Everyday optometric practice is “doing what’s clinically indicated consistently every time, and then being able to justify your decisions to patients and colleagues”, says Alan Hawrami MCOptom, specialist optometrist and Director of two practices, Osborne Harle and Kent Eye Care. 

However, for optometrists, eye care can mean balancing clinical excellence against commercial pressures. They are often expected to contribute to the commercial performance of their practice, which can create uncertainty and anxiety, particularly for pre-registration optometrists and early-career clinicians. There can also be questions around what to do when an optometrist’s priorities as a clinician conflict with the priorities of the business, such as asking patients to come back for tests, doing further investigations like dilation, and time to make a referral compared to maximising sales, taking walk-in patients and overbooking the clinic.

Alan says a common example of a commercial pressure in optometric practice is where a walk-in patient says they want to buy glasses that day, but their eye test is overdue.

“You can’t compromise what’s clinically indicated by justifying commercial pressures,” he says. “My rule is if what you’re going to do changes management or reduces clinical risk it’s not optional, it has to be done.”  

A 2025 General Optical Council (GOC) survey of registrants highlighted the commercial pressures optometrists face (GOC, 2025). Thirty-eight per cent of respondents said they “felt under pressure to see a high number of patients every day, which has impacted on [their] ability to provide safe patient care”, and 30% “felt under pressure to meet commercial targets at the expense of patient care”.

The GOC is carrying out a thematic review on commercial practices and patient safety, with its findings due to be published in the summer of 2026 (GOC, 2026a).