OFNC – Derisory GOS Fee Imposed by DHSC

26 March 2024

Government has today announced that, despite the clear rejection of its offer by the sector, it has decided to impose another real-terms cut to the NHS sight test fee. Therefore, from 1 April 2024, the GOS sight test fee will increase by just 39p to £23.53 in England. There will also be no increase in the domiciliary visiting fee nor in the pre-registration training grant nor (for the second year running) in the CPD grant.

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.

The OFNC challenged DHSC and NHS England on this throughout February and March, at which point we updated the sector about the unacceptably low offer and asked for an urgent meeting with Health Minister Andrea Leadsom to press again for an increase of at least as much as other areas of primary care which are suffering similar pressures.

DHSC and NHS England have refused to review the evidence or treat primary eye care fairly and, since we have refused to accept the real-terms cut to fees, DHSC has now unilaterally imposed this on the profession. This represents yet another failure by the NHS in England to invest in eye care or the future of the sector despite multiple years’ rhetoric about transformation. We have left both Ministers and officials in no doubt about the way the news will be received by the sector. In our bid and correspondence with officials since, we had set out data clearly showing the need for a fee increase and we have  highlighted the flawed and inconsistent reasoning that underpins the small fee uplift that is being imposed on the profession. This included:

• The impact of cost and wage inflation on an already under-funded sight test.
• The history of previous under-inflationary settlements.
• The impact of fuel and transport cost increases on the domiciliary sector.
• The cost increases resulting from the changes to the education and training for optometrists; and
• The cost of additional administrative burdens on GOS providers resulting from changes to referral processes.

In their response, officials repeatedly relied upon the use of the GDP deflator to determine the NHS sight test fee. This was, as our response to them pointed out, utterly illogical as it ignored the supporting evidence. Also in previous years, when inflation was increasing rather than decreasing, Government had refused to use the GDP deflator since that would have resulted in higher fee increases; now, however, they seek to rely on it.

We also pointed to the fact that GOS was again being unfairly treated in comparison with other areas of health spend, with the proportion invested in GOS already having fallen significantly in recent years. Finally, we set out the impact of this figure on a sector already under considerable strain, including smaller community practices caring for some of the poorest in the community.

In their responses, officials have been unwilling or unable to engage with these arguments and have been determined to merely impose the new figure. While we have continued to press for a Ministerial meeting to discuss the unacceptably low offer, no meeting has been offered.

We have no doubt that contractors will rightly be very angry about such a low increase being imposed on them, combined with real term cuts to training and education given commitments in the NHS workforce plan. This will have a massive demoralising effect on the sector at a time they are being asked to take on more NHS work to help hospitals struggling with waiting lists and to meet needs. The OFNC will be writing to the sector to survey the impact of this latest real-terms cut to NHS eye care.

Paul Carroll, OFNC chair said “This derisory increase shows that talk is cheap. Despite effusive praise for the important role that primary eye care plays in meeting the nation’s vision and eye health needs, once again we find ourselves at the back of the NHS queue. It is hard to take seriously, warm statements made by Ministers, when they are not backed up by action.”