“Optometry is ready to help”

Although the clothes may be different, the message for audiences at both conferences is the same: a year after the Government came to power, hospital waiting lists remain at eye-watering levels (pun fully intended) and a secondary care-dominated NHS continues to preside over the decline of a once-proud primary care system.

For the Labour party, who were elected partly on its intention to fix a broken system, it is time to start delivering. Optometry is ready to help.

“Now we have a clear idea of what we are campaigning for, it is time to engage more broadly”

The AOP asks…

Over the past couple of months, at the AOP we have been working through exactly what the shape of our policy ask is and how we express it, informed by the PA Consulting report we co-commissioned last year.

We have also been looking at what we can learn from the successes – and failures – of change in Scotland and Wales, and at the experiences of our colleagues in pharmacy, who successfully drove through the introduction of Pharmacy First. Indeed, we have been talking extensively to some of those who secured that change in policy.

Now we have a clearer idea of what we are campaigning for, it is time to engage more broadly, not least with our members, whose ideas and opinions are essential to us.

So what are we proposing?

If we want to see High Street optometry in England given the ability to offer the same range of clinical services as it does in Scotland and Wales, a strategy of continuing to push for an incremental increase in local Integrated Care Board (ICB) commissioned services is unlikely to appeal to hard-pressed politicians. Ministers want quick results and easy headlines, and a message to electors in 2029 that the percentage of patients who have access to cataract or glaucoma services in the community has increased by 20% is not exactly going to convince voters that the NHS has been transformed.

Treading the route of the profession in Wales and Scotland is not a realistic option for England: any such contract would cost far more than the Government has to spend and would take far more time to negotiate than Ministers have to play with. Equally, from an optometry point of view, opening up the core General Ophthalmic Services (GOS) sight test to renegotiation would be fraught with risk. While we all want to see – and will continue to push for – the Government pay a fair rate for the sight test, the chances of that happening in England in the immediate future are next to none, and the risk of destabilising the entire High Street business model is one which most business-owners would shy away from (we know: we’ve asked them).

The alternative is exploring the ambition of developing a national approach to commissioning, rather than continue on the independent area-by-area pathway.

The success of the pharmacy sector in driving up clinical activity via the Pharmacy First model is one which we could seek to emulate. Like pharmacy, optometry has a national framework for eye care, a framework which we could possibly use as a vehicle for national commissioning of an extended range of clinical services in the same way as pharmacy. While we tend to talk of GOS as though it is just the sight test, in reality, the GOS framework is far more complex. Just as we have a nationally commissioned domiciliary model to complement the in practice GOS sight test, we could push for other services – MECS and CUES, pre- and post-op cataract, glaucoma monitoring to name but four – to be commissioned via the GOS framework.

“Winning it will not be easy – healthcare is a noisy space and getting heard is hard”

So, what we are potentially looking at is a simple ask: leave the sight test where it is (although pay us a better rate for the job), but use the wider GOS framework for the national commissioning of a wider range of services.

Simple, quick and effective; with a decent implementation plan, we could get it done well in advance of the next election. Cost would of course depend on how many services we are talking about and what price we could achieve, but compared to most NHS reforms, the money – in Treasury terms at least – would not break the NHS bank.

As I say, the ask is simple. But winning it will not be easy – healthcare is a noisy space and getting heard is hard. Even if we get Ministers’ support, the process of negotiating an acceptable deal would be fraught with difficulty – not least because we could expect a great deal of opposition from secondary care. But if changemaking were easy, the world would be a very different place.

There will be some who will say we are being unrealistic in even asking and more will want to know that every detail has been explored, and every risk has been covered off before even floating the idea. With the latter, we want to spend time over the next six months or so exploring how we can shape the detail and understanding the risks. To the former, we have to point out that the travails of the Government present us with a huge opportunity. Government needs healthcare solutions, and we can offer one which is simple, affordable and quick. We may not get what we ask for, but not even asking is too shameful indeed.