Advice on Covid-19 for England

Children's vision screening

You can read the Clinical Council for Eye Health Commissioning (CCEHC) recommendations for the vision screening backlog here

Update – impact of new lockdown on practices in England

Issued 8 January 2021

Following the introduction of a new national lockdown in England this week, the OFNC has continued its discussions with NHS England on potential additional support for optical practices affected by the new restrictions.

Under the new rules optical practices are able to remain open, prioritising essential and urgent care and also offering routine care where capacity allows. However, it is already clear that the new restrictions are having an impact on people accessing eye care, and will cause continued difficulties for domiciliary providers in accessing care homes until the vaccination programme makes progress.

The OFNC and NHS England have agreed to work together to monitor activity levels, and will continue to meet frequently to assess any changes to the current situation and discuss the parameters under which NHS England may consider further intervention to support providers. We will provide further information on this as soon as we can.

GOS contractors are invited to contact their OFNC representative body in confidence with information about the viability of services as a result of the new restrictions. The OFNC will draw on this information (in anonymised form) in its work with NHS England. ABDO members should contact policy@abdo.org.uk

Meanwhile the OFNC’s member bodies are working with others in the sector and with NHS England to ensure that all patient-facing staff in optical practices and domiciliary providers can access COVID-19 vaccinations as soon as possible, and will continue to provide updates.

Operational Guidance Vaccination of Frontline Health Social Care Workers  issued 7 January 2021.

NHS England has now published Operational Guidance: Vaccination of Frontline Health & Social Care Workers

This confirms that by mid-January NHS Trusts will establish ‘hospital hubs’ and will be the default provider of Covid-19 vaccinations for “all healthcare and social care workers”. This includes frontline staff in primary eye care settings.

At this stage:

  • employers should read Appendix 1 section 5 “HR, Staff Engagement and Communications” and do what they can to support staff with questions they might have and to help coordinate efforts where contacted to do so
  • employed staff do not need to take any further action

All optical sector bodies are working together to support this effort and will keep you up to date with developments.

ABDO Statement on optical practice in England from 5 November 2020

ABDO can officially confirm that optical practices are recognised as essential medical/health care providers and therefore do not need to close in the event of any national or local lockdown. All eye health care should continue to be delivered including routine care.

We acknowledge that due to lockdown there may be considerable reduced footfall in some areas and we are working with NHSE to agree what support, if any, can be made available to practices affected.

Please also note that ABDO supports the flexibility in relation to the GOC statement on dispensing spectacles during Covid-19 where it is absolutely necessary. In relation to dispensing to children, in line with patient safety, members should verify spectacles are fitted properly and therefore fit for purpose to aid the child’s vision as prescribed. As a consequence children should be provided with a dispensing appointment with a registrant when collecting their spectacles.

Issued 4 November 2020

ABDO Statement on optical practice in England from 5 November 2020

ABDO can officially confirm that optical practices are recognised as essential medical/health care providers and therefore do not need to close in the event of any national or local lockdown. All eye health care should continue to be delivered including routine care.

We acknowledge that due to lockdown there may be considerable reduced footfall in some areas and we are working with NHSE to agree what support, if any, can be made available to practices affected.

Please also note that ABDO supports the flexibility in relation to the GOC statement on dispensing spectacles during Covid-19 where it is absolutely necessary. In relation to dispensing to children, in line with patient safety, members should verify spectacles are fitted properly and therefore fit for purpose to aid the child’s vision as prescribed. As a consequence children should be provided with a dispensing appointment with a registrant when collecting their spectacles.

Issued 4 November 2020

Latest Advice

Standard operating procedure in Primary Care Optical settings issued 26 October.

Optometry second wave letter issued 26 October.

OFNC Guidance on Covid-19 funding for optical practices in England

As set out in the statement of 26 October, this guidance provides more information about the Covid-19 funding arrangements set out in NHS England’s letter of 26 October (reference 001559). This OFNC guidance has been endorsed by the NHS England-Improvement optical commissioning team.

We may update this guidance to reflect further questions from the sector, and as we receive more information from NHS England. Please always check that you are accessing the most recent version.

This version was updated on 18 December.

Future additional support payments

NHS England has now confirmed practices will receive the average GOS payment for both August and September if they deliver at least 40% of their pre-pandemic GOS 1 (sight test) activity. The August payment was made in September. Due to the delay in NHS England confirming the September arrangements, average payment adjustments due to contractors will be made retrospectively on contractors’ next GOS payment date, starting from 13 November where possible. All contractors who receive payment between 1 and 12 November, and some contractors who receive payment on 13 November, will receive any average monthly payment due to them for September along with their December GOS payment.

We understand the NHS Business Services Authority (BSA) will audit a random sample of practices that receive these average GOS payments, to check their activity has met the 40% threshold.

