The goodwill the NHS eye care system runs on — and who pays for it

Goodwill is not a funding model. But right now, it is holding the NHS eye care system together — and the OFNC wants to put a number on exactly how much of it you are quietly providing for free.

The Optometric Fees Negotiating Committee has launched a short, confidential survey asking all GOS contractors in England to document the unfunded work they carry out around and beyond the NHS sight test. Work that is performed every day, in every practice, on a goodwill basis. Work that keeps secondary care from being overwhelmed. Work that nobody pays for.

The deadline is 22 June 2026. If you are a contractor, this is not optional reading. This is your chance to be counted.

The problem the profession has never been able to prove

Everyone in practice knows it happens. You extend the appointment. You give telephone advice that should arguably be triaged elsewhere. You absorb administrative work connected to GOS delivery that sits outside the contracted scope. You pick up the slack where GPs and hospital ophthalmology cannot reach.

None of it shows up in a fee schedule. None of it has ever been formally quantified. And without formal quantification, it is almost impossible to make the case to ministers and senior officials that the current fee structure is structurally underfunded — not just underpaid.

That is what this survey is designed to fix.

What OFNC chair Dr Peter Hampson actually said

Dr Peter Hampson, chair of the OFNC, was direct about the stakes. He described the unfunded work that contractors perform within and around the sight test as activity that "arguably keeps the whole NHS eye care pyramid functioning." His words, not ours. And he went further.

GOS contract holders, he noted, are privately telling the OFNC that years of below-inflation fee increases are now seriously threatening their ability to continue providing this activity pro bono. The implication is clear: practices are absorbing costs that should be commissioned costs. They are doing it because the alternative is worse for patients. But the financial cushion that allows that to happen is shrinking.

When goodwill runs out — and it runs out when practices can no longer afford to subsidise a system that refuses to fund them properly — the pressure does not disappear. It moves. It moves onto GPs. It moves onto hospital colleagues. It moves onto a secondary care system already holding an ophthalmology waiting list that in England alone stood at around 608,000 people as recently as early 2024.

The numbers that make this embarrassing

The current NHS sight test fee in England is £24.13. That is the rate that has applied since 1 April 2025 — a 60p increase, imposed below inflation after seven months of negotiations that went nowhere. The OFNC made a credible case for at least £25. NHS England rejected it on grounds of affordability.

Here is the number that matters more. The OFNC's own evidence shows that the real cost of providing a routine sight test exceeds £49 — and that is before factoring in the increases in national insurance, the national living wage and other costs that government policy has since layered on top. Practices are being paid £24.13 to deliver something that costs more than twice that to provide. The gap is not academic. It is the gap that goodwill fills.

The OFNC survey is partly designed to build the evidence base for the next fees round — giving negotiators something concrete to put in front of ministers beyond the frustration that every contractor in the room already privately shares.

Why this matters more for independents than anyone else

Multiples absorb underfunding differently. A corporate group with hundreds of practices, central procurement, bulk buying power and investor capital can cross-subsidise NHS work from private revenue in ways that a single-site independent simply cannot replicate. The corporate model also has lobbying infrastructure. Direct access to senior NHS officials. Resource that the average independent GOS contractor does not have.

The OFNC survey is one of the few mechanisms that gives individual independent contractors a direct voice in the fees negotiation. The data is collected confidentially, reported only in aggregate, and used to make the profession's case in rooms where individual practices have no seat at the table.

If the survey underrepresents independent contractors — if the larger corporate blocks complete it and the independents do not — the resulting evidence base will underweight the practices where the financial pressure of unfunded goodwill is most acute. Independent practice owners who are quietly subsidising NHS eye care on tighter margins than their corporate competitors need to be in this dataset. Not because it is required. Because it is the only way the evidence reflects the reality.

The bigger picture: what happens if goodwill is withdrawn

Dr Hampson's warning about the NHS 10-Year Health Plan eye care ambitions deserves attention. The plan carries significant aspirations for shifting ophthalmology services into primary care settings — for optometry to take a larger, more formal role in managing conditions that would otherwise consume hospital resources. It is, in principle, the right direction of travel.

But that plan depends on a community optometry sector that is financially viable enough to expand its scope. A sector that is slowly having its goodwill eroded by fees that do not keep pace with costs is not a sector that can absorb additional clinical responsibility. The workforce and infrastructure exist. The commercial model to sustain them, at current fee levels, does not.

This survey is not just about this year's fees round. It is about building the permanent evidence base that the profession can use every time this argument needs to be made.

Complete it before 22 June

The OFNC has set a deadline of 22 June 2026. The survey is short, it is confidential, and the results will be anonymised before any data is shared with ministers or officials. There is no operational risk in completing it. There is a real risk in not completing it: a fees negotiation conducted without your data, on evidence that does not include your practice, against a system that will assume your current level of goodwill contribution is sustainable for another year.

Complete the survey. Make the invisible visible. The profession has been absorbing the cost of NHS underfunding in silence for long enough. The OFNC is offering a formal mechanism to document that cost. Use it.

If the pressures of NHS underfunding are part of why you are thinking about how to structure your practice differently, this is exactly the kind of conversation our Grow Independent service is designed for. Book a Free 20-Minute Practice Growth Call