“For all our differences, there is much to unite us”

Now things are very different. We have the opportunity to persuade the new ministerial team that optometry has a portfolio of immediate solutions to some of the problems they are facing – the suite of costed initiatives that are discussed elsewhere in this edition of OT were deliberately designed for that purpose. Plus, we also have a longer-term opportunity: to influence the coming 10-year plan to embed the strategic shift of power from secondary to primary care that Lord Darzi has called for. It is all to play for.

But the AOP – and optometry – cannot do it alone. Make no mistake: the dominance of secondary care thinking on health policy identified in the Darzi report is very real. The way that some health voices talked about the proposed shift to provision in the community was revealing, with an immediate response that hospitals have been growing their community provision for years and what was therefore needed was more emphasis on community diagnostic hubs and virtual wards. Doctors – and particularly senior consultants – dominate; even the individual appointed to represent the interests of patients, the Patient Safety Commissioner, is a doctor.

Pushing back against a hospital dominated agenda will require optometry to work closely with the rest of primary care in a way that we have not done before

Pushing back against a hospital-dominated agenda will require optometry to work closely with the rest of primary care in a way that we have not done before. And for all our differences, there is much to unite us. We are embedded in the communities we serve in a way that hospitals can never be, working out of High Street premises and seeing our patients not merely as patients, but as customers, neighbours and sometimes friends.

We are also, critically, aware that healthcare is a system rather than a place, that the NHS is not an organisation, but a series of interlocking services, delivered in many places and by many different entities. In the eyes of some of its critics, the NHS may have ossified into an institution, inward-looking and complacent. The same criticisms cannot be levelled at us.

At a time when GP practices are struggling, pharmacies are closing and NHS dentistry is in many places entirely unavailable, NHS decision-makers must surely now accept that moving in the direction Darzi has mapped out is not merely the latest policy fad

We also have a lot more in common. Unlike the secondary care sector, primary care is, and always has been, provided by private sector businesses; even GPs, who most people think of as being employed by the NHS, in practice work for (or own) private businesses. However, looking across the primary care spectrum, there is universal discontent about the NHS’ contracting approach: dentists, pharmacists, GPs and optometrists alike contrast the penny-pinching and admin-laden way which the NHS approaches primary care with the financially lavish arrangements with hospital trusts. In addition, the culture of decision making at local, ICB level is dominated by the hospitals; the absence of primary care voices in ICB decision-making skews funding decisions in favour of the hospital agenda. Given this, it is scarcely a surprise that the share of NHS funding being spent on primary care provision has shrunk over the past decades.

As this edition of OT focuses on, optometry is not just a key arm of the healthcare system, but also a business. Money may not be the primary concern of optometrists, but maintaining the economic health of the sector is vital to patient interests. At a time when GP practices are struggling, pharmacies are closing and NHS dentistry is in many places entirely unavailable, NHS decision-makers must surely now accept that moving in the direction Darzi has mapped out is not merely the latest policy fad. It is vital to preserving the health of the nation.