England

12 October 2023

Read letter here.

14 June 2023

Read letter here.

23 March 2023

Another real terms cut imposed on NHS primary eye care

Like other areas of the NHS, primary eye care has been hit over the past 18 months by inflation, including the rising costs of fuel and salary pressures. The impact has been made worse however in primary eye care by years of severe GOS underfunding.

OFNC had submitted an evidence-based bid for an increase in both fees and grants but, once again, this evidence was disregarded by NHS England who offered an increase of only 4.5% from 1 April 2023 in GOS fees and optometrist pre-registration training grants. Made worse by no increase in CPD grants.

The OFNC had made clear to NHS England that:
• based on the evidence from more than 750 NHS providers in England, the NHS is paying 50% of what it costs on average to provide this essential health care
• the sight test is a vital NHS service and a core part of primary care on which the NHS depends to meet eye health needs and prevent avoidable sight loss
• primary eye care infrastructure in England is at risk due to chronic NHS underfunding.

This meant that the OFNC could not accept NHS England’s offer on behalf of the profession. NHS England therefore has imposed its below inflation 4.5% increase.

Following last week’s news of 5% settlements for employed NHS staff groups, OFNC wrote to the NHS for a further 0.5% to grounds of parity. This again was rejected on the basis that the 5% pay offer for employed NHS staff is not directly comparable with
GOS.

On 22 March sector leads met with Primary Care Minister Neil O’Brien in his offices in Parliament at which this disparity was raised. The issue of joint work with NHS England to obtain agreed data on which to base future negotiations was also raised.

Although this does nothing to help with fees in the current year, it does help lay the ground for a more constructive engagement in the future.

Gordon Ilett, OFNC chair said: “We held a positive meeting with the Minister about the future of eyecare but meanwhile the system continues to undervalue and underpay us. Once again, we have had a lower settlement imposed on us than some others in
healthcare despite official figures that show inflation remains high. The Minster is fully aware of the importance of primary eye care for the nation’s health and the key role that our workforce, skills, facilities, and equipment will need to play if the government
is to turn around its capacity problems in the hospital eye service, improve access for patients and relieve pressure on GPs. This meeting has opened a new dialogue about the value of the primary eyecare sector and we also hope it will allow a better way forward for evidence-based fee discussions with officials in the future.”

The OFNC will shortly be issuing FAQs to help providers who have asked for advice on how to manage NHS capacity in light of rising costs and underfunding of the sight test.

Letter and directions setting out general ophthalmic services fees and optical voucher values from 1 April 2023.

Read here.

The Optometric Fees Negotiating Committee (OFNC) notes that the Department of Health and Social Care (DHSC) has today recognised that patients who depend on NHS support for essential vision correction need more help. DHSC has announced a 4.5% uplift to all NHS vouchers starting 1 April 2023. Although well below both current and recent levels of inflation, this is at least a small attempt to help those patients in most need during the cost-of-living crisis.

The NHS provides support in the form of vouchers towards the cost of essential vision correction so that children and adults on means-tested benefits can obtain glasses and contact lenses. Seeing well helps children’s educational development, helps adults stay in work, and reduces the risk of falls in older adults.

As Healthwatch England, Advice NI, Public Health Wales and Scottish Government all recognise, the cost-of-living crisis is a public health challenge that impacts people on the lowest incomes the hardest. Left unaddressed, the cost-of-living crisis will widen health inequalities and life opportunities.

As this NHS patient benefit is already targeted at those in most need, the OFNC had hoped DHSC would have corrected for inflation in this very tough year for patients. However, this small uplift is a step towards minimising the risk that NHS patients in England may put off essential eye health examinations and risk long-term damage to their eye health.

The OFNC awaits the announcement of the DHSC decision on the chronically underfunded NHS sight test fee which continues to put NHS primary eye care under considerable pressure and risk.

PPV guidance

The optical sector Information and IT Committee would like to remind all holders of NHS mail accounts in England of the important changes to NHS mail.

