24 April 2025

Funding shortfall ‘putting pressure on primary care optometrists’

by Hannah Williams

A Healthwatch survey has found that people are avoiding regular visits to the optician due to concerns about potential costs. While most people are happy with the service they receive, a real-term decline in the NHS optical voucher for sight tests means opticians are under pressure to charge for other services, the report says.

The report, 'Seeing clearly? Attending sight tests and accessing opticians', highlights a decrease of over 30% in the real-term value of NHS optical vouchers in the past two decades according to Healthwatch figures, and the NHS sight test fee has fallen even more. Additionally, changes to eligibility for qualifying benefits have increased pressure on patients and opticians.

Of the 1,766 self-selected respondents who answered the relevant questions, more than two-thirds had attended an eye test in the last two years. Of those who had not, 14% said they had avoided eye care in the past two years due to perceived costs. This figure rises to 39% among those who described themselves as "not at all financially comfortable" compared to 3% of those who were "very financially comfortable".

"An estimated 50% of sight loss is avoidable," reported Healthwatch. "That's why it's vital that people can have their eyesight tested regularly and get the help they need if there is a problem." The NHS and optometrists typically recommend people get their eyes checked every two years and sooner when advised or if there are any concerns.

Louise Ansari, Healthwatch's chief executive, emphasised the importance of regular visits to the optician to identify any avoidable sight loss and get the help people need. "NHS funding to help meet eye care costs has not kept pace with inflation, which, in turn, is causing high-street opticians to rely more on selling additional services to make their businesses viable," she said. "It is essential that this situation does not impact the most disadvantaged in society."

Although 84% of survey respondents were eligible for free eye tests and 72% qualified based on age (over 60), many still struggled with extra costs. Even among those eligible for financial support, 63% had been offered additional services at an additional cost.

Many of the survey's respondents described experiences of good quality care and communication. All primary care optometrists should adhere to the General Optical Council's Standards of Practice, which include putting patients at the heart of their work and giving people clear information about the costs of professional services and products.

The report recommends the Department of Health and Social Care review its support for NHS eye care for those from the poorest households, supported by a communications campaign targeted at low-income eye care patients so that they are fully aware of what services they can access free of charge.

The report drew comment from across the optical sector. Daro Bjayou, FODO's policy officer, said: "It's encouraging to see the positive feedback from survey respondents about the care provided to them by their local opticians. Everyone should be able to access high-quality primary eye care, but years of underinvestment in NHS primary care services is putting the service under pressure. That is why we support both recent Healthwatch reports which call on the government to invest in primary eye care for the benefit of patients. "

This is the second Healthwatch eye care report, following the publication in March of 'A strain on sight; waiting for NHS specialist eye care'. It argued for expanding the scope of primary care optometrists to help with early identification of serious eye conditions and faster referrals to reduce pressure on NHS services.

The report found that 85% of patients waiting for care supported optometrists being able to refer patients directly to specialist services without requiring a GP consultation. Additionally, 65% of respondents said they would be comfortable with optometrists monitoring and treating eye conditions.

Sarah Cant, director of policy and strategy at the College of Optometrists, said: "Regular eye examinations by qualified optometrists play a key role in detecting early signs of eye disease and preserving sight, and financial barriers should not stand in the way of patients getting this vital care. Without adequate funding, optical practices will struggle to maintain services - reducing access for those who need it most."

Adam Sampson, the AOPs chief executive, said: "No one should have to choose between paying for the basics like rent and food, and accessing eye care. Healthwatch makes it clear that NHS funding has failed to keep pace with reality, leaving both patients and optometrists in an increasingly untenable position."