OFNC Statement: NHS disregards evidence and imposes more real terms cuts on GOS

8 December 2025

Today the Department of Health and Social Care (DHSC) has confirmed it will impose yet more real terms cuts on NHS primary eyecare services. GOS1 fees will rise by just 2.5% to £24.13 for financial year 2025/26.  All other payments and grants will be frozen at 2024/25 levels. This follows a freezing of patient benefits (NHS voucher values) announced earlier in the year.

OFNC Paul Carroll said: “Once again primary eye care seems to be singled out for unfair treatment despite the growth in the NHS budget and Lord Darzi’s independent recommendations about rebalancing NHS spending and rebuilding primary care. It is hard to fathom why, other than the low priority the NHS always gives to eye care outside hospitals.”

GOS fees

The fees and grants imposition by DHSC comes after nearly seven months of discussions with NHS England, during which NHS England acknowledged the strength of OFNC’s evidence but continued to disregard the evidence on actual costs, and instead use its own forecasting data which it recognised as being suboptimal.

The Minister requested for the OFNC to engage constructively with the process, and in good faith, we proceeded to work collaboratively with officials with the goal of ensuring the GOS sight test fee was uplifted as much as possible within centrally pre-set spending constraints. We made a very credible case for at least a £25 sight test fee within NHS England’s £17.6m budget headroom, but this was rejected by NHS England on supposed grounds of affordability.

NHS England therefore continued to seek to impose an unrealistic 2.39% uplift to the sight test fee, although this was later increased marginally to 2.5%. This was not an offer OFNC could accept on behalf of the primary eyecare sector, because it fails to recognise how much the sight test fee has been, and is still being, systematically underfunded and because NHS England’s approach is based on modelling assumptions which we know to be unsound.

As a result, DHSC has now taken the decision to impose the below inflation increase on practices – the sight test fee increases by just 60p. This will be backdated to 1 April 2025. All other payments will remain frozen at last year’s rates including domiciliary visiting fees, CPD grants and pre-registration optometrist training payments.

We have left officials in no doubt about how furious and disappointed practices and practitioners will be about this latest imposition given all the evidence shows that the real costs of a providing a sight test exceed £49, that is before counting the increases in national insurance, the national living wage and other taxes the government now requires primary eye care providers to fund.

This year has been exceptional in many ways, not only the very disheartening outcomes but also the fact that NHS England was not in a position to even start discussing fees until May when budgets had already been set and agreed with Ministers based on unreliable data. We are therefore taking the step of publishing a timeline and summary of our engagement with the NHS below, with the usual link to official correspondence so that all practice owners can see the arguments put forward.

We know that many practices will now be struggling with the question of whether they can continue to offer NHS eye care as in the past, so, at your request, we have produced some FAQs to help practices shape their thinking.

CPD window

Owing to the delays, this year’s CPD grant claim window (for CPD undertaken in 2024/25) will run from 8 December 2025 to 31 March 2026.The grant remains at £596.

Clinical placement training payment

One element of the new arrangements which may not immediately be noticed is that, through separate discussions, OFNC has agreed with NHS England and DHSC that there will be a clinical placement training payment available to contractors in respect of students on long practice placements under the new MOptom programmes at UK universities. This will also be available to contractors in respect of pre-registration optometrists enrolled on the College of Optometrists Scheme for Registration until that is phased out.

The rate of payment will be the same as the pre-reg grant for the current year (2025/26) – £4010 but will be claimable in two half-placement ‘blocks’ or for a full placement (two blocks) from PCSE within three months of the end of the block (half placement) or whole placement. This change of time limit for claims will bring clinical placement training payments in line with the time limits for other GOS claims.

 

Sector statements

AOP: NHS disregards evidence and imposes more real terms cuts on GOS

FODO: NHS disregards evidence and imposes more real terms cuts on GOS

Timeline

Official OFNC correspondence relating to 2025/26 fee discussions can be found here. A summary is included below for contractors, who will rightly be questioning why NHS England and DHSC continue to ignore the evidence on the cost of provision and to impose cuts on primary care despite commitments to rebalance the NHS so that it is less dependent on unsustainable models of hospital care.

