Negotiating on behalf of the optometry profession

Could you describe in a couple of sentences what the Optometric Fees Negotiating Committee (OFNC) is?

Peter Hampson (PH): The OFNC is the national negotiating body with the Department of Health, representing the optometry profession, and taking in the views of the other bodies that aren’t technically part of it. The members are the AOP, the Association of British Dispensing Opticians, FODO, and the British Medical Association (BMA). The Local Optical Committee Support Unit and the College of Optometrists are not formal members, but are observers and can contribute to the wider the wider discussion.

What has the OFNC done to help optometrists in 2023?

Paul Carroll (PC): Over the past three years, we’ve negotiated an uplift to the General Ophthalmic Services (GOS) of about 8.5%.

PH: Our achievements so far this year represent the work from 2022, because of the staging of when decisions are made by the Department of Health and by NHS England. Whilst within this year we’ve got a 4.5% uplift, that represents all the work that went on last year.

We are now starting to put together the 2024 bid, to submit later in 2023. We’re also holding regular meetings with NHS England on general updates and policies, such as pursuing where they are on the Special Schools Eye Care Service, making sure that any regulation changes that they submit are given due scrutiny, and that we have an overview of how GOS is progressing.

While not directly OFNC-related, we’ve also been keeping pressure on Primary Care Support England with the challenges that have been going on with regards to payment for contractors.

How do you approach negotiating with NHS England for increased fees?

PC: There is an ongoing dialogue, and part of any effective negotiation is understanding what the pressures are on the body that you’re negotiating with and what their wishes are, and also the parameters within which they're working. Coming out of COVID-19, the dialogue with NHS England has been much stronger than it has been historically. Both sides better understand the needs, wishes and capabilities of the other side. So, we’re going into this year’s round with that positive recent history.

What we will certainly be doing this year is building on an important piece of work that we did last year, which was to start to enrich the data set that we that we base these discussions on.

Practitioners, members, colleagues and businesses will recall that last year we asked for their help in compiling some data on time taken to deliver certain services. This was presented as part of the bid last year, and we were looking to develop on that work in the current year.

Coming out of COVID-19, the dialogue with NHS England has been much stronger than it has been historically

PH: The general process involves internal strategy meetings. There are meetings of the members of the OFNC to discuss the priorities, what we are going to look at, taking in all the things Paul has just mentioned: the wider political landscape, the challenges for other sectors, issues for the NHS and for the Department of Health, and putting all of that together and working through those workstreams.

With the staging, the challenge is that when you do a piece of work, say in June or July, and we gather data to start writing a bid, by the time that submission is in, in September, the world has moved on. So, the bid you’ve put in doesn’t necessarily reflect the pressures that are ongoing at that point.

We got 4.5%, which in recent history was a good result for the sector. Of course, then the world moves on and other parts of the NHS receive a different offer. But we couldn’t wait until those things had happened, because that wasn’t the deadline we were working to.

Part of any effective negotiation is understanding what the pressures are on the body that you’re negotiating with and what their wishes are, and also the parameters within which they're working

What are your priorities in taking on your new roles? Is there anything you want to focus on?

PC: There’s the day job, which is preparing for the current year’s bid and negotiation. That’s the meat of what we do. This year, we’re doing that in a particular context of the changes within the structures of the NHS.

PH: The Academy of Royal Medical Colleges held a consultation on a number of items [including optical coherence tomography [OCT] use, published earlier this year]. Neil O'Brien, the parliamentary under-secretary of state for primary care and public health, , mentioning two or three things that are pressing for us. 

The first is OCT usage in diabetic retinopathy screening, which has the potential to hugely reduce the number of false positives. Currently, the way the screening protocol is written means we end up with technical maculopathies and true maculopathies, ie ones that need treating and ones that don’t.

OCT will allow us to differentiate between those. At the moment, that isn’t in use. There’s an aim to put it in use. We want to make the case that there are many places you could put that OCT technology, but one of the best uses is within optometry, because there’s a really expansive network of OCTs already paid for. The NHS isn’t going to have to find capital expenditure for them. They’re readily available, with practitioners who know how to use them. We would be the logical place, and we will be making a case for that.

