Big companies only care about money and profits, nothing else. I have seen managers forcing expensive dispenses with the result of unhappy patients which will never return to the same practice. The result is money in the till for the day but they do not invest in the future. They are killing the golden hen. Coming back to those ferocious managers, they do not last in the practice. As soon as their figures are up the move to another practice or company with a significant pay increase. Who will clean the mess left behind? The Optoms and the professional staff that really value their profession.
The main problem is that the Optom work has never been valued. You take your care to the garage and expect to pay for labour and spares. When you go to the Opticians you only expect to pay for the specs and the Optoms job has no value at all.
Increasing the sight test fee to £50 per sight test might be a good idea. The problem is that we should offer more for the money. I mean better visual fields (quite often the way they are performed in some practices is appalling), better retinal photographs exactly for the same reasons, OCT scans, contact tonometry before referring patients to hospital even gonioscopy, orthoptics and prescribing