£24.13 a Sight Test: The NHS Backlog Is Real, the Fee Is Not

The NHS is paying £24.13 for a sight test. That is not a mistake. That is a choice.

For the financial year 2025 to 2026, the Department of Health and Social Care confirmed a 2.5% increase to the GOS1 sight test fee. It now stands at £24.13. Every other payment — domiciliary visiting fees, CPD grants, pre-registration training support — was frozen at 2024/25 levels. NHS optical voucher values, which help eligible patients towards the cost of glasses and contact lenses, were frozen earlier in the same year.

The Optometric Fees Negotiating Committee called it what it is: yet more real-terms cuts imposed on primary eye care. ABDO described it as bitterly disappointing. The College of Optometrists said the increase was below inflation and deeply disappointing. None of them were being dramatic. They were being accurate.

Meanwhile, nearly 600,000 people in England are currently waiting for an ophthalmology appointment. Ophthalmology is one of the largest backlogs in the entire health service. Glaucoma alone accounts for somewhere between 20 and 25 per cent of all hospital eye service activity. The College of Optometrists published a review in April 2026 concluding that hospital-only glaucoma care is simply no longer viable — and that between 40 and 75 per cent of new glaucoma referrals could be avoided entirely through community-based filtering services delivered by optometrists.

Read that again. Up to three quarters of those referrals. Avoided. In the community. By qualified optometrists who are already there.

Community optometry is the answer. The government knows it. The funding doesn't reflect it.

The government's 10-Year Health Plan signals a shift from hospital to community care. And in May 2026, the King's Speech confirmed that NHS England itself is being abolished — its functions folded directly into the Department of Health and Social Care under a new NHS Modernisation Bill. The biggest restructuring of NHS governance in over a decade. The rationale: cut bureaucracy, bring the health service back under direct democratic control.

Fine. But here is the question that restructuring does not answer: who is actually going to deliver the community-based care the government keeps promising?

The AOP has consistently argued that the 5,358 community optometry practices in England represent a ready-to-use, cost-effective solution to the eye care backlog. Research commissioned by the AOP, Fight for Sight, Primary Eyecare and Roche calculated that enabling enhanced services at scale across England could free up two million health service appointments annually — including 1.2 million in the hospital eye service — and deliver a £98 million net gain per year.

A £98 million net gain. Against a £24.13 sight test fee that has not kept pace with inflation.

The Healthwatch England report published in March 2025 found that 85% of patients waiting for specialist eye care would support better use of community optometry to cut waiting times. Patients are not the problem here. They understand what the system apparently does not: that the solution is already on the high street.

What this means for your practice right now

Independent optical practices have always operated across both NHS and private income — GOS fees, private sight tests, dispensing, specialist clinical services. That mixed model is not new. What is new is the pressure on the NHS side of it.

The OFNC chair, Paul Carroll, put it directly: primary eye care keeps being singled out for unfair treatment, despite the evidence, despite Lord Darzi's independent recommendations about rebuilding primary care, despite the government's own stated direction of travel. Some practices are already reflecting on whether their GOS contract still makes financial sense. That is a rational response to an irrational situation — not a retreat from the NHS, but a legitimate business decision when the fee no longer covers the real cost of delivery.

The structural forces here are not subtle. The health service needs independent optometry desperately. It needs it to clear a backlog of 600,000 ophthalmology patients, to manage a glaucoma epidemic heading towards 1.145 million people by 2030, to deliver the shift from secondary to primary care that the 10-Year Health Plan promises. And it is paying £24.13 a sight test to get it.

That gap — between what the system needs from independent optometry and what it is prepared to pay for it — is the central tension in every independent practice business plan right now. Enhanced services, where Integrated Care Boards are commissioning them properly, can change that equation. Private clinical services — dry eye, myopia management, specialist contact lens fitting — already do for many practices. The question is whether the NHS side of the model is sustainable at current fee levels, and for how long.

If you are building your practice model from scratch, or stress-testing the one you already have, Grow Independent is the place to start. If you are still weighing up whether independence is the right move, Go Independent gives you the honest picture.

Because one thing is clear. The system is not going to solve this for you. The solution is the independent optical professional, doing what they have always done — looking after patients, properly, on the high street — but on terms that actually make sense.