20 June 2020

Latest on risk levels, NHS England and re-opening for face-to-face eye care in Wales, Scotland and Northern Ireland

In this update:

1. Covid-19 alert moves from Level 4 to Level 3 across the UK
2. Updated Covid-19 framework for primary eye care providers
3. Guidance on flexible furlough
4. Scotland to resume face to face essential and emergency care
5. Wales moves to Amber
6. Northern Ireland to re-establish GOS 
7. NHS England latest
8. GOC statement on the ESR
   
   

1. Covid-19 alert moves from Level 4 to Level 3 across the UK

The Joint Biosecurity Centre has recommended that the Covid-19 alert level should move from Level 4 (a Covid-19 epidemic is in general circulation; transmission is high or rising exponentially) to Level 3 (a Covid-19 epidemic is in general circulation). 

The Chief Medical Officers (CMOs) for England, Northern Ireland, Scotland and Wales and have reviewed the evidence and agree with the recommendation to move to Level 3 across the UK.

The CMOs have clarified that: “There has been a steady decrease in cases we have seen in all four nations, and this continues. It does not mean that the pandemic is over. The virus is still in general circulation, and localised outbreaks are likely to occur.”

FODO commented: “This is very welcome news. However, as the sector reopens for routine care, and to ensure that we can continue to meet all patients’ eye health and vision needs, we all need to continue following rigorous infection prevention and control (IPC) procedures – see our guidance below.”

Read the UK Chief Medical Officers statement 

2. Updated Covid-19 framework for primary eye care providers

As planned, we have reviewed our Covid-19 guidance and have made minor updates in response to recent guidance by the NHS in England, Scotland and Wales, the HSC Board, ABDO and the College of Optometrists.

Updates include:

• Recommending members appoint a Covid-19 lead
• Removing NCTs from the AGP section – given it is now safe to use NCT (read more)
• Hosting our original PPE at a glance resource as a standalone page, so it is easier to access and share.
• Including new links to specific sections in Welsh Government and ABDO guidance on dispensing and contact lens practice. 

You can access all you need by following this flow diagram

3.  Guidance on flexible furlough

We have published guidance on the flexible Coronavirus Job Retention Scheme (CJRS). This guidance summarises the main changes to CJRS and also links to FAQs. You can access extra support by emailing us at [email protected] or calling us on 01244 688422. 

4.  Scotland to resume face to face essential and emergency care

The Scottish Government has confirmed that the country has moved to Phase 2 of its Covid-19 response. From Monday 22 June, retail premises with street access can reopen if they have systems in place to manage Covid-19 risks, but shopping malls/centres will remain closed for non-essential shops until Phase 3.

Eyecare services 

Optical practices should reopen for emergency and essential care under Phase 2 from Monday 29 June.

The guidance defines emergency and essential care as:

• Emergency care: Appointments for patients where, in the professional judgement of an optometrist or OMP, 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: Appointments for patients who would not usually be considered as emergencies, but where, in the practitioner’s professional judgement, a delay in an examination may be detrimental to a patient’s sight or wellbeing. Essential care during Phase 2 may include a patient who is incapacitated after losing or breaking their glasses/contact lenses and requires a replacement to function as failing to do so would be detrimental to their sight or wellbeing. Practitioners should give patients most at risk of permanent sight loss if their condition is left untreated priority over others who they may also need to see face-to-face. 

Optometry Scotland has reminded practices that there is no value in recommending blanket recall reminders at this stage of the pandemic.

Emergency Eyecare Treatment Centres (EETCs) will cease to operate after 28 June 2020. 

Mobile practices are not permitted to see patients face-to-face during Phase 2, although remote consultations should continue to be undertaken and recorded. Where a patient requires face-to-face emergency or essential eye care following a remote consultation, this should be per local Health Board pathways. 

Safety declarations

Practice owners/contractors must complete and submit a signed declaration form, including a Health and Safety Risk Assessment, (see below), for that individual practice to the relevant Health Board’s satisfaction before face-to-face emergency and essential eye care can resume. These items should be submitted as soon as possible and by Thursday 25 June at the latest for a 29 June restart. 

Practices and practitioners should keep up to date with NHS Education for Scotland (NES) guidance on the safe provision of emergency and essential eye care on Turas. This guidance will be updated continually. You will need to create a Turas account if you do not have one.

Finance

During Phase 2, practices (including mobile practices) will continue to receive Part 1 payments in the form of a monthly payment equating to their average monthly item of service GOS(S)1, GOS(S)3 and GOS(S)4 income across the 2019/20 financial year. 

During Phase 1, practitioners were also able to make Part 2 claims for remote consultations, EETC consultations and intra-referral to IP optometrists. These payments will stop from 29 June, and all outstanding claims for Part 2 payments must be submitted by 15 July. 

GOS claims

Practices must continue to submit GOS claims in the usual way, so that accurate activity data can be gathered to inform phase 3 arrangements. Lack of accurate data will make it impossible to reach an adequately calculated financial support arrangement for Phases 3, 4 and beyond and practices which have not submitted data, could lose out.

Patient signatures

Patient/patient representative signatures on the GOS(S)1 ‘cheque book’ slip and GOS(S)3, GOS(S)4, HES(S)1, HES(S)3 and HES(S)4 forms remain suspended.

PPE for NHS work

PPE will be delivered to practices during week commencing 22 June. This will be provided free for NHS work at this phase of the crisis. 

