ABDO advice on Coronavirus

ABDO Advice on COVID-19

This page summarises the latest advice during the COVID-19 outbreak. Scroll down for advice by country and FAQs for practitioners and the public.

COVID-19 – Patient care at growing risk as NHS England ignores optics

NHS England’s failure to act is forcing hundreds of optical pracices to close, with a direct and dangerous impact on the eye healthcare of patients in England during the COVID-19 crisis, the OFNC warned today.

Optical practices in other parts of the UK, as well as pharmacists and dentists, have already been offered emergency NHS funding to enable them to continue providing urgent and essential care during the COVID-19 crisis. But NHS England has given no guidance to practices in England on their role during the crisis, despite constant pressure from the OFNC.

The OFNC and its member bodies, along with others in the optical sector across the UK, have stepped in to fill the gap where we can, issuing guidance on what services practices should provide during the crisis. However, we cannot fill the void the NHS has left on the problem of funding.

Optical practices have had to stop routine sight testing in line with public health guidance. That means the vast majority of their income has vanished overnight. Like other NHS providers, they need a financial lifeline to help patients and the public – who will otherwise be forced down higher-risk pathways to A&E.

The NHS in all parts of the UK except England has recognised the vital role optical practices can play in providing urgent and essential eye care to patients during this crisis, and keeping patients away from overstretched GPs and hospitals. This is even more vital now that the Royal College of Ophthalmologists has recommended hospital eye departments reduce their clinical activity by 80-90%.

With no certainty of NHS funding during the crisis, hundreds of optical practices have already closed their doors and many more will follow in the next few days. On Wednesday OFNC wrote to Ministers and NHS England warning that “many optical practices in England are now in complete despair”. We have published the letter here.

Today OFNC Chair Paul Carroll said “Eye care patients are now at serious risk because of blockages somewhere in the NHS England system. We are now asking Ministers to intervene urgently to sort this out, so we can help the public with eye and vision problems during this national crisis.”

The Optometric Fees Negotiating Committee

The Optical Fees Negotiating Committee (OFNC) is the national negotiating body for eye care in the UK and England with the Westminster Parliament, the Department of Health and Social Care, and NHS England-NHS Improvement.   It comprises the leaders of the UK representative bodies: ABDO, AOP, FODO and BMA (for OMPs) and works in partnerships with the College of Optometrists and the General Optical Council

CCGs that commission MECS have agreed to proceed to offering remote consultations for MECS where possible within current contracts. Following all the announcements – Primary Eyecare Services have outlined that all MECS should have a telephone/video consultation in the first instance and face to face arranged where necessary.

Practices should note the triage form is in addition to the usual clinical triage forms used in various parts of the country.

ABDO can confirm that the professional indemnity we provide to our MECS accredited CLOs will cover the provision of MECS services in this way during the COVID-19 situation.  All record keeping should include information to support the decision made in how care is delivered.

Telemedicine Guidance V1.0

25 March 2020, 12.45 pm

The UK Government has now published further guidance clarifying that opticians are exempt from the general requirement for retail businesses and premises to close.

Optical practices may therefore continue to provide urgent and essential eye care to the extent that they can, including remote care, while managing COVID-19 risk to keep patients, staff and the public as safe as possible.

This is a key health service to meet urgent eye care needs during the crisis, especially for isolating elderly people and key workers, and to divert patients from GPs, A&E and hospital emergency eye departments.

Optical staff involved in offering urgent and essential eye care meet the Government definition of a key worker for the purpose of access to transport and schools. ABDO has published an ‘essential workers’ template letter for optical practices to help their staff demonstrate this to schools, and the sector is working on further resources covering transport etc. Key workers should only place children in school where absolutely necessary because they cannot safely be cared for at home.

Meaning of ‘urgent’ and ‘essential’ care

The Welsh, Scottish and Northern Ireland governments have all issued advice on the care that optical practices should continue to provide during the COVID-19 crisis. NHS England has yet to provide guidance but is expected to do so very soon.

On 23 March the College of Optometrists, OFNC and the UK optical bodies all issued statements advising optical practices to stop providing routine sight tests and care in the current circumstances. Optical practices should only remain open to provide urgent and essential care.

Our current view is that:

Urgent or emergency care would include urgent clinical advice or intervention e.g. for red eye, contact lens discomfort, foreign object, sudden change in vision, flashes and floaters which might suggest detachment etc.

Scottish Government guidance for practices in Scotland states that as is already the case, it is up to the professional judgement of an optometrist or ophthalmic medical practitioner to determine whether or not the circumstances in which a patient presents constitutes an emergency. Professional guidance already exists to help practitioners in this regard, such as the College of Optometrists Guidance for Professional Practice

Essential eye care would include appointments for patients who would not normally be considered to be emergencies, but where, in the practitioner’s professional judgement, a delay in an examination may be detrimental to a patient’s sight or wellbeing.

This definition is from the Scottish Government guidance for practices in Scotland. Optometry Scotland takes the view that a sight test is highly unlikely to meet the definition of essential care. In other parts of the UK, practices may consider a sight test as essential care if for instance a key worker needs a sight test and new spectacle prescription in order to continue to work. Other examples of essential care could include a visually impaired person or child who needs eye care where a delay in care may be detrimental.

Managing COVID-19 risk

Practices that remain open to provide urgent and essential care must have in place appropriate measures to manage COVID-19 risk. These should include:

  • Displaying the College of Optometrists or equivalent poster at the entrance of the practice
  • Using remote consultations wherever possible, closing for routine sight testing, and only admitting patients on appointment for essential and urgent eye care which cannot be provided by phone, video or email
  • Keeping up to date with and following Public Health England guidance on limiting the spread of COVID-19 in workplaces, including:
    • maintaining a distance of at least 2 metres from others where possible
    • regular hand-washing and cleaning – ABDO has published an FAQ on the cleaning of practices, equipment and spectacles to manage COVID-19 risks.

Personal Protective Equipment (PPE)

The optical sector bodies are in constant contact with government, public health and NHS authorities about PPE. The situation is fast-moving and we recommend that you check the College of Optometrists website for regular updates using the link below

The College has provided the following guidance (as of midday on 25 March) for optometrists providing urgent and essential care:

“We understand the growing concern about the potential for tears to lead to COVID-19 infection and are waiting for more information on this. In the meantime, optometrists should not put themselves at unnecessary risk and we are asking the UK governments to provide appropriate PPE for optometrists who are providing essential services. If you need to use personal protective equipment, it is important that you use the correct type and are trained in how to use it.

