“Argument alone rarely succeeds”
AOP chief executive, Adam Sampson, reflects on getting his head round the true cost of a GOS sight test, and dealing with the profession’s annual disappointment at the Government controlled fee
24 January 2023
One of the trickier aspects of my role at the AOP is dealing with the fall-out of the annual refusal by government to recognise the true value of the work the sector does under the general ophthalmic services (GOS) contract. When I arrived in the sector, it took me a fair while to get my head round the fact that the GOS fee covers less than half the true cost of a GOS sight test. Even now, when I understand a bit more about how that funding gap is offset in part by the income from the sale of glasses to people undergoing a sight test, it still seems more than a little unfair.
Sadly, of course, in these days of increasing private involvement in healthcare, even the dimmest government Minister now grasps the concept of cross subsidy. And looking at our sector, which is overall continuing to post healthy profits and where the number of GOS providers is going up not down, it is difficult to argue that we are at risk of seeing the sort of provider deserts that affect, say, dentistry (although that picture may not change pretty rapidly if things continue as they are, of course). For all the sophisticated and well-evidenced arguments, the sector has put forward for a double-digit increase in this year’s GOS fee negotiations, in a world where government is signalling a willingness to play hardball with higher profile healthcare professionals like nurses and ambulance drivers, we cannot count on them treating optometrists any differently.
When I arrived in the sector, it took me a fair while to get my head round the fact that the GOS fee covers less than half the true cost of a GOS sight test
I could be wrong – indeed, it would be great if I were. However, while you should always hope for the best, you should plan for the worst. And so it was that I spent a few hours last week sitting with some of the AOP’s Board and Council considering what we might do if, as before, we get a disappointing settlement.
In past years, our response has been muted. In part, this is because, unlike in wage negotiations, our active assent to the Government offer is not required: they can simply impose the decision they have made. While the past settlements have not redressed the historic mismatch between income and cost, in a low inflation environment, that has not put the sector in a significantly worse position.
This year, things are somewhat different. Like everywhere else, inflation in the optics sector is running at levels we have not seen for decades: wages, energy costs, goods and materials – all are significantly more expensive than they were this time last year. As we argued strongly when we put in the bid, another year with GOS fees falling behind basic costs would be grossly unreasonable. And in a context where other healthcare professionals are taking strong action in response to the Government’s refusal to increase their incomes, it would look strange for optometrists simply to swallow a disappointing result without demur.
The sector has put forward for a double-digit increase in this year’s GOS fee negotiations, in a world where government is signalling a willingness to play hardball with higher profile healthcare professionals like nurses and ambulance drivers, we cannot count on them treating optometrists any differently
But, as our internal discussions made clear, our options for an effective and meaningful response are not immediately obvious. Any industrial action would have a devastating effect on the sector’s income. Nor can optometrists rely on the automatic groundswell of public sympathy enjoyed by nurses and ambulance workers to offset the reputational risk involved in exposing patients to potential risk by withdrawing services. We are not in the same position as most of our peers in healthcare and we do not have the levers of influence that they do.
That does not mean that there is nothing we can do, but that we will have to be more imaginative and nuanced in what action – if any – we take. It will also be absolutely essential that we strive for a consensus across the sector, whatever view the AOP may come to, for any response to have any noticeable impact on government. To that end, we will be discussing what ideas we have with our fellow organisations to agree a common line.
If all the high-profile action by other healthcare workers is having little impact, we have to be realistic about the likelihood of any response changing the settlement for 2023. But we also have to be mindful, not just of this year, but of our positioning in years to come. Reasoned argument is an essential prerequisite for achieving what we want, but if there is one thing that my years of campaigning has taught me it is that argument alone rarely succeeds.