In December 2025, the Department of Health confirmed the NHS GOS sight test fee in England would rise to £24.13 from April 2026. That’s a 2.5% increase — about sixty pence. The profession’s own bodies didn’t dress it up: the OFNC called it a real-terms cut, again, and they’re right. Sixty pence does not cover what’s happened to your rent, your wages, your energy bill, or the price of the equipment you test with.
Here’s the uncomfortable bit. A lot of independent practices are still built, quietly, around that fee. The diary fills with NHS-funded tests, the optometrist works flat out, the day feels busy — and the business underneath it barely moves. If that sounds familiar, this one’s worth twenty minutes of your time.
The maths nobody in the practice wants to do
Take an honest look at what an NHS sight test actually earns you. The fee is £24.13. Now subtract the optometrist’s time for a proper 20 to 30 minute exam, the pre-screening, the reception time booking and checking the patient in, the room, the kit, and the share of your fixed costs that test has to carry. By the time you’ve done that, the sight test on its own is somewhere between break-even and a small loss for most independents. It isn’t a profit centre. It never really was.
That’s not a disaster — as long as you understand what the sight test is for. It’s the front door. It’s how a patient comes into a relationship with your practice. The money was always supposed to be made in what happens next: the dispense, the clinical add-ons, the second pair, the patient who comes back for the next ten years and brings their family.
The trap is treating the sight test as the destination instead of the doorway. Fill your week with break-even tests, measure success by how full the diary looks, and you can run yourself into the ground while the bank balance flatlines. A busy practice and a profitable practice are not the same thing, and the gap between them is exactly the part the NHS doesn’t pay for.
This isn’t an argument against the NHS
Let’s be clear, because this gets misread. NHS-funded sight tests are a genuine public good. They catch glaucoma, diabetic changes and tumours in people who’d never pay out of pocket for a check. Walking away from GOS would be wrong clinically and daft commercially — it brings people through the door who become loyal, paying patients for life.
The argument is narrower and more practical: don’t let a fee that’s set in Whitehall, frozen in real terms, and entirely outside your control become the thing your whole business depends on. When most of your income is decided by someone else’s spending review, you’re not really running a business. You’re running a contract. And contracts get cut.
The independents who’ll still be standing in five years aren’t the ones who shout loudest about the fee. They’re the ones who quietly built enough private value around each patient that a 2.5% government uplift simply doesn’t decide their year.
The three places your real margin actually lives
If the test is the doorway, the margin is in the three rooms beyond it. Most independents are leaving money in all three.
1. The dispense
This is the obvious one, and still the most under-worked. The difference between a practice that dispenses well and one that just “sells glasses after the test” is enormous — and it has almost nothing to do with pressure selling. It’s about understanding the patient’s life well enough to recommend the right lenses, the right second pair, the occupational solution, the better coating that genuinely helps. A patient who leaves with one pair of single-vision lenses and a patient who leaves properly dispensed can differ by hundreds of pounds — for the same test, the same chair time, the same clinical relationship.
2. Private clinical services
Dry eye clinics. OCT-led monitoring. Myopia management for children. Contact lens fitting and aftercare. Colorimetry. Enhanced services your local NHS may or may not commission. These are services patients will pay for directly, because they solve a problem they actually feel — and because nobody else on the high street offers them with the time and continuity an independent can. This is where a single optometrist with a slit lamp and a bit of focus can build a revenue stream the multiples can’t be bothered to replicate.
3. Recall and retention
The cheapest patient you’ll ever earn is the one you already have. A patient who comes back every two years, dispenses well each time and refers their partner is worth a fortune over a decade — and costs you nothing in marketing. Yet most practices run recall like an afterthought: a postcard if you’re lucky, nothing if you’re not. Tightening your recall system so the right patients come back at the right time is the single highest-return thing most independents could do this quarter, and it barely costs a thing.