“Current guidance is that face masks are only needed for those who are dealing with patients with confirmed or suspected cases of COVID-19. The Royal College of Ophthalmologists advises that patients with no known risk, should be seen as normal – with the ophthalmologist using scrupulous standard infection control as for any patient (e.g. hand hygiene, clean instruments). They recommend that there is no known need for using face masks or gloves for every patient but that discretion is to be used. Ophthalmologists should use normal surgical masks for specific situations or patients, especially prolonged slit lamp exposure time or patients with watery, discharging eyes. They should balance mask use with the possibility of supplies running low if the pandemic is prolonged.

“We have guidance on how to adapt your practice to minimise prolonged close contact in our FAQ ‘Should I continue with business as normal?

If a practitioner has concerns about any procedure (especially aerosol effects) when carrying out urgent or essential care on an asymptomatic patient, they should apply their professional judgement when deciding whether to perform it. If they decide not to, they should inform the patient and note the reason in the patient record (annotating COVID-19) and where necessary rearranging care. In recent statements, the GOC has acknowledged that “registrants may be called upon to …vary their practice …. in challenging circumstances (and that) registrants should act in good conscience, for the public benefit, exercising professional judgement in all of the circumstances that apply”.

OFNC, Optometry Scotland, Optometry Wales, Optometry Northern Ireland

25 March 2020

The Optical Fees Negotiating Committee (OFNC) is the national negotiating body for eye care in the UK and England with the Westminster Parliament, the Department of Health and Social Care, and NHS England-NHS Improvement.   It comprises the leaders of the UK representative bodies: ABDO, AOP, FODO and BMA (for OMPs) and works in partnerships with the College of Optometrists and the General Optical Council

The Government has updated the list of essential workers which applies throughout the UK.

The exceptions in relation to optical practices and optical staff include the following:

Medical services (such as dental surgeries, opticians and audiology clinics, physiotherapy clinics, chiropody and podiatry clinics, and other professional vocational medical services).

Please note this is to provide essential/urgent care only.

ABDO has developed a form for employers to complete if staff require their child/children to attend school as they will be providing or supporting essential eye care in practice. 

Dear Sir/Madam,

RE: ESSENTIAL WORKERS & SCHOOL ATTENDANCE

I appreciate that the current situation relating to school closures is creating challenges that are new and difficult to manage in this unprecedented time.

There is a child/children attending your school [INSERT NAME(S)] whose parent [INSERT NAME] work for [INSERT NAME OF COMPANY].

The Company is a provider of eye health care, working as part of the NHS primary care provision to maintain the delivery of essential and urgent eyecare to the public during the COVID-19 pandemic. Essential eye health care provided in practice removes the need for patients to attend GP surgeries and hospitals for eye health care. Therefore as a result, we have a ‘duty of care’ to maintain service. Without our support, the provision of eye health care would be effected.

As the company provides care in optical practices, in the community, it is not possible for essential work tasks to be done from home.

As an essential worker, providing and supporting essential NHS eyecare services, could you please enrol the child’s/children’s attendance at school during the closure period.

Please make contact if you require further information. I have provided the link to the Government website below as well as the abstract where opticians are listed within the exceptions:

https://www.gov.uk/government/publications/further-businesses-and-premises-to-close/further-businesses-and-premises-to-close-guidance


“Exceptions:
Medical services (such as dental surgeries, opticians and audiology clinics, physiotherapy clinics, chiropody and podiatry clinics, and other professional vocational medical services)”

Yours sincerely

[Insert company name]

Copy and paste above or download template.  

Joint statement from the Optometric Fees Negotiating Committee (OFNC), Optometry Scotland, Optometry Wales and Optometry Northern Ireland

On 23 March the UK Government published a revised list of business and premises required to close. This included retail premises, with exceptions for a range of premises including pharmacies and health shops. The list does not mention optical practices.

Our understanding is that the four UK governments intend optical practices providing  NHS services to continue to provide essential and urgent eye healthcare services during the COVID-19 crisis, subject to suitable risk management measures both to meet essential health needs, especially for isolating elderly people and key workers, and to keep pressure off GPs, A&E and hospital emergency eye departments.

The OFNC in consultation with the other UK optical bodies has confirmed that optical practices in the UK providing urgent and essential eye healthcare are key health services and should continue to function where possible during the COVID-19 crisis.

This means that NHS primary care premises are exempt from general closure requirements for retail premises.

The condition is that those which are able to open have in place appropriate measures to manage COVID-19 risk. These should include remote consultations wherever possible, closing for routine sight testing and only admitting patients on appointment for essential and urgent eye care which cannot be provided by phone, video or email.

The Welsh, Scottish and Northern Ireland governments have all issued advice on this as has OFNC for England. NHS England has yet to provide guidance on this but is expected to do so very soon.

On 23 March the College of Optometrists, OFNC and the UK optical bodies all issued statements advising optical practices to stop providing routine sight tests and care in the current circumstances. Optical practices should only remain open to provide essential and urgent services.

Currently:

  • Essential eye care would for be instance where a key worker or elderly person needed a sight and new spectacle prescription, had broken their glasses, where a contact lens wearer needed more lenses, or where a visually impaired person or child needed eye care.
  • Urgent care would include urgent clinical advice or intervention e.g. for red eye, contact lens discomfort, foreign object, sudden change in vision, flashes and floaters which might suggest detachment etc.

Scottish Government guidance for practices in Scotland on these issues is:

Emergency care

As is already the case, it is up to the professional judgement of an optometrist or ophthalmic medical practitioner to determine whether or not the circumstances in which a patient presents constitutes an emergency. Professional guidance already exists to help practitioners in this regard, such as the College of Optometrists Guidance for Professional Practice

Essential care

As these measures will likely be in place for some month, essential care is to be interpreted as meaning appointments for patients who would not normally be considered to be emergencies, but where, in the practitioner’s professional judgement, a delay in an examination may be detrimental to a patient’s sight or wellbeing.

