Lack of what we perceive a suitable fee is not an acceptable legal defence for not fulfilling your legal obligations to the patient. I work in 2 practices in 2 different areas and one is signed up to the local enhanced service to do that. They (not me) get £42 for repeat fields and IOP. But I still recall the patient within NICE guidance timescale in other practice and practice has to fund that. It isn’t my choice they don’t sign up to enhanced services.
GOS fees will never be adequate. Read the Bosanquet report which about 20 years ago said the economic cost of a “sight test” was £37 and the then government still payed less than half that.
Scottish colleagues did not reduce their spectacle charges when their government funded retinal cameras etc and payed over £40 per exam with a lower second exam fee to investigate any issues. So that killed any argument that we charge higher spectacle prices to subsidise uneconomic GOS fees. And if anyone is working for a practice offering free eye tests. ……well !!!! So look after your legal obligations and responsibilities and let contractor worry about costs. It might take less than 5 minutes extra to repeat IOP, but against that it’s potentially years struck off the GOC and not earning for those who use the argument “I am not paid to do that”!
Does anyone else ever look at the GOC website and read the transcripts of investigations, then say “there but for fortune …….”