If your practice does not receive an average GOS payment for August or September, and you believe it has delivered at least 40% of pre-pandemic GOS 1 activity, you should contact your normal PSCE contact in the first instance.

 

Further support after September will only be available to:

  • Domiciliary contractors (additional services contract holders)
  • Fixed practice contractors (mandatory services contract holders) whose GOS claims would normally be at least £2,500 a month and comprise more than 40% of practice income, are in deprived areas, are struggling to recover, and which meet the new criteria to qualify for support, or can show they need support on an exceptional basis (see FAQ 6 below)

The support available to qualifying domiciliary contractors will be:

  • 60% of historic average GOS (as paid in previous months) to cover October 2020
  • 45% of historic average GOS to cover November 2020
  • 30% of historic average GOS to cover December 2020

This additional funding will be paid to domiciliary contractors in one instalment in February 2021. The delay is due to the need for PCSE to calculate the domiciliary contribution to average monthly payments for contractors that hold both mandatory and additional contracts.

The support for other qualifying contractors will take the form of additional payments on top of their actual GOS activity levels in October, November and December 2020, to bring their total GOS income for each qualifying month up to 90% of their average GOS payment. The payments for October and November will be made in December if NHS England receives eligible applications in time and is able to confirm to PCSE which contractors qualify in sufficient time to meet the December payment cycle. The payment for December will be made in January 2021.

 

Domiciliary contractors will be automatically eligible for further support payments covering October,  November and December 2020. They will not have to apply for the support, and will not have to meet service delivery targets to qualify for the support.

Fixed practice contractors will only qualify  for further support payments covering these months if they meet all the following criteria:

  • The practice is located in the first or second most deprived decile in England as measured by the Index of Multiple Deprivation
  • The practice can show from its management accounts that before the pandemic, GOS claims made up at least 40% of the practice’s normal income across the full year 2019/20
  • The practice had historic GOS income of at least £2,500 a month in the period from March 2019 to February 2020
  • The practice submits a declaration that it is experiencing financial hardship because of the impact of COVID-19
  • The practice delivers at least the following proportion of its pre-pandemic GOS 1 (NHS sight test) activity:
    • 55% in October
    • 65% in November
    • 80% in December

Domiciliary contactors will receive the support automatically.

Fixed practices will be contacted by the NHS BSA (via email where contact details are held, or by letter) if they believe you meet the deprived area requirement, to assess whether your practice meets the other criteria listed in FAQ 3 above, and is therefore eligible for further support payments.

Fixed practices wishing to claim the support will need to complete a declaration form provided by NHS England, and submit it to NHS England & NHS Improvement Extended Contract Arrangements at england.dentaloptoms@nhs.net. All applications must be made by email. If you need an electronic copy of the declaration form, you should contact england.dentaloptoms@nhs.net.

If you think your fixed practice meets the deprived area requirement, but you do not receive an invitation to apply for financial support, you should contact NHS England & NHS Improvement at england.dentaloptoms@nhs.net to request a declaration form. You can then use that form to submit the required information in support of your application.

NHS England anticipates that most GOS contractors are now able to provide sufficient face-to-face care to ensure the ongoing viability of their businesses. However, following representations by the OFNC, NHS England accepts that domiciliary GOS contractors, and contractors in areas of high relative deprivation which  depend heavily on GOS income, are likely to need ongoing support after the end of September to maintain eye care services to their respective populations.

NHS England has confirmed that regional teams will consider applications for support on an ‘exceptional’ basis, where practices don’t meet these criteria but are reliant on GOS income and can demonstrate hardship as a direct result of COVID-19. If you need support but do not meet all the criteria, you should contact NHS England and NHS Improvement at england.dentaloptoms@nhs.net and apply for inclusion in the scheme. You will be asked to complete a declaration form and provide as much information as possible in support of your application.

If necessary, your representative body (ABDO, AOP or FODO) will be able to provide further advice on how to make a special case for support.

Yes. All providers in England with additional services (domiciliary) contracts will receive the following support payments:

  • 60% of historic average GOS (as paid in previous months) to cover October 2020 – this will be paid in December
  • 45% of historic average GOS to cover November 2020 – this will also be paid in December
  • 30% of historic average GOS to cover December 2020 – this will be paid in January 2021.

You will not have to meet any activity requirements or other additional criteria to receive these payments. You should not need to contact your NHS England regional team to arrange these payments, and should contact PCSE directly if you do not receive a payment you are expecting.

If you made GOS claims for domiciliary work between March 2019 and February 2020, your practice will be eligible for support payments in respect of that element of its work. The support payments will be the relevant percentage (60%, 45% or 30% as above) of the historic average value of your practice’s GOS domiciliary work between March 2019 and February 2020. You will not receive support payments in respect of non-domiciliary GOS work during that period, unless your practice qualifies under the criteria for ongoing support for fixed practices.