OFNC, Optometry Scotland, Optometry Wales, Optometry Northern Ireland

24 March 2020

Summary

We realise that so far there has been less clarity for the eye care sector from NHS England than in the other UK countries and that Government messaging about risk has changed significantly as the crisis has unfolded.

OFNC is therefore issuing this advice to the sector in England setting out

  • that providers should no longer be offering or providing routine sight tests even as a matter of clinical judgement as previously
  • that providers should be focusing on contingency plans to provide essential and urgent eye care to those who need throughout the crisis without putting staff at risk
  • that this does not mean all practices should remain open if this is not possible and those that can may well operate on a remote consultation/advice only basis
  • initial thoughts on the meaning of ‘essential’ and ‘urgent’ in this context which many change over time.

The national optical representative bodies (ABDO, AOP and FODO) have now issued/are issuing guidance for their members in line with this advice.

The OFNC (which is comprised of the national representative bodies) is in close touch with NHS England-NHS Improvement, DHSC, the College of Optometrists, the GOC and LOCSU, all of whom are sighted on this advice.

We hope to shortly to receive further advice from NHS England-NHS Improvement about necessary contractual and financial support to sustain essential and urgent eye care over the coming weeks and months.

National Situation

In the meantime, we are all operating in extremely difficult and rapidly changing circumstances in responding to the coronavirus (COVID-19) outbreak.

As in any crisis, our priorities must be the safety of patients who need essential or urgent eye care and eye care colleagues and the wider public, and ensuring that no unnecessary eye health burdens fall on other parts of the NHS and social care which are already stretched.

 

OFNC and the national optical bodies are in constant contact with the government and NHS England-Improvement and our advice is based on the latest evidence and advice from Public Health England, the government’s chief scientific and clinical advisers, the College of Optometrists, the Royal College of Ophthalmologists and the ABDO.

The country is now moving fully into the late Delay Phase of the pandemic and the Prime Minster has advised that a total shut down of normal social functioning may be necessary to slow the spread of the virus.

Advice

Pending further advice from NHS England, which is expected urgently including about NHS financial and contractual support, practices will be making contingency plans to deliver essential and urgent services to their patients and others who need it –by phone or as remotely as possible whenever possible and clinically appropriate to do so.

During this stage of the crisis, all routine sight-testing should be postponed to prevent the virus spreading.   In all other cases, scrupulous hygiene and disinfection regimes should be adhered to including the basics of frequent, thorough (20 second) handwashing, frequent surface disinfection and sneezing/coughing etiquette.

Not all practices will be able to remain functioning throughout the crisis owing to factors beyond their control such as staff absences through travel restrictions, staff themselves in at risk groups that have to self-isolate.

Others will be looking to how they can most safely and effectively provide essential and urgent[1] eye care services.

This may involve

  • remote working
  • consolidation of sites – whilst maintaining capacity to sustain social distancing, e.g. staggering appointments to minimize number of people in the practice at any one time
  • rostering staff to minimise essential travel, footfall and social contact at work
  • networking IP optometrists
  • postponing non-essential sights tests (note key workers and other groups might be in particular may need of essential eye care, especially in the event of a prolonged lock-down period)
  • dealing with most eye care issues via telephone or video calling
  • implementing social distancing between staff and patients as much as possible
  • implementing social distancing between staff at all times (e.g. including commuting, lunch breaks etc)
  • thinking about how to advise other healthcare workers who may be able to access high risk patients who have eye issues in locked-down locations such as care homes
  • regularly checking the College of Optometrists website for changing clinical advice and Q&A. You can access the College of Optometrists website here https://www.college-optometrists.org/the-college/media-hub/news-listing/coronavirus-2019-advice-for-optometrists.html
  • using the flexibilities about posting spectacles and contact lenses and making safety, judgements about using recently expired prescription and contact lens specifications on the balance of risk to ensure people can continue to use spectacles and contact lenses whist avoiding all unnecessary travel
  • knowing local contingency arrangements for seeking ophthalmology advice and how and where to refer patients who do need urgent ophthalmological care (e.g. retinal detachment, wet AMD, closed angle glaucoma)
  • ensuing staff recognise that their own health and safety is the top priority (otherwise we will not be able to help patients and the public in need)
  • ensuring staff know that, if they have any doubts about safety (e.g. potentially aerosol effects of non-contact tonometry) or any other procedure, they should not perform it but should inform the patient and note the record with reason (annotating COVID-19). You can access GOC professional regulatory guidance about professional practice during the crisis here https://www.optical.org/en/news_publications/Publications/joint-statement-and-guidance-on-coronavirus-covid19.cfm
  • supporting staff mental health and wellbeing during the crisis as they may well have serious worries about loved ones, supplies and finances outside work
  • understanding that a practice which has closed its doors to walk-ins but which is answering enquires from patients and the public (even by a skeleton staff working from their own homes) is still providing essential and urgent eye care services.

Personal Protective Equipment (PPE)

At present PPE is not advised for eye health practitioners working in primary care settings who should only be seeing asymptomatic or COVID-19 negative patients and then rarely face-to-face.

Nevertheless, we are in close touch with government, public health bodies, supply chains and he College of Optometrists about this.  PPE is currently being prioritized for the highest risk specialties, including ENT.  It is unlikely therefore that PPE for optical practice will be prioritized in the short-medium term, despite requests.

However, if official guidance on the use of PPE in primary eye care settings changes, new guidance will be issued and PPE resources distributed to ensure effective coverage across the health service.

If evidence and official guidance on the use of PPE in primary eye care settings change, we will issue further advice.  We will also inform you if supply pressure ease or priorities change.

Practices and practitioners should take these factors into account in implementing this guidance.  In particular, staff should not perform procedures where they could be at risk and should note patient records accordingly (annotated COVID-19).

Duration

Depending on the effectiveness of public health measures, of which this advice is part, the coronavirus/COVID-19 crisis could continue for a matter of months rather than weeks.  Our job as health professionals is to ensure that as far as possible people continue to have access to high quality essential and urgent eye care and advice especially the isolated elderly, keyworkers and children whilst, at the same time keeping, ourselves safe using remote advice and consultation wherever possible.

This advice is intended to help practices and practitioners do that.

If the crisis worsens, this may involve working as part of local NHS planning networks or community essential services hubs and may include colleagues volunteering for shifts to fulfil these roles.