• 4 February 2025. OFNC raises concerns about how NHS England and DHSC had disregarded the evidence on the cost of providing the GOS sight test for many years. OFNC Explains that the cost pressures on primary eye care services are significant, but NHS England and DHSC continued to decline restarting joint data collection to provide further evidence on the cost pressure caused by low GOS fees.
• 4 February 2025. OFNC writes to the Minister of State for Care, explaining that the sector supported the government’s three big shifts for the NHS, but that we needed a fairer approach to funding NHS primary eye care services.
• 19 March 2025. NHS England write to OFNC, recognising for the first time that OFNC had undertaken “comprehensive” work to “present evidence to NHSE and DHSC” on the cost of delivering GOS.  However, NHS England also sets out how the budget for primary eye care had already been agreed, and that the uplift would be just 2.39%. In essence, acknowledging the NHS understands the cost of providing an NHS sight test but will not pay this, and officials are content for this aspect of NHS care uniquely being indirectly funded by patients.
• 20 March 2025. OFNC issues a statement warning there would be delay in agreeing fees because of issues at NHS England and that early signs were of an inflation only increase.
• 27 March 2025. DHSC confirms it will freeze patient benefits. OFNC issues a statement about how this would adversely impact patients and practices.
• 27 March 2025. OFNC writes to NHS England about its proposed approach, setting out how this afterthought approach would not be acceptable to the profession and was in fact an insult to the practices, optometrists and dispensing opticians who work hard every day to fix and protect the nation’s vision and eye health and contribute massively to the economy. OFNC also challenges the subjective nature of the NHS England approach.
• 9 April 2025. The Minister of Care writes back to the OFNC, acknowledging “ongoing concerns about the level of the NHS sight test fee” and that his department had asked “NHS England to take forward a more collaborative approach on setting fees [with the OFNC], in line with other parts of primary care” and he “encouraged [the OFNC] to engage with the fee discussion process”.  The OFNC continues in good faith to engage with NHS England, despite NHS England challenges in understanding its own data and the limitations of the data.
• 29 July 2025. NHS England provides its interpretation of its own datasets, which are known to be of questionable quality, and seeks again to impose a 2.39% uplift on GOS sight test fee.
• 1 August 2025. OFNC formally writes to NHS England to set out how we have raised concerns on multiple occasions about the data it is relying on to impose fees on primary eye care. OFNC sets out concerns about how the £633m budget is being analysed by officials and how this will fundamentally risk short-changing primary eye care once again. OFNC sets out different affordability scenarios and pushes for an uplift to the proposed fee NHS England is trying to impose.
• 11 August 2025. NHS England formally recognises issues with the data quality it is depending on and agrees to meet again to discuss concerns.
• 13 August 2025. OFNC highlights factual inaccuracies in NHS England’s correspondence and challenges how NHS England has computed distribution of a £17.6m uplift for primary eye care. OFNC requests a meeting with DHSC and NHS England about the approach and to resolve issues with modelling assumptions made by NHS England.
• 28 August 2025. OFNC writes to NHS England following a meeting on 19 August. OFNC again raises concerns that NHS England has not been able to explain or evidence why its modelling assumptions on the ratio of sight tests to GOS3 vouchers depart so significantly from long-term trends, and how this adversely impacts on the sight test fee NHS England is proposing.
• 22 October 2025.  DHSC uses NHS England data to model various scenarios and shares its analysis with both NHS England and OFNC.
• 23 October 2025. OFNC writes to DHSC to explain again why there are methodological problems with the NHS assumptions being used to compute the proportion of the GOS budget thought to be required to fund vouchers. It seems the underlying data NHS England is depending on is of insufficient quality and DHSC and NHS England are inclined not to consider sector datasets on the ratio of GOS1 to GOS3.
• 29 October 2025. NHS England writes to OFNC to explain it will recommended to DHSC to uplift GOS sight test fees by an additional 4p, taking the proposed fee to £24.13, an increase of 2.5%.
• 14 November 2025. OFNC issues a statement on the ongoing delay, setting out issues with data at NHS England and reassuring practices that CPD grant window would open in due course.
• 21 November 2025. DHSC writes to OFNC to confirm it will only increase GOS 1 to £24.13.
• 27 November 2025. OFNC rejects this on the basis that the evidence has not been properly considered and that DHSC will have to impose such unfair fees on the profession, sending a signal to the sector that the government and NHS are going to punish primary eye care for doing a good job.
• 8 December. DHSC imposes real terms fee cuts.

About OFNC

The Optometric Fees Negotiating Committee (OFNC) is the national negotiating body for eye care in England with the Westminster Parliament, the Department of Health and Social Care and NHS England. It comprises the leaders of the UK representative bodies: ABDO, AOP, FODO and BMA (for OMPs) and works in partnerships with the College of Optometrists and the General Optical Council.