact lenses. That in turn enables them to continue to provide the vital sight test service.
What needs to change
Since most sight tests in the UK are NHS-funded, the NHS sight test fee is the key influence on practices’ finances and their approach to charges. The fee in Scotland is much greater than in other parts of the UK because the Scottish Government has recognised the value of eyecare in public health.
Until now optical practices in England, Wales and Northern Ireland have been able to carry on providing NHS sight tests despite the inadequate level of NHS fees, because of the income they obtain from the sale and supply of glasses and contact lenses. That private income effectively cross-subsidises NHS sight tests.
This is not a rational funding model for a key component of our healthcare, and is quickly becoming unsustainable. That’s partly because people are increasingly turning to online sales of contact lenses and spectacles3,4.
This in turn is going to drive UK high street optical practices to cut costs, for instance by closing branches or reducing staffing numbers. But all these options have damaging consequences for eye health. In particular, closing practices can make it harder for the people who most need NHS sight tests to access them.
We fear that ultimately many practices – particularly those in relatively deprived areas, where a larger proportion of sight tests are funded by the NHS – will find it economically impossible to keep offering sight tests under the current funding model5.
What we’re calling for
To ensure that people who need NHS sight tests remain able to access them, NHS sight test fees in England, Wales and Northern Ireland must increase to better reflect the actual cost to practices of providing the test.
The precise cost of the test can vary depending on local factors, but as a rule of thumb, we think it’s fair to assume that the current NHS sight test fee in England covers around half the actual cost of carrying out the test. We are currently carrying out research among our members to better quantify the real cost of the sight test.
It’s up to each optical practice to decide what to charge for private sight tests. We encourage them to be open with their patients about their charges and costs, and – where they choose to offer their professional services for a charge that doesn’t reflect the true costs of providing them – to provide clear information on the full cost of the service being provided, so that patients can better understand the benefit in kind they are receiving.
- NHS sight test fee arrangements in Scotland use a different funding model based on patient need, so this paper does not apply to Scotland.
- People are entitled to an NHS sight test if they are: under 16; in full-time education up to 18; 60 or over; registered partially sighted or blind; diagnosed with diabetes; or at risk of glaucoma.
- Around 21% of contact lens wearers only buy online, and these buyers are more likely to be between 25 and 44, whereas people who buy lenses in optical practices are older, suggesting the online purchase will continue to grow as a proportion. Source: General Optical Council 2015 Contact Lens Survey, p12
- 18% of prescription eyewear wearers have bought products online and a further 45% would be prepared to do so in the future. Source: Mintel, Optical Goods Retailing Report, February 2018, p 15
- Shickle D, et al. (2015) Why is the General Ophthalmic Services (GOS) Contract that underpins primary eye care in the U.K. contrary to the public health interest?British Journal of Ophthalmology; 99:888–892
Reviewed August 2018
Read the rest of the AOP position statements.