NHS England and the OFNC will keep developments under review and will provide further information nearer the time.

The NHS England letter of 26 October says that if public health measures require it, it may be necessary to return contracts back to the operating model used between 1 April 2020 and 17 June 2020, when practices were not able to provide routine care, and received average GOS payments if they were open for essential care.

This is only likely to happen if a regional lockdown or further national lockdown significantly reduces GOS contractors’ ability to provide routine care. The OFNC will issue further guidance if this becomes necessary.  There is more information about what practices need to do to be considered open for essential care in the OFNC FAQs of April 2020.

Reduction to past support payments

NHS England’s letter of 1 April, which set out the plan for average GOS support payments to practices that remained open for essential care during lockdown, said that “an agreed and fair reduction for any variable costs associated with service delivery (e.g. in recognition of reduced consumable costs associated with dispensing of frames and lenses) will be applied to all reimbursements. This will be discussed and agreed with the OFNC.”

The level of the reduction negotiated between the OFNC and NHS England was confirmed in NHS England’s letter of 26 October. The reduction will be:

  • 43% of those average support payments made to holders of mandatory (fixed practice) contracts in respect of the period from 1 April to 17 June 2020
  • 86% of those average support payments made to holders of additional services (domiciliary) contracts in respect of the same period.

However, on 18 December NHS England and the OFNC announced they had agreed that these planned deductions would not take place. Instead the savings contractors are deemed to have made in variable costs associated with service delivery have been offset against additional PPE costs contractors are deemed to have incurred for NHS work before the DHSC PPE portal became available to them in August. GOS contractors will therefore be effectively compensated for these costs without having to request reimbursement or produce receipts or invoices.

As set out in FAQ 11, NHS England has now confirmed that it will not recover this money, because the savings contractors made in variable costs have been offset against their additional PPE costs.

The reductions were agreed between the OFNC and NHS England. The 6.43% reduction for mandatory contracts reflects an estimate of the average saving that contractors will have made during the period from 1 April to 17 June by receiving payments based partly on historic GOS voucher claims, without incurring costs relating to frames and lenses. The 7.86% reduction for domiciliary contracts also reflects an estimate of the average saving to contractors from reduced travel costs during that period.

For comparison, NHS England has negotiated a reduction of 16.75% to average support payments to dental contractors over the equivalent period.

Reimbursement for PPE costs

The Department of Health and Social Care  has now provided access to free PPE for all GOS contractors, via an online portal which went live on 17 August. More information about the PPE portal is available here. The OFNC is aware that some GOS contactors have experienced difficulty in ordering the amount of PPE they need to support their GOS work from the portal, and is in urgent discussion with DHSC and NHS England to resolve this.

DHSC had said that it will reimburse contractors for additional PPE costs incurred before they were able to access free PPE via the portal. It has now been agreed that those costs will be offset against the planned reductions in past GOS support payments – see FAQs 11 and 12 above.

NHS England Standard Operating Procedure

We are reviewing the changes to the SOP, but understand that they largely reflect existing sector guidance on operating under Covid-19 conditions. We will issue further guidance if necessary.

More advice

ABDO members are advised that optical practices are not required to close when:

  • contacted by Track and Trace.
  • the area they operate within is locked down.

This is because all optical practices have increased infection prevention and control, implemented social distancing and are utilising PPE and have done since March when practices throughout the UK remained open during lockdown to provide essential, urgent/emergency eyecare.

If your practice is contacted by Track and Trace, or in a region that has been locked down, and you have adhered to all measures above, there is no reason to close. Issued 19 October 2020.

Registered healthcare professionals, including optometrists and dispensing opticians, will no longer be exempt from the requirement to self-isolate for 14 days when returning from high-risk countries. The government announcement brings all registered health and care workers in line with the general public.

The original exemption was to help healthcare professionals aboard return to the UK to work. However, now people are starting to travel abroad for holidays, the government has changed its advice. Scotland, Wales and Northern Ireland are responsible for their Covid-19 regulations so advice my vary in these countries. 

Self-isolation period extended to 10 days

The UK’s Chief Medical Officers confirmed yesterday, 30 July, that the UK would extend the self-isolation period from 7 to 10 days for those in the community who have symptoms or a positive test result.

The change is in response to emerging evidence that people might remain infectiousness between seven and nine days after illness onset. Read more.

Healthcare registrants to self-isolate on return to England from high-risk countries issued 31 July 2020.

Update on GOS issued 5 June 2020.

The OFNC has today had further discussions with NHS England on arrangements for when and how optical practices can provide more face-to-face eye care. Despite recent speculation, NHS England has confirmed that a date for full resumption of face-to-face GOS has not yet been agreed. Read more…

 

Update on Essential Care in England issued 27 May 2020.

