The Wellbeing Conversation Optometry is Still Not Having

At 100% Optical last month, Neil Retallic took the stage to talk about burnout, breathing, and daily huddles. He quoted the Health and Safety Executive. He cited his PhD data. He was thoughtful, evidence-based and genuinely trying to help. And yet the single biggest cause of work-related stress in optometry went completely unmentioned. Not touched on. Not acknowledged. Not even hinted at. The commercial pressure to sell. The ghost clinics. The eye test conveyor belt. The thing nobody told you about at university.

What the research actually found — and what it quietly skipped

Retallic's session drew on data from surveys with more than 1,500 optometrists and pre-registration practitioners using validated measures of psychological distress. The headline numbers were stark. Seventy-one per cent of pre-regs scored at concerning levels of distress. Approximately half screened positive for depression or anxiety.

These are serious numbers. They deserved a serious session. And parts of it were serious.

But read back through the AOP's own write-up of the session. The stressors identified came straight from the HSE framework: demand, control, relationships, support, role, and change. Fine. Legitimate. Useful. And then came the solutions: daily huddles, checking in with your team's emotions, having a bar of chocolate and a rant after lunch.

At no point in the reported session did anyone name the actual structural pressure that drives a significant proportion of optical distress. The pressure that arrives the moment you qualify and enter a multiple. The pressure that has nothing to do with clinical complexity and everything to do with targets, upsell rates, and frames-per-patient ratios.

The GOC said the quiet part out loud. Nobody at the conference seemed to notice.

Last September, the GOC published its 2025 Registrant Workforce and Perceptions Survey, which received more than 3,700 responses. And the commercial pressure data is extraordinary.

Forty-eight per cent of optometrist respondents said the standard time allocated to conduct a sight test is insufficient to provide safe patient care. Not inconvenient. Not rushed. Insufficient to provide safe care. That is nearly half the profession.

Thirty-eight per cent said they felt pressured to see a high number of patients each day, which affected their ability to provide safe patient care.

Thirty-three per cent said they felt under pressure to sell certain types of glasses or contact lenses to earn more money for the business.

30% had felt pressured to meet commercial targets at the expense of patient care.

Twenty-two per cent said they had felt under pressure to sell a product or provide a service they considered unnecessary for the patient.

And overall job satisfaction? Down to 55% in 2025. From 58% in 2024. From 62% in 2023. Three straight years of decline.

The GOC was clear enough about the cause. They launched a full thematic review into commercial practices and patient safety. They are now consulting specifically on sales targets and incentives in the eye care sector.

The regulator named it. The well-being session did not.

Ghost clinics and eye test volume: the stress they never teach at university.

There is a specific kind of professional dread that qualified optometrists in corporate practice know all too well. It has no formal name in the psychological distress literature. Call it the ghost clinic problem.

You arrive at 9 am. Your clinical list shows twelve patients booked. Your pre-test room is staffed. Your dispensary is stocked. And by 11 am, you have seen two patients, because ten of your twelve were booked by an automated system, had no intention of attending, and no one called to confirm them the day before, because confirmation calls cut into the booking assistant's own KPIs. Your test volume for the morning is two. Your personal target for the morning is six. You did nothing wrong. You will still have that conversation.

Or you arrive, and the list is full. Genuinely full. Sixteen patients across the day in twenty-minute slots. Adequate for a straightforward refractive case. Not adequate for the 74-year-old with early macular changes, the anxious parent bringing a child who has never had an eye test before, or the referral back from ophthalmology who wants a proper conversation about what happens next. You can provide adequate care, or you can provide good care. You cannot reliably do both at that pace. Every optometrist in that situation knows it. The 48% figure in the GOC survey is not a surprise. It is a confirmation.

And then there is the selling. Not a clinical recommendation. Selling. The expectation — sometimes unspoken, sometimes very much spoken — that you will mention the premium anti-reflection coating, the transitions, the extended warranties, the upgraded frame range. That your dispense rate for recommended extras will reach a certain level. That your clinical consultation will contain a commercial handover that leads reliably to a certain basket value.

Nobody covered this at optometry school. The ethics module covered informed consent and confidentiality. The clinical module covered the slit lamp technique and visual fields. Nobody covered what you do when your store manager asks why your add-on sales are below target for the third month running.

And it gets worse for the newest people in the profession.

The 71% pre-reg distress figure deserves its own section.

Pre-registration optometrists are not in a free-standing clinical environment. They are predominantly placed in corporate practices because that is where the majority of pre-reg positions exist. They are learning clinical optometry while simultaneously navigating a commercial environment they were never trained for, under supervision from qualified optometrists who are themselves under the same commercial pressure, many of whom — as Retallic's own research found — reported feeling they hadn't been taught how to manage people's emotions and didn't know what to do when someone said they weren't feeling great.

So the pre-reg is stressed. The supervisor is stressed. And the solution offered is a daily huddle and a bar of chocolate.

The GOC's 2025 survey added new questions on supervision for the first time. More than half of supervisors cited helping others join the profession as their motivation. That is genuine. And their reported experience was pressure around time management and workload. The structural conditions that make pre-reg training stressful are the same structural conditions that make qualified practice stressful. They are not a supervision failure. They are a commercial model problem.

The well-being conversation in optometry is not wrong. It is incomplete.

This is not an attack on Neil Retallic or on the 100% Optical education programme. The research is real. The distress is real. Burnout is real. The tools for managing stress — peer support, reflective practice, understanding your own warning signs — are genuinely useful.

But there is something deeply uncomfortable about a wellbeing session hosted at an industry trade show, sponsored by the commercial sector, that discusses distress without once examining the commercial structures generating it. It is like a session on NHS waiting list stress that never mentions NHS underfunding. It identifies the symptom. It markets a coping strategy. It does not touch the cause.

Retallic himself observed that if someone came to him with a clinical or commercial problem, he knew how to handle it. Commercial targets — he knew what they were and could work towards them. The framing was instructive. Commercial targets are assumed. They are the given. The stress they generate is the variable to be managed.

That assumption deserves to be challenged far more directly than it was on that stage.

What this means if you own an independent practice — or are considering it.

The commercial pressure documented in the GOC survey is not a feature of optometry. It is a feature of optometry in a corporate, multi-model setting. It is not inevitable. It is structural. And the structure is a choice.

Independent practice owners set their own test times. Forty-five minutes or sixty minutes if the clinical case requires it. No store manager is measuring your dispense rate against a national average. No regional director is running a report on your add-on conversion. The patient in your chair is your patient. The conversation you have with them is your conversation. The recommendation you make is your recommendation.

That is not a luxury. It is the basic clinical environment that optometry school implied you were training for. The one that the GOC's own data confirms is that a significant proportion of practitioners in corporate settings never actually experience.

Thirty per cent of respondents in the GOC survey felt pressure to meet commercial targets at the expense of patient care. In an independent practice you own, there is no commercial target that overrides your clinical judgement. Because you set both, and they point in the same direction.

Declining job satisfaction for three years in a row is not a mindfulness problem. It is not a daily huddle problem. It is a structural problem. And there is a structural answer. It is not the only answer, and it is not available to everyone immediately. But for the optometrists and dispensing opticians reading the GOC data and recognising themselves in it, it is worth knowing that the structure can be changed.

If the clinical environment you trained for does not match the one you are working in, that conversation is worth having. The path exists. This is where it starts.

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