NHS Mail – use it or lose it

NHS Digital has announced a change to the terms of usage for NHS mail accounts. Previously if accounts were not used for 90 days they would be marked as inactive and then deleted if not used after another 90 days.

These time periods are reducing. From 1 December 2022 if an account has not been used for 30 days it will be marked as inactive and deleted after a further 30 days. Deleted accounts can be restored for up to 30 days after that but will then be permanently deleted and you will have to apply again for a new NHS mail account.

To keep an account active you will need to ensure you carry out one of the following at least every 30 days.

o   Log into the NHSmail portal

o   Log into O365 application

o   Use O365 applications (i.e., Outlook with cached credentials)

o   Send an email

A pragmatic way to ensure your email stays active is to use Outlook to check your emails regularly which will prevent your account being deactivated.

NHS Mail help

If practices have an issue with an NHS mail address, they are sometimes being directed by the NHS Business Services Authority (NHSBSA) to LOCs, but these are not issues LOCs can resolve.

The NHSBSA has apologised for the confusion and provided new contact details for NHS mail issues.

Administration of NHS mail accounts can only be done by the National Administration Service (NAS)

• To request a new account if your account has been deleted please contact optomadmin@nhs.net.
• If you are unsure whether your account is still active, or you require support, you should first contact nhsbsa.paos-support@nhs.net.
• Guides on how to register GOS contractors and performers (including locums), a user guide to NHS mail and some FAQs can be found here:
• support.nhs.net/article-categories/optometry/
• If you have not applied for an NHS mail account previously and wish to do so, that can be done via this link: forms.office.com/r/SzaDjwpZxM

Please note that if you are a GOS contractor with more than 10 practices, then the Egress encryption service remains the only solution at present. The Information and IT Committee secretariat is working to understand how and when a different solution will be in place.  In the meantime, please contact alan.tinger@fodo.com if you require more information.

The LOCSU Annual Review can now be found here

Download new making accurate claims in England here.

9 March 2022

The Department of Health and Social Care (DHSC) has said it will increase GOS sight test fees in England by 2 per cent from April 2022. This follows a 1.9 per cent increase in April 2021. The GOS CET allowances and pre-registration supervision grants will also rise by 2 per cent.

This year the OFNC again pressed DHSC and NHS England to address the chronic underfunding of the NHS sight test as well as to close the widening gap between GOS fees and inflation. At the time of the bid, the Bank of England was already forecasting inflation to peak at 5 per cent in 2022 before correcting to 2 per cent in 2024.

As a result, the OFNC had proposed that the sight test fee should be increased to £23.26 (+7 per cent) whereas DHSC is proposing £22.14.

The OFNC is acutely disappointed with this response and has left DHSC in no doubt that the proposed 2 per cent increase will be a blow to primary eye care providers who have shown an active commitment to delivering health care throughout the pandemic to meet public needs and reduce pressures on secondary care.

With inflation rapidly rising month by month, we have made it clear to DHSC that this is real terms cut to funding and that the ongoing underfunding of primary eye care in England is likely to result in reduced capacity exactly when patients and the NHS need it most.

The DHSC has also laid regulations which will increase NHS optical voucher values by 2 per cent from April 2022. Voucher values are an important patient benefit for those that need this support, and it is right that they are increasing after 6 years of being frozen and declining in real terms.

GOS Fees and Grants 2022-23

• Sight test £22.14.
• Domiciliary additional £39.04 for first and second test; £9.77 for third and subsequent tests.
• CET grant £596.
• Pre-registration supervision grant £3,837.

Vouchers at a Glance

The optical bodies will be issuing an updated Vouchers at a Glance to reflect the new patient voucher values as soon as possible.

Primary eye care has long been able to deliver a wide range of NHS care outside hospitals, including diagnosis, treatment, follow-up to surgery, and the co-management of long-term conditions.