OFNC is grateful to all the dedicated care worker in the eye health sector who are keeping the population well and supported through this crisis.

[1] Essential eye care would for be instance where a key worker or elderly person needed a sight and new spectacle prescription, had broken their glasses, where a contact lens wearer needed more lenses, or where a visually impaired person or child needed eye care,  Urgent care would include urgent clinical advice or intervention e.g. for red eye,  contact lens discomfort, foreign object, sudden change in vision, flashes and floaters which might suggest detachment etc.

ABDO statement for Members – 23rd March 2020 re COVID-19 Situation:

We very much sympathise with the worry amongst members, and the profession overall at this time, especially regarding all the factors which are currently unknown. We understand the unrest in relation to the time it is taking NHS England (NHSE)to provide direction on the specifics to deliver eye health care during this situation. The safety of our members, their staff, their families, patients and the general public are our priority and we have been working hard behind the scenes in representing our members’ interests as well as raising your concerns direct with Government officials throughout the UK, to do what is best for everyone.  Unfortunately we did not receive an update from NHSE today.  Therefore we have provided you with this update to inform you of what is being discussed, some yet to be agreed.

Further to our OFNC update on 20th March where we explained the discussions being had with regard to easements in contracts and regulation during COVID-19, NHSE has now asked the OFNC to develop a service specification for services which primary care optical practices could put in place as quickly as possible, to meet essential and urgent eye care needs during the COVID-19 crisis. LOCSU is pulling this together on behalf of the profession with input from ABDO, AOP and FODO. We hope to release a statement with more detail on this through the OFNC in the next 24 hours.

Following the College of Optometrists’ statement today on the recommendation to provide only essential eyecare, ABDO suggest that practices now utilise the contact lens and spectacles telephone dispensing forms to provide contact lenses and spectacles, still to be processed/collected, and to do so using the postal pathway endorsed by the GOC.

Key worker status with regards to optical staff has not yet officially been confirmed by any Government.  The OFNC put the case forward to have optometrists, contact lens opticians, dispensing opticians and optical assistants recognised as key workers for practices that will be able to remain open to provide essential and urgent eyecare. We have yet to have this confirmed although it is expected that we will have this granted considering the expectations on the delivery of essential and urgent care and we have drafted a letter to be used by practices when/if the position is clarified that optical staff are key workers.

With regards to PPE, we put the case forward to Government representatives for optical practices to be issued with this resource two weeks ago but we have been informed that there has been supply issues in the hospitals (who are the priority) receiving this and they are not expecting to be able to provide these resources to optical practices throughout the UK in the short term.

We understand this update does not answer all of the questions members have in the current situation but we hope it assures you that ABDO is working in your best interest to support all of you in maintaining the delivery of essential and urgent eyecare, those of you that have had to close or will need to close during this unprecedented time.

Clive Marchant

President

23 March 2020: Recommendation to only offer ‘essential’ eye care

We have listened to our members’ concerns, and the public health advice coming from the UK’s governments to avoid social contact where possible. As a result The College recommends that every optometrist and practice owner stops providing routine sight tests and routine eye examinations, and offers only essential services. Essential services would include sight tests based on a clinical need, and urgent eye care pathways. We note that some practices are doing this on a voluntary basis already.

There are several reasons for this:

  1. Practices now need to contribute to the public health endeavour of ensuring that people only go out when necessary. Routine sight tests can be safely delayed.
  2. It is essential we help to keep the nation‘s sight healthy – from NHS frontline staff to those in self-isolation. Our communities still need essential eye care, and secondary care may need our support to see urgent cases. We therefore need to ensure our members and all optical staff are able to protect themselves and maintain the safety of their communities.
  3. We understand the growing concern about the potential for tears to lead to COVID-19 infection and are waiting for more certain evidence on this.  In the meantime optometrists should not put themselves at unnecessary risk, and we are asking UK governments to provide appropriate PPE for optometrists who are providing essential services.

We note that the Welsh and Scottish governments have already issued advice on essential primary eye services and stopping routine sight tests. We are pressing NHS England and the HSCNI to do the same, and to provide financial support to enable practices to continue to be viable eye care centres.

I feel unsafe seeing patients without appropriate personal protective equipment (PPE)

We are calling on UK governments to provide access to PPE and training on how to use it for optometrists wishing to provide essential eye care.

I am a pre-reg trainee – how will this affect me?

Although assessments have stopped, we know that we have previously advised that trainees can continue to see patients. With only essential services being provided, trainees can help with telephone triage to decide whether a patient should be seen. We are currently liaising with the GOC on changes that we can make to the Scheme for Registration requirements so that trainees are not unfairly held back in their progress.

What is essential?

Examples of essential optometric practice would include providing replacement spectacles for a key worker who has broken theirs, or seeing patients with acute eye- or sight-related symptoms. It would not include seeing patients who are attending practice for their routine sight test without eye- or sight-related symptoms.

We recommend that – before making any appointment – you operate a telephone triage service to determine whether or not a patient falls into the ‘essential’ category, and explain to other patients why you are postponing their appointment.

This will affect my business – how will I cope?

We understand that this is a difficult decision for practice owners to make, but we feel this is the right decision for optometrists, their staff and the wider public in helping slow the spread of the pandemic and ensuring that we are able to help with the backlog of patients that will ensue as a result. We are pressing NHS England and NHSCI to provide financial support to enable practices to continue to be viable eye care centres.

The GOC statement can be found here.

Dear Member

We are writing to update you on action that we have taken in response to COVID-19 at the highest-level to protect domiciliary patients, staff and providers in all four UK countries.

As we all know, domiciliary practice is similar to fixed-premises practice in that normal clinical, infection control and staff and patient health protection advice applies.  You should have been receiving this advice through the NHS and the optical professional and representative organisations in all four countries.

In many ways however domiciliary practice is very different in the complexity, vulnerabilities, disabilities and co-morbidities of the cohorts of patients we care for and the fact that a lot of this care is provided to patients in care homes.  We also depend on a highly skilled eye health professionals and clinical support staff who have additional training and knowledge in supporting this vulnerable population.

The cost of our skilled workforce however means that if a care home decides to isolate patients on precautionary grounds, which many have been doing, no patients in that location can receive care and the vital services we provide cannot function.  Given the low margins in the sector, we are acutely aware that the current restrictions could easily result in domiciliary practices closing which would be in neither patients nor the NHS’s best interests.

