Opticians and the worrying discontinuation of NHS services

Is the current system for opticians fit for purpose, or is it an unsuitable relic of the last century?

In recent years, more opticians have been following dentists, and discontinuing providing NHS services. NHS service providers are paid a fee for providing these services, which is no longer in line with inflation. This problem is nationwide, but there is an increasing number of opticians within East Sussex who are no longer providing these services. To understand why opticians are choosing to stop providing NHS services, the basis of these NHS services must be understood, and why it may no longer be fit for purpose.

The Opticians Act (1989) and the General Optical Council (GOC, which is the UK-wide regulator for optometrists and dispensing opticians) govern what services are required to be provided by opticians in the United Kingdom, and any restrictions involved with those services, subject to approval by the Privy Council. This also includes any criminal offences established by the act. The GOC also reserves the right to suspend or ‘erase’ a practicing optician from their register, which they are required to be members of to practice.

It may be unfair to wholly blame must be shared by the NHS.

The NHS sets the fee for NHS sight tests, currently set at £23.53. These are regulated by the GOC, and not the Care Quality Commission. The Sight Test Fee was most recently raised in April 2024, below inflation at the time, with an offer that was not accepted by the Optometric Fees Negotiating Committee (OFNC). Before this raise, the OFNC said in a press release in March:

“At the beginning of the negotiation process, the OFNC submitted evidence to DHSC and NHS England showing that the NHS pays less than 50% of the cost of a GOS sight test. The 2024/25 OFNC bid took account of wider NHS cost pressures and proposed an affordable £2.86 increase to the NHS sight test for 2024/25.

“The NHS has ignored this evidence and Ministers have instead increased the NHS sight test by just 39p (1.68%) based on the forecast 2024/25 GDP deflator.”

This change is not just considered insufficient by the Negotiating Committee, and as a sign of the attitude towards optometry, but is indicative of wider issues within the practice. Many consider this to be just another sign that those who set the fees do not take opticians seriously. Dimple Mentah, chair of the East Sussex Local Optical Committee (LOC) said:

“I think the answer is kind of probably sort of multifactorial, really. And that, and I think in reality, it's probably not that bad in that there's not that many, but there are definitely a few that are starting to… And yes, you're right, some are leaving it, some are reducing it so effectively they're providing NHS rather than providing full time access… they're potentially reducing it a little bit.

“I think in reality the main reason really is just the cost is the primary reason. So, what we get funded for an NHS site test is significantly less than the running cost of the business basically. And therein lies the problem. So usually for most opticians, what happens is when they do an NHS site test that they're effectively doing it at a loss when you factor in the cost of running the building, the insurance staffing costs, the cost of the optometrists, all of these costs, as with everything else at the moment, is increasing significantly. And over the last well for many years, I mean, we're talking sort of decades, really.

“The increases that we've received from the government in terms of the tariff for the for the site test has been relatively insignificant. There's been a recent one and I think this is where things are sort of coming to a head at the moment is that recently in April there was an increase and we're talking, you know, it was less than it was about 1% if not less than that really. So, we're talking pennies literally, pennies and it's just becoming very, very difficult for some businesses to be able to operate on that model nowadays.”

The NHS contracts that opticians must have in order to provide NHS services are General Ophthalmic Services (GOS) contracts. These are regulated by the Integrated Care Board (ICB) for an area, which has replaced Clinical Commissioning Groups recently. NHS Sussex ICB, when given a freedom of information request, stated that 10 optical practices have discontinued their contracts providing NHS services within the past two years (as of March 2022), with 134 holding a GOS contract currently. Mentah continued, now referring to the restrictions placed on practices by the GOC contract:

“The second probable reason is the restrictions it provides. So, you tend to find that you know when you do provide GOS contract, you have to provide it and you have to obviously and correctly, I suppose you now have no restrictions in terms of who you who you see and when you see them… But obviously when it comes to running the business, it's not really cost effective to do that. So, but you can't provide any restrictions you have to you know everyone has an entitlement to be seen at any particular time. So again, it swings around about, but it does, it does cause a problem.”

So, what does this mean for the public? The more opticians that stop providing NHS services, the fewer there will eventually be for patients to access. For opticians, the decision to go private is not an easy one, although there are groups – such as Opticians Going Private on Facebook – to support them. Despite the NHS’ commitment to providing healthcare to all, their system of dealing with opticians is no longer up to scratch. Modifying the Opticians Act may only quell the fire, whilst the general lack of respect given will only further drive opticians away.