The definition of essential eye care in NHS England’s letter of 1 April is that it: “includes but is not limited to 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 may include where patients have broken or lost their glasses or contact lenses and need a replacement pair to function.” Read more…

Find out how to self refer for coronavirus testing in England here.

Find out how to self refer for coronavirus testing in England here.

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OFNC guidance on changes to primary care in England and answers to FAQs

As set out in the statement of 1 April, this information below addresses the main questions raised by OFNC members so far about the NHS England optical letter of 1 April 2020 (001559) and other recent developments. The FAQs have been endorsed by the NHS England-Improvement optical commissioning team.

We will update this guidance as the situation develops. This version of the FAQs was updated on 18 April 2020. New questions are marked ‘[NEW]’ for ease of reference.

Updated 18 April

No, you do not have to close.

You should not offer routine sight-testing and dispensing (to avoid all unnecessary travel and person-to-person contact) but you may stay open so that your clinical team can provide:

  • essential eye care as defined in the NHS England letter, and/or
  • urgent / emergency care.

This includes providing remote advice, reviews, consultations, dispensing and contact lens supply, including to patients not entitled to GOS, in line with the College of Optometrists’ guidance on providing care during the crisis and the GOC’s guidance on the provision of spectacles and contact lenses.

No, you do not need to be physically present in the practice. Government advice is that all unnecessary travel should be avoided and person to person interaction (even if social distancing) minimised to help reduce risk for patients, staff and the wide public. ‘Open’ in these circumstances means providing essential eye care in accordance with College of Optometrists and government Covid-19 guidance. These services can be provided from home locations wherever possible.

The key to being ‘open’ is that patients must be able to contact the practice during normal opening hours, but this can be by phone or email – for instance you could divert your practice landline to an alternative number, or provide an answerphone message asking patients to contact a mobile phone or to send you an email.  Calls and emails should be managed promptly and efficiently in line with the importance of providing an essential service.

Please see FAQ 3 below for more on meeting patients’ needs during the crisis. Direct input from practitioners may require scheduling in order to accommodate demand and practitioner availability. Appropriate clinicians should be available to deliver face-to-face services where clinically necessary, subject to confirming the patient and other household members have no COVID-19 symptoms, and following College of Optometrists guidance including on the use of PPE. Face-to-face consultations should take place at the patient’s normal practice unless:

  • there are reasons preventing this in a particular case (such as lack of PPE), or
  • in the particular circumstances another location is requested by the patient.

NHSE has advised that where possible remote reviews and consultations (via phone or video) should be available to prevent the need for patients to attend the practice in person. The College of Optometrists guidance on providing care during the crisis advises that you should operate a locked-door policy and admit patients for pre-booked appointments only. The College has published guidance on conducting remote consultations.

If practice attendance is required, you should double-check whether the patient or any household member has symptoms of COVID 19. If they have, the patient should be treated via alterative local pathways as appropriate. If they have not, the face-to-face consultation should take place at the patient’s normal practice unless:

  • there are reasons preventing this in a particular case (such as lack of PPE), or
  • in the particular circumstances another location is requested by the patient.

Practices may need to exercise flexibility around opening hours in response to patient demand, staff availability, self-isolating, infection control and PPE availability during the course of the crisis, especially those practices that might otherwise operate extended hours. Contractors are required to deliver their total contracted hours and should maintain up to date details on their practice website, so that patients know when and how to contact them. Practices should keep their local area team informed of any temporary changes.

You also have the option of changing your standard NHS contractual opening hours via the formal contract variation process. However, this is unlikely to be necessary throughout the crisis unless you plan to do so permanently.

If a contractor chooses to cease operations entirely, they should notify their regional commissioner, and support payments will stop for this period.

You can find a form to assist you in online contact lens consultations here: Contact-lens-telephone-review-form-19-March-2020

The Department of Health and Social Care (DHSC) and NHS England-Improvement are aware that it is difficult to access all necessary supplies of PPE at the present time. If you cannot access the correct PPE for the services you offer at any point, you should temporarily stop face-to-face contacts in line with College of Optometrists guidelines which state:

  • “if you are unable to get the PPE to enable you to see patients according to national guidance, you should not conduct face-to-face consultations at a distance of less than 2m. We realise that this means that in most cases you will be unable to see patients. However, you can provide other services that do not require face-to-face contact, such as supplying spectacles or contact lenses by post, or offering telephone or video advice.” Updated: 9 April 2020

The safety of patients and staff should be your top priorities during the crisis. If you cannot access the correct PPE you should continue to offer essential care remotely, and work with other providers with PPE for face-to-face consultations where it is clinically necessary and safe to do so. The NHS will recognise that your practice remains open if you are working to official and best practice Covid-19 guidelines, and you will continue to receive GOS grant funding provided you provide essential care remotely during normal hours.

