💬 The final poke in the eye for NHS Optometry Another Real-Terms Cut for NHS Primary Eye Care Today the DHSC confirmed that the GOS sight test fee for 2025/26 will rise by just 2.5% to £24.13 — an increase of only 60p. All other fees and grants remain frozen. To put this into perspective: - In 2014, the GOS1 fee was £21.10 - Since then, inflation has risen by ~40% - Yet the NHS sight test fee has increased by only 3% in eleven years - Meanwhile, the true cost of providing an NHS sight test now exceeds £49 What many people outside the sector do not realise is that NHS primary eye care has been financially propped up for decades by spectacle sales. The NHS fee does not cover the cost of the clinical service, meaning practices must absorb the shortfall. In reality, the gap is subsidised through the price of glasses, making the idea of a “free NHS sight test” more of a political headline than a sustainable funding model. But as the cost of glasses increases, more patients understandably purchase their eyewear online. This creates a serious knock-on effect: A significant proportion of spectacle revenue traditionally goes straight back into the practice to fund advanced diagnostic tools such as retinal photography, OCT scanners, visual field machines and tonometers — essential for early disease detection and preventing avoidable sight loss. When more sales move online, that reinvestment disappears. Not only is the practice unable to upgrade essential clinical equipment, but a large proportion of online sales go to companies based outside the UK, meaning tax revenue is lost too.
The public are not complaining so it won’t change until they do. The public can get a free nhs test the same day without any problems due to large companies treating a “nhs sight test” as a loss leader, then relying on a spec sale to balance the books! They are fighting the wrong battle. The wording simply needs to change to “a voucher towards an eye examination”. The larger practices who work on conveyor belt volume can still offer a basic screening. Smaller practices then have the choice to charge a top up. We offer comprehensive Eye Examinations including a through glaucoma, macular examination with a honest result for a £30 top up fee. Many practices offering “free” have conversion sales targets to sell specs ……… is that honest? The public should be asking their optometrist “What is your conversion rate target when they are told they need new specs.
Despite seven months of engagement, NHS England and DHSC have again relied on flawed modelling and outdated assumptions, resulting in another real-terms cut. For Mellis Eyecare, this means continuing to deliver a high-quality NHS service at a loss — something that becomes harder to sustain each year as costs rise and funding fails to keep pace. Politicians frequently say that more eye care should be managed in primary care, yet the funding provided makes this increasingly unrealistic. This approach is quickly killing off optometry practices in the North East, where margins are already tight and reliance on NHS services is high. We are expected to do more and more for the same fee, while an increasing number of patients who genuinely require NHS attention are being turned away or told they must wait a minimum period before treatment can begin when they have been referred to secondary care.