GOS/NHS services

To mitigate against this unacceptable outcome, we have been supporting the national bodies (OFNC, OW, OS and ONI) and partners (College of Optometrists, GOC and LOCSU in England) who have been working urgently with governments, health departments and the various NHS systems, to ensure that GOS and other NHS funding continues to flow to practices during the crisis.  Domiciliary provision because of its particular and immediate vulnerabilities has been at the top of the agenda in all four countries.

So far Welsh Government has announced a package of measures, including continuing funding, to keep eye care services operating throughout the crisis whether or not normal service provision is possible

Letter to Primary Care Optometry Teams[1]

Temporary Primary Care Contract Changes[2]

Frequently Asked Questions Covid-19[3]

 

This is very welcome.

Negotiations are also underway in England, Scotland and Northern Ireland and further announcements are hoped for in the near future.

We are also exploring how business rates and other easements may be extended to head offices and other non-retail locations of mobile businesses which do not yet benefit from the business rates relief measures announced by the government in response to COVID-19.

Potential Redeployment 

We are also discussing with the four governments and NHS systems how our highly trained domiciliary professional staff might be able to respond to urgent cases in care homes, which may otherwise have restricted access, and how they and our facilities may potentially be redeployed during the next stages of the crisis. For example, we are also exploring how providers might be able to support care homes based on current government advice[4].

Professional Regulation 

Meanwhile the General Optical Council (GOC), together with the other health and social care regulators, has made clear that we are now all working in highly challenging circumstances in which professionals may need to depart from established procedures.  Where a concern is raised about a registered professional, those circumstances informed by any national guidance will be taken into account. Learn more.[5]

The GOC is also due to issue further guidance shortly about using professional judgement to make eye care as safe as possible.

Q&A

We will also support the College and ABDO who are developing Q&A guidance on clinical matters while the optical bodies are dealing with NHS contractual and business queries.

Further Information

We will continue to keep you posted on development across the four countries.  If you have any general queries, please contact Peter Fogarty DEC secretary peter.fogarty@fodo.com or Gary Robjent at gary.robjent@fodo.com

Please also let us know personally if we can help you or your staff in any way to keep this crucial NHS service operating for the most vulnerable individuals in society during this very difficult time.

 

Dawn Roberts   

Co-Chair

Dawn.Roberts@specsavers.com

Gordon Ilett

Co-Chair

gordonilett@gmail.com

 

 

[1]https://fodo.com/downloads/1_FINAL%20COA%20Letter%20to%20Primary%20Care%20Optometry%20Teams%20in%20Wales.pdf

[2] https://fodo.com/downloads/2_2020%20-03-17%20-%20Temporary%20Primary%20Care%20Contract%20Changes.pdf

[3] https://fodo.com/downloads/3_Frequently%20Asked%20Questions%20Covid-19.pdf

[4] https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance/covid-19-guidance-on-residential-care-provision

[5] https://www.optical.org/en/news_publications/Publications/joint-statement-and-guidance-on-coronavirus-covid19.cfm

The Optometric Fees Negotiating Committee (OFNC) and its members (ABDO, AOP, BMA and FODO) are working closely with NHS England on supporting GOS contractors in England through the coronavirus crisis. NHS England has confirmed that eye care is an essential part of the NHS and primary care service, both of itself and in keeping pressure off other NHS services such as GPs and A&E. NHS England’s aim is to keep essential eye care operating as far as possible to ensure essential and urgent eye health needs are met whist protecting patients, staff and the public.

Issues that the OFNC and NHS England are urgently working on with the aim of supporting optical practices in England, include:

  • The financial implications for practices of a downturn in GOS fee income because of the crisis
  • More flexibility around GOS contractual requirements, to help practices and domiciliary providers give patients the care they need as quickly and safely as possible, and to support practices who may not have the staff available to provide services, due to illness or self-isolation
  • Guidance to help patients, optical practices and other parts of the NHS understand the GOS services that optical practices in England will continue to provide during the crisis and to direct patients to them
  • How the whole sector can work together to mobilise new services in optical practices as quickly as possible, to meet essential and urgent eye care needs during the crisis and reduce demand on GP and hospital services.

OFNC and its member bodies are working very closely with LOCSU, which is co-ordinating the sector-wide work on new services, and with the General Optical Council, College of Optometrists, Optometry Wales, Optometry Scotland and Optometry Northern Ireland and government to streamline communications and provide evidence-based advice to the front-line throughout this crisis.

We and the NHS in all countries thank you for your support to the population at this difficult time.  We will share more information about these measures as soon as we can.

OFNC

Read the joint statement here.

Today, the GOC has published a new statement on the supply of spectacles and contact lenses, which allows registrants to use their professional judgement to decide whether it is necessary for a patient to attend for a sight test or contact lens fitting/check in order to supply spectacles and contact lenses. This follows the publication of a statement for education providers yesterday on the ability to adapt education delivery approaches during this time.

The GOC has also signed a joint regulatory statement on remote consultation and prescribing which is particularly relevant during this period of social distancing.

Further statements to support optometrists, dispensing opticians, optical students, optical businesses, the education sector and other stakeholders will be published over the coming days and weeks.

Consultation forms to download:

Spectacle lens telephone review form

Contact lens telephone review form

The General Optical Council (GOC) understands that many of its registrants and stakeholders will have questions about the impact of COVID-19 and wants to ensure that everyone in the optical professions is aware of the steps the GOC has taken in light of the emergency.

Support for registrants

The GOC has established a dedicated COVID-19 page on its public website where it is directing registrants to the latest Government guidance.

Along with all other healthcare regulators, the GOC has signed a joint regulatory statement which acknowledges that registrants will need to act differently and deliver care in different ways during the COVID-19 emergency in line with Government and public health guidance.

The GOC will take account of this in fulfilling its regulatory functions and will also be publishing a series of optical sector specific statements to reassure registrants that when they act in good conscience and exercise professional judgement for the public benefit, the GOC will support them.

GOC office

In line with Government advice, GOC staff are now working remotely instead of in the office, which is now closed to visitors. The GOC will no longer take telephone calls and all enquiries should be made by email. You can visit the Contact Us page on the GOC website for a full list of email addresses within the organisation.

