What to consider before shifting to a private model

Frustration with under-funding, prioritising the value of clinical care and escaping the administrative burden of GOS.

OT has heard about many factors that have prompted practices to shift to a solely private model of care (read more in Sight test by subscription).

But what factors should a practice consider before reducing or ending GOS work?

OT spoke with head of clinical and regulatory at the AOP, Henry Leonard, for his thoughts.

What are you observing within your role when it comes to GOS contracts?

We have noticed a growing number of practice owners in England considering reducing the amount of General Ophthalmic Service (GOS) sight testing they offer or terminating their GOS contracts entirely.

GOS in England is widely considered to be unfit for purpose, and many practice owners are frustrated at the hoops they need to jump through to meet their contractual requirements, particularly when the fee they receive for this work is so derisory. This isn’t a new phenomenon, but the COVID-19 pandemic has caused many practice owners to reflect on, and in some cases re-evaluate, their relationship with GOS work.

What guidance would you give to practices considering reducing GOS work?

It’s important to think carefully about the implications of reducing or ceasing GOS work because a formula which works well for a particular type of practice, in a particular area, may not be successful elsewhere. Think about the demographics of your patient base, and what proportion of patients are entitled to GOS sight testing and optical vouchers.

Within the sector it’s no secret that GOS work is heavily cross-subsidised by spectacle sales, so you need to think carefully about whether enough patients would be prepared to remain at your practice if they were no longer able to receive GOS sight testing and optical vouchers towards appliances. It’s not as simple as looking at the proportion of GOS sight testing compared with private work because a practice which caters for a population of affluent retirees may have a high proportion of GOS sight testing but a relatively low proportion of optical vouchers.

It’s also important to consider what type of practice you are running; a well-established boutique-style practice specialising in bespoke high-end designer frames will probably find it easier to transition than retailers which market themselves towards the budget end of the market. It may be possible to pivot from one type of practice to another before making the switch, but if you’re thinking of doing so, you should consider whether there is a market for this, and also whether any local competitors already have this end of the market sewn-up. It’s also worth remembering that you don’t need a GOS contract in order to claim optical vouchers, so even after you’ve terminated your GOS contract, you can still accept and claim NHS optical vouchers which have been issued elsewhere.

How can direct debit plans work in optical practice?

I think we’re beginning to see independent practices starting to dip their toes in the water by reducing their GOS hours, with a view to terminating their GOS contract entirely once they’re confident it’s going to be sustainable. I’d encourage these practice owners to look at offering direct debit plans for both eye examinations and contact lenses because when these are introduced properly, they can boost patient loyalty, increase sales and ensure the practice receives a steady and predictable income, making the practice less reliant on income from GOS work.

People are used to paying their utility bills by direct debit, and practice owners are often pleasantly surprised at how many of their patients are happy to sign up to direct debit plans for their eye care. The key is getting practice staff on board, so they are comfortable talking to patients about the benefits of joining your direct debit plan. When introducing changes communication is crucial, and both patients and practice staff need to understand why these changes are happening. Some patients will inevitably drift away, but in our experience these tend to be the patients who weren’t generating any income for the business in the first place.

What are the downsides of reducing or terminating GOS work?

Aside from the obvious, albeit often unfounded, concern that not enough patients will choose to remain as patients of the practice, owners need to think carefully about the possible consequences of reducing or terminating their GOS work. The pandemic has illustrated some of the benefits of being a GOS contractor, which included support payments to help businesses stay afloat, and easier access to personal protective equipment. In addition, if the practice holds other NHS contracts, it’s may not be possible to give up GOS work without losing these contracts as well, so this is something practice owners should check with the commissioning body.

Many practices now use NHS mail when referring patients, but it isn’t always possible to obtain and retain a practice NHS mail address if the practice doesn’t hold any NHS contracts. Finally, it’s important to remember that NHS England may remove performers from the Ophthalmic Performers List (OPL) if they haven’t performed any GOS work within the past 12 months, which means practitioners may lose their eligibility to claim a CET/CPD allowance. Re-joining the OPL at a later date can be an onerous and frustrating experience.

What are the next steps if a practice decides to reduce GOS work?

If practice owners are considering reducing their GOS work, they can change their GOS hours by means of a ‘contract variation’. Further guidance on the process can be found in chapter eight of NHS England’s Eye Health Policy Book. Contractors can also terminate their contact entirely by serving notice in writing at any time. Ordinarily, a GOS contract will terminate three months after the date on which the notice is served, but in some cases it may be possible to agree a shorter notice period with agreement from NHS England.

If you’re considering reducing or terminating your GOS work, and you’d like to discuss this further, members can contact the AOP’s in-house regulatory team at [email protected]