What “private revenue” really means for a small independent
When people hear “go private” they picture a glossy Mayfair boutique charging £180 for an eye exam. That’s not the point, and for most practices it isn’t the route either.
Building private revenue means something far less dramatic: making sure every NHS test you do is wrapped in genuine private value the patient is happy to pay for. It means a private enhanced eye exam option for those who want longer and more thorough. It means an OCT scan offered as standard. It means a dry eye assessment for the patient who keeps mentioning their gritty eyes. It means dispensing that matches the patient to the right product instead of defaulting to the cheapest. None of that is hard sell. It’s just doing the full job and charging fairly for the parts the NHS was never going to fund.
Run the numbers on your own practice. If you could add even £15 of private value, on average, to every funded test you already do, what would that do to your year? For most independents that’s the difference between a stressful, treading-water year and a comfortable one. And it’s sitting in patients who are already walking through your door.
The mindset shift: from volume to value
The hardest part of this isn’t operational. It’s a shift in how you think about a good day.
For years the instinct has been volume — see more patients, fill more slots, keep the diary rammed. When the fee covered your costs, that logic held. It doesn’t anymore. Forty break-even tests in a day is forty units of work that move the business almost nowhere. Twenty-five tests, each properly dispensed and clinically complete, with a few private services woven in, can be worth far more and leave your team less burned out.
That means being willing to give appointments more room, not less. It means resisting the urge to cram the diary and instead protecting time to do the dispense and the clinical conversation properly. Counter-intuitively, the practices making the most money per patient are often the ones seeing slightly fewer of them. You can’t have that conversation about a patient’s life and lenses in a slot you’ve squeezed down to fifteen minutes to fit one more NHS test in.
You can’t grow what you can’t see
Here’s where most of this falls apart in practice: the owner has a gut feeling but no numbers. They think dispensing is soft. They think recall is leaking. They suspect the NHS-to-private ratio is too heavy. But they can’t prove any of it, so nothing changes.
You can’t manage what you can’t measure. The practices that break the NHS-dependency cycle are the ones that can actually see their business — what share of revenue is NHS versus private, what each optometrist’s dispense rate looks like, how many patients are overdue recall, which services are growing and which are flat. That’s not a spreadsheet exercise you do once a year. It’s a dashboard you glance at every week, built from a system that already holds the data because it’s running your patient records and your billing in one place.
When you can see your NHS-versus-private split in black and white, the conversation changes. “We should probably do more private stuff” becomes “private is 18% of revenue and I want it at 30% by Christmas — here’s the plan.” That’s the difference between a wish and a strategy.
Where to start this quarter
You don’t fix this with a grand relaunch. You fix it with four unglamorous moves, starting now.
First, find out your real NHS-to-private revenue split. If you can’t pull that number quickly, that’s your first problem to solve — because everything else is guesswork until you can. Second, pick one private clinical service you’re equipped to offer properly and build it into your week — dry eye and OCT-led monitoring are the usual best starting points. Third, fix recall, so the patients you’ve already earned actually come back. Fourth, look hard at your dispensing: are your team matching patients to the right solution, or defaulting to the easy sale and leaving value on the table?
Four moves. None of them require a bigger premises or a marketing budget. All of them turn patients you already have into a more resilient business.
The practice that owns its own future
The independents who thrive through the next few years won’t be the ones waiting for the GOS fee to finally catch up with inflation. It won’t. They’ll be the ones who decided their practice’s income was their responsibility, not the NHS’s — and built private value, strong recall and proper dispensing around every patient who walks in.
That kind of practice doesn’t flinch when the December fee letter lands with another below-inflation number. It’s already standing on its own.
If you want to see where your practice’s real margin is hiding — and you’re tired of running blind on gut feel — that’s exactly the kind of visibility Raven Vision was built to give independent opticians. It was built inside Shaukat’s own practices for this reason. Take a look at what’s included and book a demo, or see the straightforward £149-a-month pricing. No lock-in, no setup fee — just a clearer view of the business you’ve already built.