Homeworkers will not always have secure environments in order to have potentially sensitive and confidential telephone calls or take personal information and so this approach ensures that people’s personal data is protected. In some instances, where it is essential and where a confidential environment can be guaranteed, the GOC may make calls.

The GOC urges those wishing to communicate with them to send communications electronically in order to minimise post and ensure it is dealt with as effectively and quickly as possible. This includes supplier invoices, which the GOC will endeavour to pay as quickly as possible.

GOC Fitness to practise (FTP) hearings

To ensure the safety and wellbeing of everyone concerned, the GOC will no longer be conducting office-based hearings. The GOC is exploring options to support remote hearings and will issue a statement on this shortly.

A message from GOC Chief Executive and Registrar, Lesley Longstone

“In these extraordinary times, we are fortunate that in all four countries of the United Kingdom we have a group of exceptionally well qualified eye care professionals on whom the general public and fellow healthcare professionals can rely. Uncertain times mean that our registrants may be called upon to work at the limits of their scope of practice and vary their practice for protracted periods of time and in challenging circumstances.

With our COVID-19 statements we hope to reassure practitioners, academics and students that when they act in good conscience, for the public benefit, exercising professional judgement in all of the circumstances that apply, the GOC will support them.

We will also continue to closely monitor and follow Government guidance and act accordingly. We want to thank everyone for their cooperation.”

To read the latest statements and guidance, visit the dedicated COVID-19 page on the GOC website.

Read on for advice for each nation, and FAQs below

23rd March OFNC Advice to all Optical Practices and Practitioners in England

OFNC has issued advice to the sector in England setting out

  • that providers should no longer be offering or providing routine sight tests even as a matter of clinical judgement as previously
  • that providers should be focusing on contingency plans to provide essential and urgent eye care to those who need throughout the crisis without putting staff at risk
  • that this does not mean all practices should remain open if this is not possible and those that can may well operate on a remote consultation/advice only basis
  • initial thoughts on the meaning of ‘essential’ and ‘urgent’ in this context which many change over time.

OFNC statement 20-03-23

 

Coronavirus – your questions answered

For answers to some of the most frequently asked questions, watch this short video. Please share this through your channels.

Taking action against fake news

The NHS has unveiled a package of measures in the battle against coronavirus fake news – working with Google, Twitter, Instagram and Facebook – to help the public get easy access to accurate NHS information and avoid myths and misinformation.

The measures include search engine Google pointing people first to verified NHS guidance when someone types in ‘coronavirus treatments’ or ‘coronavirus symptoms’. The NHS is also working with Twitter, Instagram and Facebook to verify or ‘blue tick’ over 800 accounts belonging to NHS organisations including hospital trusts and local commissioning groups.

Information for those working in the NHS

Guidance for health professionals

We are keeping the NHS up to date with regular webinars, guidance and bulletins. Our coronavirus website is the go-to-place for the latest guidance for the NHS: england.nhs.uk/coronavirus/

Primary care

Dr Nikki Kanani, NHS England and NHS Improvement’s Medical Director for Primary Care is regularly writing to colleagues in general practice to provide the latest information. You can find her updates in the primary care section of our coronavirus website: england.nhs.uk/coronavirus/primary-care

Secondary care

Guidance for those working in secondary care is on our website: england.nhs.uk/coronavirus/secondary-care

This has recently been updated with guidance for hospital chief pharmacists on managing medicines supply.

 

Updated 03/03/2020

NHS England and NHS Improvement have issued standard operating procedures (SOP) in relation to coronavirus.  The information can be accessed using the following link.

The SOP is to support the interim guidance published by Public Health England on 25th February.  This guidance can be accessed here.

The World Health Organisation (WHO) has uploaded a course online which takes approximately 1 hour to complete.

The content within the course includes:

Module 1: Preparedness, readiness and IPC:

  • Provides an overview of Infection Prevention and Control measures for preparedness and readiness.

Module 2: The novel coronavirus (COVID-19): its epidemiology, risk factors, definitions and symptomology:

  • Provides an introduction to the novel coronavirus (COVID-19).

Module 3: Standard precautions, transmission-based precautions & COVID-19 specific recommendations:

  • Reviews various precautions which should be taken to prepare for and respond to COVID-19.

Posters and patient information leaflets can be accessed from the Public Health England resource site.

We hope this information is helpful and will advise members of any updates as we receive them.

 

The World Health Organisation has declared the Coronavirus a public health emergency.

UK Government advice can be found here.

Health Secretary Matt Hancock announced yesterday that regulation (Health Protection Coronavirus Regulations 2020) has been put in place to impose restrictions on individuals considered by health professionals to be at risk of spreading the virus. These regulations provide NHS staff, dealing with possible cases of the virus, the power to keep individuals in isolation where they are a threat to public health.

A public information campaign has been launched by the Department of Health on how individuals can protect themselves from infection.  The advice is to:

  • always carry tissues and use them to catch coughs and sneezes, and bin the tissue
  • wash hands with soap and water, or use sanitiser gel, to kill germs

Our advice is to make all staff aware of the information above and keep themselves aware of the updates using the link provided.  Staff should also share the information with any patients they have contact with, who they think may be affected or at risk due to recent travel etc. and advise them to eek advice online.

25th March PCA from Optometry Scotland

Here you can see the latest PCA which covers provision of emergency or essential eye care during ‘lockdown’; clarification of financial support measures announced in PCA(O)2020(4); emergency dispensing…

20th March letter from Scottish Government

General Ophthalmic Services (GOS) – COVID-19: Suspension of all routine community eye care services, and the move to providing only emergency and essential eye care; Financial measures to support community optometry practices; and other important COVID-19 updates can be found here.

Information and resources regarding novel coronavirus (COVID-19)for all community optometry practices and practice staff in Scotland can be found here.