Read PCA(O)2020(10)

Read Optometry Scotland’s message to practitioners

Download Practice Declaration Form – Phase 2 Emergency and Essential Eye Care 

Optometry Scotland will be hosting a remobilisation webinar on 25 June, 6pm-7.30pm. Learn more and register here.       

5.  Wales moves to Amber

The Welsh Government has confirmed (19 June) that the country is moving to the Amber phase of the pandemic and that non-essential retail can reopen in Wales from 22 June. 

Eyecare services 

Optometry Wales has confirmed that that practices can start to follow optometry recovery guidance (Amber phase): Covid-19 with immediate effect. 

Domiciliary services remain suspended and can only be accessed through the local Domiciliary Eye Care Service (DECS) already arranged by Health Boards. 

Safety assessments

Before reopening, practices must complete this self-assessment form and return to NHS Wales Shared Services Partnership, together with confirmation of practice opening hours, to [email protected]. 

Optometry Wales, the Welsh Optometric Committee and NHS Wales Optometric Advisers have developed a patient risk stratification tool to assist with the clinical prioritisation and scheduling based on:

• Urgency of needs 
• Particular unmet needs of vulnerable groups
• Available capacity to undertake activity. 
  
  

Finance

During the initial stages of the Amber phase, practices will continue to receive an average NHS monthly payment as described in the Amber phase document.

GOS claims 

During the Amber phase, submission of GOS forms remains suspended. Practices will however still be required to submit daily activity data. Details about this from Welsh Government have not yet been announced.

Patient signatures

Patients are not required to sign any documents. 

PPE for NHS work 

All practices will receive free Personal Protective Equipment (PPE) supplied through NHS Shared Services Partnership. 

Read Welsh Government letter

Read the supporting Q&A 

Access patient risk stratification tool

6.  Northern Ireland to re-establish GOS

Eyecare services

The Health and Social care Board (HSCB) has confirmed that from Monday 29 June practices can resume offering eye care – including the main elements of routine eye care, eye examinations and ophthalmic dispensing, and the provision of Enhanced Services. 

Domiciliary eyecare provision will not be included initially “due to the higher level of Covid–19 risk”. 

Assurance returns 

Practices are asked to complete a contractor Covid-19 assurance return. 

The HSCB has also published Covid-19 guidance, reiterating existing sector guidance, but adding useful local advice, for example, interpreting services can be accessed through ‘The Big Word’ telephone interpretation service. Learn more. 

Finance

The HSCB has given notice that the resumption of non-urgent ophthalmic activity will require amendments to be made to the temporary Covid-19 financial support arrangements. Optometry Northern Ireland is in discussion about this. Further details will be provided in the near future including a firm start date for the next stage of recovery.

Patient signatures

OCSPR/LESPR and the other ophthalmic claim forms (i.e. Level 1 and Level II Enhanced Service) do not need to be signed by the patient until further notice. You should record patient consent in the clinical records and signatures replaced with ‘Covid-19’. 

Read the letter

Read the operational guidance 

7.  NHS England latest

As envisaged in the 17 June ‘Resumption of Optical Services’ letter, OFNC has held a series of urgent meetings with NHS England over the past week to discuss financial arrangements beyond 30 June and an appropriate variable abatement rate for GOS payments until 30 June. These meetings build on constructive discussions over the past month and will continue on Monday 22 June. In the meantime, average monthly payments to contactors for June will be paid in July, providing some ongoing stability.

NHS England has asked OFNC to remind all contractors and practitioners in England that:

• Patient signatures are not required on any GOS forms for the time being – forms should be annotated ‘Covid-19’ in the signature box instead and submitted as usual
• Practitioner signatures are still required
• GOS 4s for adults need pre-authorisation from [email protected] which will provide a unique claim code to enter on the form. 

NHS England has highlighted these points to regional teams to ensure there is a common understanding.

Members in England are encouraged to register for an NHSMail account, which can be used to exchange patient or sensitive information securely with other health and social care professionals. Register here. 

Regional office local questionnaires 

The new Standard Operating Procedure (SOP) issued by NHS England on 17 June provides useful guidance which builds on but does not duplicate other sector guidance. It also provides helpful tips which practices in England will find useful in reopening for routine care. 

Some regional offices have also been issuing aides-memoire and, in some cases, quite lengthy questionnaires to support practices. Some have even suggested these are mandatory or a prerequisite for reopening but this is not the case. The questionnaires have not been agreed nationally and are not in the SOP, and LOCs are querying them locally. Until the position is further clarified, we are advising FODO members to check the status of local discussions with the relevant LOC and, if necessary, respond to regional office questionnaires along the following lines:

“Thank you for your aide-memoire/checklist which we understand LOCs are discussing with you. We can confirm that [PRACTICE NAME and ODS CODE] is open from [DATE] in accordance with NHS England’s 17 June letter and SOP. We have carried out a risk assessment and are currently focusing on keeping our patients, staff and the public safe in line with College of Optometrist and ABDO guidance. We hope this is helpful in enabling you to form a regional overview.” 

8.  GOC statement on the ESR

The GOC has issued a statement about its Education Strategic Review (ESR) in response to an article in ‘Dispensing Optics’ magazine in June. In the article, the general secretary of the Association of British Dispensing Opticians (ABDO) expresses concern that the GOC did not pause the review during the pandemic. Read the statement.