The government is working to improve supplies and distribution of PPE. It is important that when you do get access to PPE that you follow DHSC advice and use it “only where there is a clinical need to do so”. Learn more in the DHSC PPE plan.

We are aware that NHS England area teams have issued requests for information about practices’ opening arrangements in different formats. These OFNC FAQs have been endorsed by the NHS England optical commissioning team. If you have any difficulty in explaining your arrangements to your area team, please refer them to these FAQs.

For the avoidance of doubt, you are open to provide essential care if you meet the requirements set out in FAQ 2, 3 and 4 above. In particular:

  • You do not need to be physically present in the practice during your normal opening hours for GOS services, but patients must be able to contact the practice during those hours – this can be by phone or email.
  • Appropriate clinicians should be available to deliver face-to-face services where clinically necessary, in line with College of Optometrists guidance including on the use of PPE. Face-to-face consultations should take place at the patient’s normal practice unless there are reasons preventing this in a particular case (such as lack of PPE), or in the particular circumstances another location is requested by the patient.
  • Where possible you should use remote reviews and consultations rather than face-to-face, in line with official public health, NHS and College of Optometrists guidance
  • All consultations must be conducted by an appropriately qualified member of staff.
  • The GOS support covers essential eye care. It does not cover urgent and emergency care and therefore the hours in which you provide urgent and emergency services will not have any impact on your eligibility for GOS support
  • It is accepted that you may need to exercise flexibility around opening hours during the crisis. You are required to deliver your total contracted hours and keep the local area team informed of any temporary changes

NHS England has no plans either to force practices to close or to remain open. The aim is to direct all patients who need essential eye care to optical practices during the crisis, to meet their care needs and keep pressure off other parts of the NHS. If undersupply occurs, NHS England or CCGs may work through LOCs to ask practices to volunteer to reopen if they can. In most cases, we expect practices will continue to offer essential eye care and support their own patients.

The NHS has also now developed a Covid-19 urgent and emergency eye service, see CUES below.

No, you do not need to get permission to stay open or to inform your NHS England regional team.

Yes, as long as your practice is open during your contracted hours and able to provide essential eye care through deploying the skills of the appropriate member of the team as required.

If your practice is completely closed and you are not providing any essential care (e.g. remotely), you will not receive GOS support payments for the duration of the closure. You will be able to claim any general Government business support for which you are eligible, such as business grants and payments under the Coronavirus Job Retention Scheme and the Self-Employment Income Support Scheme.

Some practices closed when the government introduced a general lockdown, and others postponed all activity because of the uncertainty around PPE and changing public health advice during the initial escalation phase. If you closed for these reasons this does not mean you have to remain closed. See question 7, you do not need to seek permission to re-open.

You should notify your NHS area team of the date you re-opened, and log the period in which you were closed so that period can be deducted from your GOS support payment.

Depending on the progress of the COVID-19 crisis, NHS England regional teams may need to work with optical practices, LOCs, and CCGs to ensure that practice opening arrangements continue to protect public health and ensure appropriate and adequate levels of care – particularly urgent and emergency care. See the FAQs on urgent and emergency care below.

In the same way as any other practice as above.  People who cannot leave home unaided will need essential eye care during the crisis the same way as everyone else.

Remote essential care (including symptom relief) should be provided.  This may involve advising and working with and through other clinicians (e.g. nurses, visiting GPs), trained care workers or carers who are admitted into the home. In the case of lost or broken glasses, consider using any available evidence such as broken glasses, old prescriptions and previous records to enable emergency replacements to be supplied.

Where there is an urgent or emergency eye care issue, you should coordinate the best possible response for each individual by working collaboratively with ophthalmology and the patient’s GP.

If you continue to provide essential care in line with official public health advice and College of Optometrists guidance, you will receive a monthly payment based on your average monthly GOS claims for the period from March 2019 to February 2020. This will include voucher claims. Where your actual GOS claims during the crisis exceed this level, you will be paid the additional claims in the usual way.

This is a grant payment, not a loan. It will be subject to a reduction for variable costs associated with service delivery, which will be agreed with the OFNC. We will provide more information about this process as soon as we can.

The GOS grant is not for COVID-19 urgent and emergency care provided under (CUES), which is funded separately.

NHS England has said average fees will be calculated on a fair and reasonable basis taking into account your average monthly GOS claims during the period your practice has been open

The OFNC will agree this with NHS England. We will provide further information as soon as we can.

You do not need to apply for the support  and will receive it automatically as long as your NHS England area team knows you are open for the purpose of providing essential care.

If your NHS England area team knows you are open, it will write to you shortly with the calculated value of your monthly payment. You will then be automatically paid this amount by PCSE in line with your normal payment schedule. Your area team will have your GOS claims payment history and will be able to deal with any queries about the value of the payment.