Through NHS England’s National Eye Care Recovery and Transformation Programme, commissioners are being encouraged to take advantage of the full range of clinical expertise and infrastructure primary eye care has to offer, recognising it as the equivalent of general practice. 

This is driven by the need to tackle outpatient waits, eliminate the risks of avoidable sight loss and address hospital capacity pressures which existed prior to Covid, and have increased significantly during the pandemic. The expansion of care outside hospital is also key to outpatient transformation and bringing the benefits of integrated care closer to home for an ageing population.

To help the NHS achieve this vital service transformation, the national optical bodies have worked with NHS England to develop an Optometry First model to be commissioned at scale utilising a consistent service specification.

Optometry First describes a comprehensive primary eye care service. It builds on the principles of CUES and reflects the vision of the College of Optometrists, Royal College of Ophthalmologists and wider optical representative bodies for a joint vision for safe and sustainable patient eye care services.

It will improve efficiency and accuracy of case-finding, extend the scope of care available within primary eye care and improve patient experience and opportunities for self-care. The model employs the core competencies of optometrists, dispensing opticians and their practice team, supported by higher qualified primary care practitioners and the multidisciplinary hospital ophthalmology team, where necessary, across a network of local optometric practices and the hospital eye service.

The service will ensure that primary care practitioners can offer first contact care through to resolution whilst also providing continuity of care for people with a long-term condition closer to home.

NHS England now wishes to test this model by working intensively with a small number of systems, as well as continuing to work more widely, with a view to strengthening the evidence base and demonstrating a route to scaling up across England.  This is an approach supported by all optical bodies.

The willingness of primary eyecare to participate is a key criterion for ICS selection. Therefore, we are urging practices and their whole practice teams to demonstrate their willingness by getting involved if their area is selected to test this new model of care. In the first instance please contact your LOC for further information who will link directly with the ICS, LOCSU and other representative organisations.

If you would like to learn more about Optometry First, please contact your LOC, LOCSU or your representative body. You can also apply for an account on the FutureNHS Collaboration Platform and view the Optometry First Toolkit online.

Read the England Health and Care Bill here.

Results from a CCEHC survey highlight the need to review commissioning and provision of low vision services to deliver more accessible and integrated care for patients in England.

The Clinical Council for Eye Health Commissioning (CCEHC) which represents the major clinical professions and sight loss charity organisations in the eye-care sector, has conducted a survey on the commissioning and provision of low vision assessment services in England.

The survey was conducted for five weeks from 5th April 2021 to gain an understanding of the impact of the pandemic on low vision assessment services between April 2020 – March 2021. The survey showed that prior to the pandemic, there was variation in the use of service specifications, protocols and thresholds for low vision assessment.  Since the pandemic service provision has been challenging, with deployed clinical staff, patients and some practitioners shielding, and lower clinic numbers to maintain distancing. This has been associated with a significant fall in certifications of visual impairment during lockdown periods.

You can read the survey results here.

Based on these findings, the CCEHC makes the following recommendations, and calls for low vision services to be included in system recovery and transformation planning:

Manage low vision assessment backlogs by:

• risk assessment of patients waiting to prioritise those in greatest need.
• triage to interim support by another part of the system.
• aiming to clear backlogs within 6 months.

Review existing low vision service provision (demand and capacity), protocols and pathways to:

• scope potential for more integrated services
• incorporate remote consultations for prioritisation and follow-up as appropriate e.g., patient initiated follow up, access to advice and guidance, review to check managing with existing aids/ new requirements.
• ensure there is domiciliary provision for those that require it.
• ensure Eye Clinic Liaison Officers are core members of the low vision service team and link across primary, community, hospital and social care.
• include provision of information on digital assistive aids (e.g., digital magnifiers) and signposting to IT courses for those who are visually challenged.

