“The conversations themselves are not straightforward”

However, what primarily sustains optometry’s presence on the High Street, in particular in England, is not state funding, but the revenue generated through retail activity, which at present remains the core of most practices’ business. Of course, NHS income it is still an important component of overall service provision.

At the AOP, I spend a lot of my time thinking – and in these columns, writing – about the clinical future of our profession. Yet always at the back of my mind is that the thing that pays most optometrists’ wages is not clinical income, but retail.

It can be an advantage that the profession overall is not primarily reliant on statutory income – but we do recognise that for some practices this funding is essential.Wage levels in optometry are set in relation to private sector pay rather than lower public-sector rates. Unlike GPs or, increasingly, pharmacists, we do not need to worry about the risk of the Government turning its funding taps off, or forcing us to undertake clinical work that we don’t want to perform.Yes, the value of the GOS sight test fee remains a bugbear, but for all the fears that are sometimes expressed, the Government is too conscious of the value – £4 for every £1 spent – that the GOS contract provides to contemplate scrapping it.

Optometrists are not alone in balancing patient, client, customer need with their own financial interests

Retail realities

The retail nature of the optometry economy has a downside too. The fact that optometry is largely a private profession, and that some optical businesses have a secondary as well as a primary care arm, can lead to tensions between the clinical and financial pressures underlying the profession.

Performing a sight test is an objective process, but helping a patient choose which glasses and lenses to purchase directly affects practice income. I am confident that every AOP member approaches such conversations dispassionately and with the patients’ interests at heart, but the conversations themselves are not straightforward.

None of this will be made any easier with the advent of myopia management. On the one hand, if a patient can benefit from it, it would be unethical for an optometrist not to raise it. On the other hand, there is an undeniable risk that some patients – or some parents – may claim that the treatment was mis-sold. Damned if you do; damned if you don’t.

Managing these conflicting pressures is not easy. But optometrists are not alone in balancing patient, client, customer need with their own financial interests. When I was dealing with complaints about lawyers, I was constantly being asked to judge whether a lawyer had put profit before ethics. Accusations like that were easy to make and hard to refute. The sensible lawyers, though, were able to rely on contemporaneous records evidencing the fact that they had talked their client through the issues involved and had also – and this is essential – been transparent about how the client’s choice has possible financial implications for the law firm. Proper record keeping and transparency were critical: with them, the service was almost always seen as ethical, but without them, there were real questions to be answered.

For all that optometry is largely retail driven, there is almost nothing I have seen since I have been in post that has ever raised questions in my mind about AOP members’ heartfelt commitment to patient interest. But I am conscious that we cannot take our reputation for probity for granted. It is not enough to claim to be ethical; you have to evidence it as well.