That same piece of work talks about glaucoma referral refinement, and talks about cataracts pre and post – again, things that are excellently placed to sit in an optometric practice setting, with a workforce that is eminently qualified, skilled, and equipped.
We can put all of these things into practices, or we think we should be able to. We will be continuing to make that case going forward: not to overlook optometry.

Speaking personally, one of the things that pains me a little is that diabetic retinopathy screening, which originated in optometry, moved out of optometry into companies that deliver it separately. Again, optometry feels like a natural home for it, because of all its interdependencies.

We will be continuing to make that case going forward: not to overlook optometry

Do you think NHS England or the Government is looking at Scotland and Wales being slightly more progressive, and potentially following that lead?

PC: Clearly, NHS England will be conscious of what’s going on in the other countries within the UK. It is our hope that they adopt examples of good practice that occur elsewhere. There are examples of good practice in Scotland, and what appears to be the emerging advancements of clinical practice in Wales. We hope that they do look at those.

Of course, the geography and the structures in England are different, which has an effect on this. But we will certainly look to use any evidence of good practice that we gather to support any of the proposals that we make.

Can optometrists do anything to help you with your work?

PC: We’re very grateful for the support we had last year. We had a really good response to our cost and timing surveys. We're conscious that that uses up people’s resource, so we are grateful for their time and the effort they put into that. We’re also conscious that sometimes they might not see the immediate return on the work that they put in to provide us with that information. But it’s crucial for us to continue to gather this, because really this is a multi-year conversation.

With these things, you build pressure over time. In this coming round, we will build on what we did last year. We hope to find ways that the asks we have of them will make as little imposition on them as possible. But we would please ask them not to lose faith, and to continue to help us to gather the data that we need.

PH: We asked people for cost data, which we know takes a significant amount of time to interrogate: outgoings, staff wages. We know that many will be disappointed that they did that and the fee didn’t leap up by 25% or 30%, given the difference between the cost that was shown by that work, and the current fee.

But as Paul has said, it isn’t going to change overnight. It isn’t going to change in one fell swoop. If we look at the rest of the NHS, if we’d got 10% or 20% on the GOS fee, even at those big percentage figures, it would still take a number of years to close the gap and get to the fee level that was reflected in the costing survey. It’s key to provide the data; it’s key to provide the information, so we can keep the pressure on. But we also understand that that comes at a cost to practices.

PC: Everybody knows, and this includes NHS England and the Department for Health, that the NHS cannot meet the nation’s health needs without primary care optometry. They know that as fact. We also know that the cross-subsidy that private work delivers to enable GOS to happen is not sustainable in the long run. As each year goes by, that becomes more acute, and as each year goes by the more data and evidence that colleagues provide us with enables us to do that. It’s making the argument louder and louder, and more and more difficult to ignore. It is that inexorable build to keep the pressure on.

The NHS cannot meet the nation’s health needs without primary care optometry

PH: I think you raise an interesting point about the percentage being realistic. The BMA junior doctors' approach to wanting a 35% pay rise is an interesting example. If you look at the response from the NHS, from the Department of Health, from the secretary of state for health and social care, there has been quite a pushback. That’s for medics: if they stop, people die. Even with that weight of responsibility, they haven’t been able to force through a 35% rise, and they have been met with challenge about how realistic or pragmatic they are being.

If that’s the context, for optometry it’s going to be a different space as well. What we do is incredibly important as optometrists, but thankfully it’s very rare that if we stop, patients die. That’s something that attracts many of us to the profession: it’s healthcare, but at a significantly lower risk than medicine. We have to have that realism, because otherwise we might not be taken seriously, and that is to the detriment of the profession and future negotiation. We have to have that conservative nature in our minds when we’re doing these things. We understand and probably share some of the frustrations that members have, but the other wider considerations, unfortunately, have to temper some of those frustrations.