Why stop NHS work? Well, in some respects the decision was forced upon us when bizarrely our contract did not automatically transfer over to our new premises when we moved. When we looked into the amount of work required to get a new one it became an easier decision to stop.
It’s done with a heavy heart though as it feels wrong and somehow disloyal, but the English* (*it is better in Wales and Scotland – not perfect, but better) the ophthalmic services contract is not fit for purpose and has not been for decades.
We will have an event later in the year to discuss what is wrong and think about how it could be better – I might even dig up my PhD proposal on the topic and tell my Andy Burnham story about the matter. We will also review the decision in 6 months, to look at the known knowns, known unknowns and unknows unknowns.
Until 1987 everyone was entitled to a biannual eye test and NHS pair of specs at minimal cost. Then the government stopped all entitlement to over 18s, unless they were on benefits and a few other exclusions- as well as de-regulating the industry significantly. “Between 1948 and 1985 the NHS supplied spectacle frames, then vouchers. In 1949 there were ten free styles of frame and seven which could be chosen for payment of an additional fee. There could be an 18-month waiting list before the finished spectacles arrived. Initially they were free, but a £1 charge was imposed in 1951. Free NHS lenses could be fitted into privately supplied frames”. (College of Optometrists website).
In 1997 Labour introduced “free” tests for the over 60s, but did not increase funding to support the decision.
When I first qualified (30 yrs ago …) the fee we got for doing a test for someone entitled to a NHS test was just under £20 and now is just over £20 (would be about £40 if it had tracked inflation). If we do a follow up test, like dilating pupils, repeating a field/pressure/picture there is no further fee. If we do a referral/letter there is no further fee. In Scotland the initial fee is around £40 and there are fees for follow up visits.
Without the sales of spectacles we would not be able to operate – we have invested £100K+ in testing equipment since we opened and obviously there are staff costs too. Although it is worth noting that optometrist salaries have tracked the fees and it’s hard to earn as much now in absolute terms as you could 30 yrs ago – they are half what they would have been if they had tracked inflation.
Specsavers were born out of this de-regulation and make it work by doing high volume, quicker work. Many companies use the test as a loss-leader – hence the endless offers / BOGOFs et / “free” test for all – which tends to undermine the profession’s argument for the government to increase fees.
Most importantly the system drives health inequalities, results in preventable sight loss – as well as not necessarily feeling great as a patient/customer in an upselling sausage machine.
The answer is not tweaking. But, being right that the system is wrong does not make leaving feel any easier. But, carrying on felt a bit hypocritical.