Develop service specifications and quality standards for integrated low vision care as part of a whole systems approach to:

• ensure consistent access and availability of services.
• offer a choice (where possible or appropriate) making optimal use of primary, community, local authority and hospital services.
• provide processes for governance, audit, engagement, service improvement, and review of services provided.
• identify a dedicated (ring fenced) low vision budget that can be accessed system wide (primary, secondary and tertiary) to ensure a sustainable service.

Ms Parul Desai, CCEHC Chair commented, “Many providers have tried to ensure safe services and looked to innovative solutions. The learning from COVID-19 is already changing the way some low vision services are delivered.  We encourage all commissioners and providers of eye health services to review their current low vision assessment service provision, particularly use of remote consultations for pre-assessment review and follow up /monitoring; and their processes for ensuring equitable access to services meeting consistent standards of care. The development of more integrated low vision services has significant benefits for patients, practitioners and organisations across health and social care. The CCEHC will be considering further phases of work to monitor progress.#2

Debbie McGill, Head of Policy and Public Affairs for ABDO said, “We were pleased to be involved in this piece of work and ask that NHSE consider the findings with a view to deliver a national low vision service in England to provide our ageing population with the eye care support they need, close to their homes. Dispensing opticians are well placed in optical practices to provide this care and advice.”

25 March 2021

The Department of Health and Social Care has said  it will increase GOS sight test fees by 1.9 per cent from April 2021. The GOS CET allowances and pre-registration supervision grants will also rise by the same percentage.

The fees for GOS sight tests in England were last increased in April 2015 by 1per cent. Since then the sector has seen five consecutive years with no fee increase, while contractors’ costs have continued to rise.

The OFNC had pressed for urgent action to address the widening gap between NHS sight test fees and inflation, and the relative underfunding of primary eye care compared to other NHS care.

Paul Carroll, OFNC Chair, said: “The 1.9 per cent increase, welcome though it is, does not fully address the erosion of GOS fees by inflation in recent years.”

“After 5 years without any increase to reflect the rising costs of care, a 1.9 per cent increase in GOS fees now will understandably disappoint a loyal and hard-working sector, which has gone the extra mile in keeping eye care services running over the past year when hospital care was often just not available. Nevertheless, we take it as a signal that the Government and NHS England have at last understood the value of primary eye care and the need to move towards fairer treatment of GOS contractors in the future.”

“We hope this is the first small step on a journey to a properly funded national sight-testing infrastructure to help meet growing eye health need, focus on prevention and deliver more care outside hospital closer to home.”

Read the OFNC response letter here

Read the Department of Health and Social care letter here

Read the OFNC case for increase here

29 October 2019

Yesterday Primary Care Support England (PCSE) launched the online Ophthalmic Payment service, which is now live. This means that all users of the PCSE Online service can now submit GOS 1, 3, 4, 5 and 6 forms online.

The full service, has also incorporated feedback from their early adopter users, to deliver even better functionality. This includes the auto population of claim values in GOS3 vouchers based on prescription entered, which will greatly improve the accuracy of claims.

PCSE will also be introducing some additional enhancements over the coming weeks, as a result of early adopter feedback including:

• extending the time out on the signature capture on GOS claims
• allowing a Performer to create a GOS3 once they have signed the declaration on a GOS1, which improves the workflow as they don’t need to wait until the GOS 1 has been submitted.

They expect to have these upgrades deployed by mid-November.

Updated User Guides will also be available for all GOS forms soon. These will include step by step instructions on submitting GOS4s, PVNs and GOS6s, and updated information on GOS1, GOS3 and GOS5. You can find out more via their website.

If you have any questions, please do get in touch with the team via pcse.optomengagement@nhs.net

ABDO, as part of the Optical Confederation, are still engaged with PCSE and NHS England regarding the cut-off date for submission of paper claims and we will keep our members informed regarding this and other updates.

Regional Lead: Abi Page FBDO
Email apage@abdoregions.org.uk

Local Leads

Natasha Beckwood FBDO

Jayshree Vasani FBDO

Ian Anderson FBDO

Email your local lead using the format initialsurname@abdoregions.org.uk