The first support payment will cover March 2020, and will top up any GOS claims you submitted for March to the value of your average monthly claims. You will then receive the same payment each month until further notice. During this period, PCSE have requested that contractors continue to submit GOS claims as normal. This will not affect the value of the monthly payments, except in the unlikely event that your claims exceed the value of the monthly payment.

NHS England wants to ensure that where it continues to pay contractors to provide essential care during the crisis, those contractors do not also receive a separate contribution from general Government financial support which directly covers the cost of providing essential GOS – in other words, they do not want the Government to pay twice for the same thing.

If you receive general Government support while providing essential care under these arrangements, which will likely be the situation for most practice owners, you should keep records to show that the general support is not being used to fund the costs of providing essential care, which will be separately funded through GOS. Other FAQs in this section set out the OFNC’s understanding of how the NHS England support relates to different forms of general Government support.

You can furlough any staff on PAYE who are not involved in providing essential care. Staff who are involved in providing essential care – even on a voluntary or part-time basis – cannot be furloughed under the rules of the Coronavirus Job Retention Scheme.

Business grants are linked to premises and applied automatically, so this grant does not have to be claimed. Business grants are provided because of the general impact of the crisis on qualifying businesses and are not linked to essential NHS care.

NHS funding is for essential NHS eye care and to ensure the primary eye care infrastructure is maintained after the crisis period. NHS England has said it intends to run a reconciliation process to check practices have only received an appropriate level of support during the crisis, and that it will work with the OFNC to agree a proportionate and workable process.

Given how the vast majority of optical practices operate, it is clear that any business rates relief and/or grants will be support for the impact of the crisis on their general business activities and not clinical care, in the same way as for other businesses receiving the support.  In the OFNC’s view there will therefore be no overlap between the NHS support and the general business grant support, except in the unlikely event that your income during the crisis, from the NHS support for essential eye care and business grants combined, is greater than it would have been under normal circumstances.

The general government income support scheme for the self-employed is new and complex, and the rules are still evolving, so the OFNC cannot yet give firm guidance on this question. The sector representative bodies will provide further guidance as the rules are clarified.

In principle we think self-employed practice owners who are providing essential care and receiving NHS England financial support may also be able to claim for support under the self-employed scheme, provided that (i) they meet all the eligibility criteria for the scheme, and (ii) they can show they have suffered ‘lost profits’ relating to private sales and services, including non-voucher dispensing, private sight tests and contact lens appointments, and any other sources of income that are not from GOS.

Anyone claiming self-employed support in these circumstances should satisfy themselves that they can show the support has not been used to cover the costs of providing essential care, and may wish to seek accountancy advice.

For GOS 1, we recommend that where you provide a remote consultation (and where necessary, a dispense) but don’t perform a sight test, you should not submit a GOS 1 claim but should maintain records and make a note of the activity. If you do perform a sight test, you should submit a signed GOS 1 claim in the usual way, using social distancing and hygiene procedures.

For GOS 3 and 4 claims, NHS England has advised the OFNC that during the crisis claims can be submitted without a patient signature provided the form is annotated ‘COVID-19’ wherever a patient signature is needed. GOS 4 claims for adults should be pre-authorised by the NHS Business Services Authority (see below).

If you are dispensing spectacles to a patient eligible for GOS 3 but you have not performed a sight test, you should submit a GOS 4 form rather than a GOS 3. During the crisis GOS 4 authorisation has been extended to cover any adult (not just those with illness-related loss as previously) meeting the following criteria:

  • Adults who are clinically deemed by a qualified clinician to require the dispensing of a spectacle prescription, determined without a face-to-face consultation
  • Adults who would have otherwise been eligible for a GOS3
  • The damaged or lost spectacles to have been older than 2 years if issuing exactly the same prescription as before.

 

The form should not be signed by the patient but annotated ‘COVID-19’. If the dispense is for an adult, the GOS 4 form will also need pre-authorisation from the NHS Business Services Authority. You should contact them on nhsbsa.paos@nhs.net or on 0300 330 9403, and they will give you a unique claim code to enter on the GOS 4 form.

No. The GOS grant is for essential care only. You only need to provide urgent or emergency NHS care if you have an existing or new contract to do so.

NHS England, LOCSU and the Clinical Council for Eye Health Commissioning have developed a new framework for urgent primary eye care during the crisis, the COVID-19 Urgent Eye Care Service (CUES). This will be commissioned through CCGs. NHS England regional teams will work with CCGs, LOCs and optical practices to ensure the availability of appropriate levels of eye care across England.

The new CUES framework is not a MECS service. Where MECS services are already commissioned by CCGs, they are already being changed to support the delivery of urgent eye care from optical practices.

No. The CUES framework is based on risk stratification.  Many patients will still only need a remote telephone or video consultation by a suitably qualified GOC registrant to assess and manage patients.

