“It’s more of an honest relationship”

1 When I took over the practice 18 years ago, virtually every test was a General Ophthalmic Services (GOS) test.

 
We bought our optical coherence tomography (OCT) machine 13 years ago, and that started us on the journey of shifting to paid clinical services.

It was a bit odd at first. The thing about that transition period is, you essentially start selling people clinical services, which I didn't particularly like. People were coming in for a free test, and we were trying to sell them an extra service.

Now we’re private, they come for a sight test, it is a set fee, and we do everything we can in that time or book them for another appointment if needed. That’s a lot simpler than saying to people, ‘do you want an OCT for £35?’ We were quite early adopters of that, so we've made it through that slightly awkward period, and I feel we’ve come out the other side.

Because we’d been building up the clinical side of the business for a while, over the first COVID-19 lockdown we decided to implement a subscription scheme through Eyeplan. Patients on the scheme get lower prices on their spectacles, but obviously they’re paying more in clinical fees already. So, we’d already partially made the shift.

2 The decision to go entirely private was made in early spring 2021, a few months before we actually did it.

 
I’d been thinking about it for ages. I never liked the position that GOS puts us in as practitioners. I don't like being essentially obliged to make up losses on sight tests by selling spectacles. It never sat very well with me.

The thing that kicked me into going private, finally, was that two of the other practitioners in Lincoln also made the same decision. We’re friends, so I knew they were doing it, and we had discussed it previously. We all went private within a few months of each other.

We also started a dry eye clinic about the same time, and that has been incredibly successful.

3 I gave notice to NHS England in July last year, and then notified our patients and explained that we were going private.

We then added the £21 pounds on to the current fee for our advanced sight test and stopped offering a basic NHS sight test, which I never thought we should be offering anyway. The vast majority of our patients didn’t have a free NHS sight test, so they were already used to paying us.

Each pair of spectacles will make slightly less profit, but we’re putting that on clinical services, which is where it should have always been in the first place

My profit margins are the same as they were pre-COVID-19 – all we’ve done is shift some of the money from spectacle sales onto clinical services. Each pair of spectacles will make slightly less profit, but we’re putting that on clinical services, which is where it should have always been in the first place. I have nothing against selling spectacles: I love spectacles, I love nice lenses and frames, but I would rather people knew what they were paying for.

4 We lost very few patients and actually gained quite a few, some of whom have said that they specifically came to us because we are now private.

 
There’s a degree of perception with some people that being private is more of a guarantee of quality. Or, maybe they realise that there isn’t quite so much pressure on us to sell them spectacles anymore. It’s more of an honest relationship.

There’s also a definite shift in the patient-practitioner relationship, which is noticeable. People look at the relationship slightly differently than they did before, and I feel there’s more mutual respect. They’re choosing to pay and see a private practitioner because they value our services. The patient base we’ve got now is a lot easier to deal with. Obviously, I make more money if we sell them specs, but it’s the cherry on the top. I haven’t lost a load of money if they walk out of the door.

We get a lot more people coming up to us for clinical services now. There have been no negatives whatsoever.

5 We still have to jump through some hoops, because we still have an NHS clinical contract.

 
It’s a fee I'm quite happy to work for; it’s one of the better paid schemes in the country. So, we still have to do a bit of NHS admin. But the drop in paperwork has been fantastic – not having to process forms and chase them.

6 The expectations of optometrists go up as the fees go down, and this probably wasn’t quite as clear to me until I stepped out of it and looked back at the GOS system from the outside.

 
It’s a perspective that was there before, but has certainly increased since I swapped to an entirely private service.

You get people saying that not offering NHS services is unethical. But actually, I feel it’s worse to offer people a service that you know you are making a loss on, and then have to recoup that loss somewhere – potentially from selling that patient spectacles.

It’s not our duty as practitioners to make up for the fact that the government doesn't pay us adequately

It’s not our duty as practitioners to make up for the fact that the government doesn’t pay us adequately, in order that people who can’t afford the full fee have access to services. It’s not our moral duty to offer services that other people are paying for, because the government won’t fund us. I think continuing to accept the GOS contract is actually more morally compromising than saying, ‘enough is enough. We’re not doing this anymore.’ I think that’s a much more honest thing to do.

There will be people who disagree and think that we should offer NHS services so that people who can’t afford the fee get access to services. There’s an argument there, but the argument is not that we should be making our other patients pay for them. It’s that the government should be actually funding the service appropriately.