25rd March update from ONI on financial support to ophthalmic contractors
23rd March update from ONI
COVID-19: Advice for Ophthalmic Contractors

As of 24 March 2020 the following situation applies:

  • All routine General Ophthalmic Services should be suspended with immediate effect from 24 March 20
  • Only essential and urgent eyecare services should be provided
  • All domiciliary eyecare services should be suspended
20th March update from ONI
Just to keep you informed. We met with the Department of Health this afternoon to discuss emergency funding to keep our doors open, and what services we could deliver during this period.
The Department is ready to make a recommendation to the Minister for some form of payment, but we do not know exactly what this entails.  We have pushed hard for at least the Welsh Agreement, where practices will continue to receive their average GOS payment each month despite any reduced level of activity.  But nothing is agreed yet.
In agreement with Ophthalmology, we have put forward a package of services that we feel we can deliver from practice during this time to take patients out of hospital care.
It is likely that as we move towards the peak of the virus that standard routine eye tests will be stood down.  If this happens, we will be focused purely on PEARS and enhanced services.  This is important for both patient safety and crisis management within the hospitals.  We need to stand by our colleagues in secondary care and deliver the bulk of eye care ourselves.
I know we have all been asking questions about PPE and ONI made a statement tonight via BBC Newsline on this subject.  Once funding has been agreed we can move into the detail of delivery and the supply of PPE will form a part of this.
This has been a difficult negotiation of unprecedented importance.  We know how stressful this is for everyone, but it will be next week before we hear from the Department.  We will let you know as soon as we hear.
In the meantime, stay safe.  Keep working on cost reduction.  Return your Covid-19 contingency plan.  Keep reading the advice pages from the College, AOP, ABDO, and BSO.
Best wishes
William Stockdale
17th March Update from Optometry NI
The current situation is unprecedented. When could any of us have imagined where we are today and the cold reality of the coming months? We are stunned by what is happening to our own profession and to everyone around us. So where are we now?
ONI have been working quite literally around the clock to find some solution for the profession in N. Ireland. We have been liaising with Optometry Scotland, Optometry Wales, the OFNC, FODO, AOP, ABDO and the HSCB and I would like to thank them all for their input and help over the weekend. It is amazing and a testament to the dedication of everyone involved when you send an email at 2 O’clock in the morning and get a reply within 5 minutes. But where has it got us? Well not to the endpoint yet but we are hopefully getting close. Please bear with us over the next few days, everyone is working to find a solution. The team at ONI know exactly what is at stake. We know exactly how concerned you are, and we know you need an answer.
We currently have a submission with the Department of Health and the Health and Social Care Board. I have been assured they are examining it and we are hoping to have a response in the next few days.
Across the province we have all been working hard and have advanced primary eye care beyond recognition. COVID-19 cannot be allowed to undo this. Northern Ireland needs our network of practices and dedicated professionals to deliver first class eye care over the years to come.
I will come back to you as soon as I have more information. Over the last few days, we have received a number of questions which I will try to answer in a separate update. In the meantime, please keep in touch. We are here to help.
Best wishes
William Stockdale

 

Information and resources regarding novel coronavirus (COVID-19) for optical practices and practice staff in Northern Ireland can be found here.

Letter from David O’Sulliva, Chief Optometric Adviser – 27 March

and resources regarding novel coronavirus (COVID-19) for optical practices and practice staff in Wales can be found here.

The Welsh Government, Public Health Wales and the Health Boards are updating pandemic flu plans and more details will emerge in the coming days and weeks to support you in working through COVID-19 at a local level. A letter has been sent to focus on what that means in practical terms for optometry teams and practices in Wales.
It is our professional, personal and moral obligation to take care of our communities, ourselves, families and colleagues at this time. We all need to stay vigilant in this evolving situation. Please ensure you keep up to date with advice and publications from the Welsh Government, Public Health Wales and the Health Boards.

It is becoming clear, providing routine optometric services ‘as normal’ is no longer sustainable as people in vulnerable groups (older people and those with underlying health conditions) need to reduce their inter person and close personal contact. In addition, aerosol generating procedures, such as removal of a foreign body with an Alger brush, should be avoided in this delay phase due to the increased risk of virus transmission.

Read the rest of the letter here: Letter to Primary Care Optometry Teams in Wales

Frequently asked questions – COVID-19

The Association of British Dispensing Opticians (ABDO) has provided this advice and guidance for members on situations they may encounter during the COVID-19 pandemic. These FAQs were written on 17 March (am) and will be updated where necessary as the situation evolves. 

We are encouraging business as usual in line with delivering necessary eye care but members, staff and patient safety are our main priority therefore yes, practices should advise patients that if they are at all unwell to not attend for their optical appointment and reschedule to another date. Practices could choose to contact patients the day before the appointment to check health and advise that they are providing a safe place for continued eye care and taking precautions by asking all patients who feel at all unwell to not attend. This will provide reassurance to those who can still attend.

The Government’s advice is, if you have travelled to the UK from the following places in the last 14 days:

  • Iran
  • Hubei Province in China
  • Special Care Zones in South Korea (Daegu, Cheongdo, Gyeongsan)

Or

If you have returned from Italy since 9th March 2020, to protect yourself and others you should go home and contact 111.

Patients should also be advised to stay at home for 7 days (if they live alone) 14 days (if they live with others and they should self-isolate too) if they have either:

  • a high temperature
  • a new continuous cough

If showing these symptoms, patients should also be advised to not go to a GP surgery, pharmacy or hospital and not to contact NHS 111 to tell them you’re staying at home. If their symptoms worsen and they feel they need medical attention they should then phone NHS 111.

The advice to practices is to ask any patient that feels unwell, in any way, to not present to the practice at all. The Government advice provided to the public is to self-isolate if they are showing symptoms that could be COVID-19 therefore patients attending optical practices for eye care should not be a risk. Practices should not deliver care to patients who have COVID-19 as they are not in supply of PPE. OFNC advises that cleaning of practices is carried out more regularly at this time and it is not unreasonable to ask patients who attend to wash their hands on entering or use hand sanitiser. The usual formal sanitising procedures should be adhered to as stated in the ABDO advice and guidelines on our website:

Principles of Cleaning, Sterilisation & Disinfection

4.4.1 There are numerous pieces of equipment that regularly come into contact with patients e.g. trial frames, chin rests, refractor heads, hand held occluders and rulers, as well as ophthalmic devices which come into direct contact with ocular tissues e.g. tonometer heads, gonioscope and other contact lenses. It is essential that they are all appropriately decontaminated, for example by wiping headrests and/or chin rests with a disinfectant wipe, to reduce the risk of transmission of infection.

