05 April 2020

Covid-19 update: primary eye care

We are open seven days a week at FODO to support you throughout the Covid-19 crisis. If you need us, contact us as usual at [email protected]. 

In this Covid-19 update: 

• Important: Personal protective equipment guidance (PPE) UK 
• PPE supplies 
• Clinical update - remote consultations and more 
• New Scottish Primary Care Announcement (PCA) 
• LOCSU levy pause 
• OFNC update 
• Further financial guidance - support for eye care providers 

Important: Personal protective equipment guidance (PPE) UK 

On 2 April (and updated 4 April), the UK published new personal protective equipment (PPE) guidance for health and care workers in context of the Covid-19 pandemic. 

The guidance is issued jointly by the Department of Health and Social Care, Public Health Wales, Public Health Agency Northern Ireland, Health Protection Scotland, Public Health England and NHS England. It therefore applies to all eye care services in the UK.  

Overview 

The College of Optometrists has updated its PPE guidance in response to this official guidance. The College guidance explains: 

• Primary eye care practices should not be seeing patients with signs or symptoms, or confirmed cases, of Covid-19 

• Social distancing and scrupulous hand-washing remain essential 

• You should assess the risk of infection to patients and colleagues in practice. This risk assessment will help you ensure you use the appropriate level of PPE based on official advice (more below). 

This is important because PPE is in addition to: 

• Other official public health advice and sector guidance 
• Social distancing 
• Best practice handwashing and best practice use of hand rub.            

PPE does not replace these core principles of infection control. For example: 

• You should continue to screen patients before they attend practice and place information notices on your practice door to minimise the risk of somebody with a possible or confirmed case of Covid-19 attending 
• If you can provide care remotely or while maintaining a 2m distance this is better than using PPE to carry out those tasks at a closer distance 
• In addition, you should use the correct PPE as instructed. 

Important detail

1. All members should read the College’s new PPE guidance in full 
    
2. Members providing ophthalmology services in hospital settings should also read the Royal College of Ophthalmologists’ updates on PPE and review its 3 April PPE table. You should check back on the main page for updates.      

Members have been in touch to seek clarity about the College’s reference to local risk assessments. Therefore, in addition to College guidance, we recommend the following. 

Individuals in charge of infection control policies in your organisation should read the UK's official PPE guidance and keep up to date with all other official guidance. Official PPE guidance includes tables which describe PPE use across different clinical settings and advice on correct usage and other safety measures.

Section 5 provides a summary of PPE recommendations in health and care settings. 

• Table 1 PPE in secondary care inpatient clinical settings 
• Table 2 PPE for primary, outpatient and community care settings 
• Table 3 PPE for ambulance, paramedics, first responders and pharmacists 
• Table 4 PPE where Covid-19 transmission is sustained. 

Please also note that the official guidance note accompanying these summary tables states:

• “It is recognised that provision of healthcare is dynamic and in a single care episode more than one context may be encountered, PPE should be changed (upgraded) as appropriate.” (Section 5) 

The rationale for updated PPE guidance also seeks: 

• “… to set out clear and actionable recommendations on the use of PPE, as part of safe systems of working, for health and social care workers relative to their day-to-day work. Incidence of Covid-19 varies across the UK and risk is not uniform and so elements of the updated guidance are intended for interpretation and application dependant on local assessment of risk.” (Section 2) 

This confirms that local assessment of risk is required. The specific advice for primary care settings is set out in section 8.9 and states: 

• “PPE guidance is provided for primary and community care in Table 2”. 

Primary eye care providers are therefore advised to read Table 2 in detail and carry out a local assessment of risk to decide whether Table 4 also applies. Section 7 of the official guidance provides more detail on risk assessment.                   Those in charge of infection control procedures should read the official guidance in full and develop protocols for the wider team. However, we also recommend that all clinical staff read the following sections of the PPE guidance: 

• Main changes to previous guidance 
• Safe ways of working 
• Risk assessment 
• PPE covering primary care and outpatient settings (section 8.9) 
• Patient use of PPE
• Using PPE best practice non-aerosol generating procedures (and if required Using PPE best practice aerosol generating procedures). 

Please also keep up to date with the extremely vulnerable list – last updated 30 March – to ensure this is factored into remote care triage processes.     

PPE supplies 

Across the UK there have been challenges in obtaining PPE. FODO advises: 

• Eye care providers collaborate with each other and the wider health and care system to help optimise the use of available PPE throughout the pandemic. 
  
  This includes sharing procurement/distribution PPE resources whenever and wherever this is necessary to adhere to UK-wide public health advice on PPE (see above). 
  
  The Competition and Markets Authority will not take any action against this level of coordination (see para 1.5 in the latest CMA guidance on Covid-19). 

