MAJORITY REPORT. taken to give effect to it. If the insurance practitioner advises a further medical examination of the patient’s eyes the proper course is for the latter to consult a medical practitioner with special experience of ophthalmic work, who would diagnose the de- fect and provide such treatment as might be required. This would in the great majority of cases take the form of the testing of sight and prescription of the necessary glasses. It was claimed by wit- nesses representing various bodies of opticians that this work was within the competence of a qualified optician ; and we are prepared to admit that where no doubt can exist that the defect is merely an error of refraction the task of prescribing the requisite glasses should not be beyond the skill of an optician who has undergone the course of training and passed the examination required by certain of the opticians’ organisations which gave evidence before us. 90. In this connexion, however, two difficulties arise. In the first place, in contrast with the position in medical practice and dentistry, there is not in this country any State registration of opticians and it is open to anyone to test sight and supply spec- tacles, however, unfit he may be to undertake the work. Secondly, in a proportion of cases, which may be no higher than 5 per cent., eye trouble may be due to some cause other than a mere error of refraction and may be a symptom of serious disease, and it is essentially a task for the qualified medical practitioner to differentiate between cases of this kind and cases of mere refractive error. It was admitted, even by medical witnesses who appeared before us to support the case of the opticians, that, other things being equal, it would be preferable, for the purpose of testing eyesight, to have recourse to a properly qualified eye-specialist rather than to the most highly qualified optician (Joint Council of Qualified Opticians, (). 17,660). It is true that there has hitherto been a shortage of medical practitioners specially qualified in ophthalmic work and this, no doubt, has contributed to the result that the testing of eye-sight has very largely fallen into the hands of opticians. We are informed, however, that the British Medical Association has compiled a list of approximately 600 doctors in all parts of the country who possess special ophthalmic experience and who are willing to undertake this work for insured persons at a moderate fee. It isnot within our province to consider the argu- ments for or against the prohibition of the testing of eye-sight by persons other than medical practitioners. But as to the pro- vision to be made for insured persons as part of the Health Insurance Scheme, we consider that a satisfactory solution could be found in connexion with a proposal which we make in Chapter X directed to the provision of a specialist ‘medical service as part of medical benefit. Such a specialist service would include ophthalmic specialists whose services would be at the disposal of insured persons requiring them, and the