There are three levels of decontamination:

Cleaning – The removal of organic and inorganic debris from a surface which might support micro-organisms and provide insulation that reduces the efficiency of disinfecting or sterilisation procedures. Detergents and ultrasonic cleaners are frequently used for cleaning purposes.

Disinfection  A treatment that reduces the number of viable micro-organisms but not necessarily bacterial spores or some viruses. Disinfection can be achieved by physical methods such as heat or by the use of chemical disinfecting agents. Chemical disinfection can be an uncertain procedure as it involves an integration between the chemical used, the micro-organism and exposure time.

Sterilisation – A treatment, which completely kills or removes all kind of micro-organisms including spores. Sterilisation can be achieved by ionising radiation, by gaseous ethylene oxide, by gaseous hydrogen peroxide, by low pressure steam and formaldehyde, by filtration, by dry heat (hot air oven) or by moist heat (autoclave).

4.4.2 To be effective all items must be physically clean before being exposed to any sterilisation or disinfection process.

4.4.3 Not all equipment, however, needs to be sterile before use and the following is a general guideline:

Sterile – Equipment introduced into a sterile body area or in contact with a break in the skin or mucous membrane.

Disinfected – Equipment in close contact with body surfaces or intact mucous membranes, such as the ocular surface e.g. tonometer heads, gonioscope and other contact lenses.

Clean – Equipment not coming into close contact with mucous membranes or sterile body areas e.g. trial frames, refractor heads.

4.4.4 Surfaces in the consulting room should be cleaned after every patient with detergent and water unless contaminated with body fluids. If contaminated with body fluids a chlorine-based disinfectant should be used. All consulting rooms should have access to a wash hand basin and it is good practice for this to be within the consulting room

This is a personal decision. Member, staff and patient safety is our priority. We would advise members to follow the Government’s advice and inform the necessary NHS primary care teams and commissioners, if you deliver enhanced services, as well as LOCSU, of your temporary closure. If ABDO can provide any further support during this time please contact our membership department. Our policy lead is working with the Optical Confederation partners to try and agree a financial support package from the NHS for optical practices who will be forced to close during this time.

Covid-19 support for business.

 

 

The advice up until 17 (am) March from the Royal College of Obstetricians and Gynaecologists (RCOG) was, if you are pregnant you are more vulnerable to getting infections than a woman who is not pregnant. You should wash your hands regularly, going to and from home, from and to work etc. Due to this advice and the latest Government advice on social distancing, we would recommend pregnant members take precautions as those with underling health problems, have been advised to do and monitor the updates provided on the RCOG.

 

Patients booking in by telephone or online who meet the case definition should be directed to NHS 111.

An unwell patient with a relevant travel history should be identified when they book in at reception and immediately placed in a room away from other patients and staff. If COVID-19 is considered possible when a consultation is already in progress, withdraw from the room, close the door and wash your hands thoroughly with soap and water.

Avoid physical examination of a suspected case. The patient should remain in the room with the door closed. Belongings and waste should remain in the room. The patient and any accompanying family should remain in the room with the door closed.

Advise others not to enter the room. If a clinical history still needs to be obtained or completed, do this by telephone.

If entry to the room or contact with the patient is unavoidable in an emergency, wear personal protective equipment (PPE) in line with standard infection control precautions, such as gloves, apron and fluid resistant surgical mask (FRSM) and keep exposure to a minimum. All PPE in full should be disposed of as clinical waste.

Should the patient need to use the toilet, they should be allocated a WC for their sole use. Instruct the patient to wash their hands thoroughly after toileting, and return directly to the room they have been isolated in and close the door. The toilet should be taken out of use until cleaned and disinfected following the decontamination guidance.

Ask the patient to call NHS 111 from their room, on their mobile.

Once a possible case has been transferred from the primary care premises, the room where the patient was placed should not be used, the room door should remain shut, with windows opened and the air conditioning switched off, until it has been cleaned with detergent and disinfectant, as should all of the practice. Once this process has been completed in line with the procedures within

the practice can be put back in use immediately.

 

 

This is personal choice for practice owners to make. If you are healthy, the World Health Organisation states you only need to wear a mask if you are taking care of a person with suspected COVID-19. Therefore, since our advice is that patients who are unwell be advised to not attend for appointments, we do not see the need to wear facemasks in practice. For further advice on wearing facemasks you can visit here.

The OFNC will circulate advice on sourcing personal protection equipment (PPE), as we receive it. The present situation is that the NHS is prioritising staff in secondary care who are managing patients who have been diagnosed with COVID-19 with this as one would expect.

The GOC has relaxed the regulations on these points during the COVID-19 situation, to enable practitioners to use their clinical judgement to be able to post spectacles and contact lenses to patients unable to attend practices due to self-isolation. ABDO, AOP, CoO, and FODO have designed a telephone review form (for both CLs and Spectacles) to assist with providing services this way.

The Royal College of Ophthalmologists and College of Optometrists have confirmed that the information in relation to the AAO advice should be disregarded.  Please refer to the advice issued.

ABDO, AOP, CoO, FODO, and LOCSU are in discussions with NHSE regarding the provision of eye care services and the support available to maintain these services, as well as support that may be made available if practices were forced to close during the COVID-19 situation.  We will keep you updated as much as we can.

The Government has provided advice for the self-employed.

COVID-19: guidance for employees, employers and businesses

Updated advice as of 13 March – From the NHS

Here is the latest information on novel coronavirus (COVID-19) for you to use with patients, the public and NHS staff.

The Government has announced that we are moving out of the contain phase and into delay, in response to the ongoing coronavirus (COVID-19) outbreak.

The most important thing individuals can do to protect themselves remains washing their hands more often, for at least 20 seconds, with soap and water. Make sure you cough or sneeze into a tissue, put it in a bin and wash your hands.

Anyone who shows certain symptoms is asked to self-isolate for 7 days, regardless of whether they have travelled to affected areas. This means people should stay at home and avoid all but essential contact with others for 7 days from the point of displaying mild symptoms, to slow the spread of infection.

The symptoms are:

· a high temperature (37.8 degrees and above)

· a new, continuous cough

You do not need to call NHS 111 to go into self-isolation. If your symptoms worsen during home isolation or are no better after 7 days contact NHS 111 online.

For the latest advice, go to NHS.UK/Coronavirus – this includes guidance on self-isolation.