We believe the only way to ensure the provision of a high quality optometric services in primary care is to sufficiently fund it. We feel that the fees given by the NHS should, as a minimum, cover a practice’s costs in providing sight tests, and that practices should be able to, when run efficiently, function without making a loss on their professional services.
Most sight tests are paid for by the NHS through the General Ophthalmic Services (GOS) budget and are negotiated by the Optometric Fees Negotiating Committee (OFNC), which is made up of representatives from the AOP, the Association of British Dispensing Opticians (ABDO), the Federation of Ophthalmic and Dispensing Opticians (FODO) and the British Medical Association (BMA). Regulations governing sight tests ensure that they’re performed identically in England, Wales and Northern Ireland. However, Scottish sight tests are delivered to a different set of criteria related to patient need and funding model therefore this position paper doesn’t apply to Scotland.
The cost of providing sight tests varies between practices depending on a number of factors, such as location, cost of property, availability of employees, employee wages, and equipment used. It’s widely accepted that the fees the NHS pay for sight tests don’t cover the cost of their provision 1. GOS sight test fees are, in real terms, lower now than they were in 1948, despite the fact that practitioners have increased the level of service. Underfunded provision of professional services, to private patients and NHS patients, devalues the profession and threatens high quality eye care. Ideally, fees and charges for private services, or negotiating fees for the provision of community services to the NHS, should at least cover a practice’s costs of the service, including all staff salaries.
Driven by a desire to provide the best care, the profession has over the years increased the standard of care it provides to patients, voluntarily and without reimbursement. It has invested in new technology to detect health problems in patients. The unfunded introduction of tonometers and automated visual field screeners alone has resulted in the detection of innumerable cases of glaucoma, which would have otherwise gone unnoticed. Early detection brings the opportunity of better patient outcomes. Optometrists are eager to deliver these benefits to patients, but they come at a cost and practitioners are unable to bear this cost alone. Underfunding sight tests will result in eye care services being unavailable in areas where there is low retail income.
The inevitable result of underfunding is that each practice has to make up the shortfall on its provision of sight tests through the sale of product – mainly spectacles. This means patients with poor eyesight have to contribute to the costs of eye care for people who don’t need spectacles. In effect, they are carrying the cost of underfunding. The uneconomical NHS sight test fee threatens the quality of service in the long term.
It’s vital for the profession to attract high-calibre students to optometric under-graduate courses. Underfunding of sight tests has already seen optometrists’ salaries fall more than almost any other profession over the last ten years.2 The most gifted students are unlikely to choose optometry if salaries aren’t competitive compared with other professions. Furthermore, while the level of training has improved for undergraduates, pre-registration students and GOC registrants, investment in training has gone unfunded too.
The requirement to fund the provision of sight tests through the sale of spectacles means that practices are mainly located in areas with high retail commerce, like high streets and shopping centres. While this makes sight tests available to those who can afford spectacles, it often leaves disadvantaged people who aren’t able to travel with poor access to eye care. Research also suggests that the perceived high cost of spectacles is a significant deterrent to people from deprived areas when seeking regular eyecare, which negatively impacts their ocular health.3 Better funding of sight tests would make the provision of eye care to poorer and other marginalised demographics more feasible and less dependent on living near high retail commerce areas.
Private and GOS sight test fees
The GOS sight test fee is known to be insufficient to cover the costs of its provision. Yet there are lots of practices, both multiple and independent, that charge private patients less than the fee they receive from the NHS. Practices and businesses are free to set their fees at whatever level they wish in order to compete in an open market, but we feel that setting sight test fees lower than the level paid by the NHS damages the OFNC’s negotiating position and is a significant contributory factor to the failure to negotiate a more appropriate GOS sight test fee. In the long term, such practices threaten the provision of quality eye care.
The benefits of funding
With proper funding we’ll encourage high calibre entrants to the profession; a motivated and valued workforce; a properly equipped profession willing to invest further in new technology; trained professionals willing to invest in their own education and development; and practices that are accessible to everyone. Standards of care cannot be improved in any sustained way, or even be maintained at current levels, without improvements to the funding of professional services. The combination of underfunding and over-investment cannot continue.
- 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
- GMB (2017) 2016 average earnings for majority of occupations well below 2007 levels published online 3 January 2017
- Shickle D & Griffin M (2014) Why don't older adults in England go to have their eyes examined? Ophthalmic & Physiological Optics, 34(1), 38-45
Position statement reviewed: December 2016
AOP community forum
How can we ensure professional services are funded and valued properly?
Read the rest of the AOP position statements.