This may lead to further steps including remote advice from an optometrist, Independent Prescriber or ophthalmologist, to remote prescribing or follow-up, or to a face-to-face consultation in an optical practice where appropriate. The CUES face-to-face consultation need not be provided by the practice that provided the initial CUES remote consultation.

A remote review is part of essential care. A patient contacts the practice with concerns about their vision or eye health and an appropriately qualified member of  staff asks a series of questions to assess whether the patient has an essential, urgent or emergency eye problem which requires a remote consultation..

Remote consultation can be part of essential care or urgent and emergency care, depending on clinical need and risks to sight and health. This is provided by a suitably qualified GOC registrant and will involve all the elements of a normal consultation, except that face-to-face tests and procedures cannot be performed.

Yes, CLOs with MECS accreditation can deliver remote reviews, remote consultations and face-to-face consultations in line with their accreditation.

At times there may be a need to concentrate face-to-face care in a limited number of hub practices, for both practical and public health reasons. These include access to suitable PPE, the presence of sufficient clinical staff (who may need to be drawn from a range of local practices to work in a single hub if the crisis affects staff availability), and premises that enable the required level of social distancing and infection control protocols at that time in the pandemic. The locations used for these hubs may need to change as the pandemic progresses.

If it is decided that a hub practice is needed in a given area, the location would be identified by the relevant CCG in consultation with LOCs. Hub locations should be selected bearing in mind local patient demographics, and local volumes and channels of service delivery.

CUES will be contracted locally by CCGs, and fees will be agreed between CCGs and LOCs. The OFNC has asked NHS England-Improvement which developed the CUES framework to make recommendations on the urgency of commissioning CUES and support CCGs with an indication of the factors to be taken into account in agreeing fees.

The NHS has published guidance on deploying the clinical and non-clinical optical workforce to support the NHS clinical delivery plan for COVID-19. This sets out the scope for members of the optical workforce who are not providing NHS eye care during the crisis to take on other optical or non-optical roles.  There will be no obligation on anyone to take on another NHS role – it is a matter of personal choice.

Self-employed members of the optical workforce who are not engaged to provide essential or urgent eye care services can volunteer for temporary roles during the crisis:

  • on a remunerated basis (rates to be agreed by locally) e.g. in eye casualty or other clinical roles
  • on a non-remunerated basis under the NHS Volunteer Responders or other schemes, where they will receive compensation such as travel and subsistence without affecting their access to the Self-Employment Income Support Scheme entitlements.

Employed members of the non-NHS optical workforce, including people who are furloughed, can volunteer for temporary roles:

  • on a remunerated basis in line with their contract of employment (checking with their employer) and the rules of the furlough scheme where relevant.
  • on a non-remunerated basis under the NHS Volunteer Responders or other schemes, where they will receive compensation such as travel and subsistence. This will not affect the income of furloughed staff.

The main optical sector indemnity cover providers (ABDO, AOP and FODO) have prepared separate Q&A to explain the insurance arrangements for the roles performed by the optical workforce during the COVID-19 crisis. You can read these Q&A here.

The NHS guidance on deploying the optical workforce acknowledges that Death in Service cover would need to be provided. Our understanding is that the Government is considering the arrangements for this and expects to provide more information soon.

This will depend on the terms of the existing cover. Anyone who has such cover and is considering taking on another role for the duration of the crisis should review the terms of their cover and talk to their cover provider if necessary.

For guidance on the other practical issues raised by the NHS England letter, including:

  • How do I provide remote consultations?
  • How do I provide emergency dispensing and supply?
  • Where can I find out more about infection control to maintain my practice environment?
  • Where do I find the latest information and recommendations on Personal Protective Equipment (PPE)?
  • How can I obtain PPE?

Please see the COVID-19 guidance of the College of Optometrists,  the General Optical Council and official PPE hub.

This Q&A has been prepared by the main optical sector indemnity cover providers (ABDO, AOP and FODO) to explain the insurance arrangements for the roles performed by optical workforce during the COVID-19 crisis.

You will be covered by your existing indemnity arrangements, as long as you remain GOC registered and your work is within the scope of normal optometric, dispensing and contact lens practice. If your role or duties have changed and you have concerns about the scope of your work, you should discuss this with your line manager or contact your indemnity provider.

You will continue to be covered by your existing indemnity arrangements, as long as your work is within the scope of normal optometric dispensing and contact lens practice. If your role or duties have changed and you have concerns about the scope of your work, you should discuss this with your line manager/practice manager/practice owner or contact your indemnity provider.

Indemnity cover for any temporary optical role in the NHS should be arranged by the NHS[1].

Before taking on the role you need to obtain confirmation from the organisation in which you are due to begin work that your work is covered by the relevant scheme. This will ensure that you are indemnified for all the work you do in your temporary role.