In addition, please note: 

• In England, LOCSU has informed FODO that is exploring providing PPE to optical practices during the pandemic. Please email [email protected]. If your own supply chain cannot provide sufficient PPE and LOCSU cannot support with local supply, please read this 1 April Department of Health and Social Care letter 

• In Northern Ireland, Optometry Northern Ireland is doing all it can to source PPE on behalf of primary eye care 

• In Wales, please direct any questions to [email protected] at Optometry Wales.  

• In Scotland the latest PCA sets out plans on how to optimise PPE use locally.       

If you are unable to access PPE you should follow College advice: 

• “In the absence of appropriate PPE, if you consider there to be an infection risk to yourself or your patients, we recommend that you see patients virtually, until your practice is able to provide these essential items of PPE. You can refer the patient to another practice in the area who has appropriate PPE, or on to secondary care if they require urgent treatment. You can continue to provide patients with contact lenses or spectacles by post and if a patient contacts you for advice there are many issues that you can resolve over the phone or by video consultation, including a clinical consultation. More guidance on this will follow.” (FAQ – I am unable to get PPE – what should I do? Accessed 5 April)

Clinical update – remote consultations and more 

The College of Optometrists has updated its remote consultations guidance. This now includes a new telephone review form. Members are advised to: 

• Ensure all frontline clinicians have access to and read the College’s remote consultations during Covid-19 
• Review the clinical telephone review form published 1 April – this is in addition to the 19 March resources which covered supplying replacement spectacles and contact lenses. 

The College of Optometrists and Ophthalmologists also published a new statement on patient management during the Covid-19 pandemic. This includes a primary care ‘decision aid’. The joint note covers principles, strategy, communication and co-management. Learn more. 

This follows the Colleges publishing a joint letter on 1 April setting out the vital role of primary eye care during the pandemic and beyond. Read the 1 April letter to Jo Churchill MP, Parliamentary Under Secretary of State for Prevention, Public Health and Primary Care.     

New Scottish Primary Care Announcement (PCA) 

The Scottish government published an updated GOS PCA on 2 April. PCA(O)2020(6) includes: 

• Details of new arrangements for all face-to-face contact between patients and community eye care practitioners, including PPE requirements 
• The establishment of designated EETCs and PPE supply for EETCs 
• New arrangements for emergency and essential domiciliary eye care provision 
• Clarification of Covid-19 key worker status for the community optical sector. 

All members operating in Scotland should read the PCA in full.  

LOCSU levy pause 

LOCSU announced on Friday that it would pause its levy for four months. It said: 

“There is no expectation that the LOCSU levy will be paid on this activity income, the GOS grant or any payments made in relation of Covid-19 support for the four months outlined. The position will be reviewed in July in line with the Covid-19 situation.” 

Read the full press release.     

OFNC update 

To recap on the week’s updates from the OFNC: 

Covid-19 

On Wednesday the OFNC responded to NHS England’s long overdue letter covering the provision of primary eye care and financial support during the Covid-19. The OFNC then published guidance on Thursday to provide clarity on the NHS package and to allow all practices in England to plan accordingly.        

Annual GOS negotiations 

On 3 April the OFNC rejected the fifth year of freeze in GOS fees. The OFNC, responding to a letter from the Department of Health and Social Care (DHSC) which states GOS fees will be frozen for another year, said:

• “…the freeze will have to be imposed by the Department without OFNC agreement. The OFNC had bid for a reasonable and affordable increase of at least 2.5% in GOS fees this year in line with wider investment in NHS care”. 

The OFNC also said: 

• “The government’s fee letter does not bear any relation to discussions the OFNC has had with NHS England and our response sets out to correct the record. In the meantime, a serious injustice has been done to the primary eye care sector and eye care patients. The trust and goodwill of a loyal workforce, who will be key to delivering the Outpatient Transformation Programme and relieving long term pressures on hospitals, has been further eroded.” 

Read the full 3 April OFNC statement. 

The OFNC has also published: 

• OFNC December 2019: NHS primary eye care – concerns from the health sector. The original bid letter, which set out the negative impact the continued freeze in GOS fees has had on patient eye health, practitioners and practices in England and need for action 
• OFNC January 2020: Follow-up letter to NHS England. This sets out the outcome of the December meeting with NHS England and next steps 
• DHSC March 2020: GOS fees 2020/21. The Department’s response 
• OFNC March 2020: GOS fees 2020/21. Setting out concerns about the March DHSC letter                

Further financial guidance – support for eye care providers 

We will be issuing a separate alert on financial support providers shortly, this includes new guidance on the coronavirus job retention scheme and more detail on other government schemes we have updated members on in the 23 March and 27 March alert.