[1] The arrangements for this will vary across the UK. Relevant indemnity schemes include the Clinical Negligence Scheme for Trusts in England, and the Clinical Negligence and Other Risk Indemnity Scheme in Scotland. In Wales indemnity will be arranged through the health body in command and control of the activities performed. Arrangements for Northern Ireland are still to be confirmed.

Since you will not be working as an optometrist/dispensing optician, you will not be covered by your existing indemnity arrangements. You will therefore need to be covered by NHS indemnity arrangements. You should:

  • Obtain confirmation from the organisation in which you are working that your work is covered by the relevant scheme
  • Not be identified or describe yourself to patients or colleagues in your new role as an optometrist or dispensing optician, to avoid any confusion or misunderstanding.

Since you will not be working as an optometrist/dispensing optician, you will not be covered by your existing indemnity arrangements. You should:

  • Obtain confirmation from the organisation in which you are working that your work is covered by suitable indemnity arrangements
  • Not be identified or describe yourself to patients or colleagues in your new role as an optometrist or dispensing optician, to avoid confusion or misunderstanding.

 

Contractors and practitioners should direct further questions to their representative bodies, using the email addresses below, so that the bodies can consolidate queries to inform more detailed guidance and FAQ resources as required:

 

LOCs can also raise LOC matters via LOCSU by emailing info@locsu.co.uk where they will be fed into the central process.

More information

NHS England has belatedly announced immediate changes to the delivery and operation of primary eye care services in England.

The announcement includes details of support payments for practices which continue to provide essential care for patients during the COVID-19 crisis. These practices will be expected to follow guidance from the General Optical Council and the optical sector bodies on how to provide this care safely. The support payments will be based on average past General Ophthalmic Services (GOS) payments between March 2019 and February 2020.

The OFNC, LOCSU and others are now working urgently with NHS England to put in place local urgent and emergency care services where these do not already exist in primary eye care.

The OFNC has repeatedly called for urgent financial support to offset the catastrophic impact the crisis continues to have on optical practices, with all routine sight testing suspended in line with public health guidance and many practices being forced to close their doors.

The primary eye care community in England has stood ready to play its full part in supporting people with essential,  urgent and emergency eye care needs throughout this crisis. Today’s announcement should provide a vital lifeline so that patients continue to benefit from eye health services. We are seeing the detail for the first time today, and the proposed stability funding appears to differ from that available in other parts of the UK in a number of ways. The OFNC will work with stakeholders to support all practices that are able to continue to offer care to their local population during the crisis.  We will provide more guidance this week.

OFNC Chair Paul Carroll said:

“The crisis has placed a great burden on frontline practitioners and practices across England. Today’s announcement throws the sector a lifeline even though there is a lot of detail to work through. The new support must be used to help more practices keep running through this very difficult time, and to reduce pressure on GPs and hospitals.

“We look forward to working together with the primary care optical team at NHS England to make sure practices can access support as quickly as possible”

The OFNC will work with NHS England to clarify these arrangements and provide further guidance as needed throughout the crisis. Contractors and practitioners should direct questions to their representative bodies, using the email addresses below, so that the bodies can consolidate queries to inform more detailed guidance and FAQ resources as required:

LOCs can also raise LOC matters via LOCSU by emailing info@locsu.co.uk where they will be fed into the central process.

The OFNC will work in close partnership with the College of Optometrists, GOC and LOCSU to ensure all bases are covered.

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.

Read the full letter here: NHS support for optical practices in England_ 1 April 2020

OFNC statement on GOS support in England – 27 March

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

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.

ABDO welcomes Public Health England (PHE) new guidance on Personal Protective Equipment (PPE) which now includes the optical workforce who are providing face to face appointments for essential and urgent care where clinically necessary. The new guidance recommends that clinicians should assess the risk of infection to themselves and their patients. If they consider there is an infection risk, then for the direct care or assessment (within 2 metres) of a patient who is not a possible or confirmed COVID-19 case they should wear gloves and an apron, and consider wearing a surgical mask and eye or face protection.

ABDO recommends that all clinicians conducting a face to face appointment within 2 meters of a patient should choose to wear the recommended PPE.  ABDO is working with AOP, FODO, LOCSU and NHS England to acquire PPE for optical practices through the NHS supply chain.  PPE has already been provided to some optical practices throughout Scotland, Wales and Northern Ireland.

Click here to view more Government information about Recommended PPE for primary outpatient community and social care by setting

Watch this video for how to add and remove PPE.

 

Members who do not have a current contract with NHS supply chains to dispose of PPE through that channel shouldfollow the advice here: Disposal of PPE

For further information on infection control please see UK Government information on coronavirus infection prevention and control.

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.

An example of one telemedicine guide from the Primary Eyecare Company can be found here: Telemedicine Guidance