Considerations for practices in England around staying open during the COVID-19 pandemic

Guidance for practice owners

Reception desk

Funding for practices 

These pages set out the things you should consider as a practice owner in England, when deciding whether to stay open during the COVID-19 pandemic. 

Small business grants and retail and leisure grants

The criteria for business grants are not affected by the availability of NHS England funding. However, if you receive NHS funding because you’re continuing to provide essential care, then at the end of the crisis NHS England will run a reconciliation process to check that the NHS funding you’ve received is reasonable. The process has not yet been agreed, but NHS England is likely to want evidence that any general Government support you’ve received hasn’t been used to fund the provision of essential care.

If the value of any business grants you’ve received during the crisis is less than the value of the retail and other private revenue you would normally have earned, this should be straightforward. However, if the value of your business grants is greater than the value of your ‘lost’ retail and private revenue, NHS England may assume you have used the difference to help fund essential care, and seek a partial repayment of the NHS support provided.

NHS funding

To qualify you must be at least open for essential care, but this can be remotely via telephone/email and only seeing patients face to face if you have no other choice. The current advice is that:

  • Patients must be able to contact the practice during its normal opening hours, but this can be by phone or email – for instance you could use an answerphone message asking patients to contact a mobile phone or to send you an email
     
  • The College of Optometrists guidance on providing care during the crisis recommends that you lock the doors of the practice during opening hours and admit patients for pre-booked appointments only. You should provide care remotely via a phone or video consultation where possible. The College has published guidance on conducting remote consultations

  • You also have the option of changing your contractual NHS opening hours via the formal contract variation process

The NHS England definition of essential care and urgent or emergency care is:

  • Essential eye care currently delivered under General Ophthalmic Services (GOS). This includes but is not limited to appointments for patients who would not normally be considered 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 

  • Urgent or emergency eye care where a contract is held with a CCG to deliver urgent clinical advice or intervention e.g. red eye, contact lens discomfort, foreign object, sudden change in vision, flashes and floaters which might suggest detachment etc., or where the patient has been advised to attend a practice by NHS 111 or another healthcare professional for urgent eye care 

Should I stay open for GOS, or close and furlough staff/ take the self-employed help

On the simplest level, if the value of your GOS income is in excess of the cost of the staff required to stay open, then, in general, you will most likely be better off to continue to provide GOS. For a definitive decision, you must also consider any changes to rent and other bills that may affect your practice expenditure along with the potential for any private income from spectacle sales and similar. 

Remember, you cannot claim furlough costs for staff actively working. If they are working, they need to be paid as normal. 

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 loss of 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.

For example, if a self-employed practice owner had total profits less than £50,000 and had seen a drop in profits of £10,000 in relation to private sales or non GOS services, they could claim the self-employed support and also receive the GOS funding support. If the practice derived most of its income from GOS and therefore profits had not dropped, then under NHS England guidelines they should not be claiming any self-employed funding. 

You may wish to seek accountancy advice on this point.

NHS deduction for consumables

The amount of deduction for “consumables” has not yet been discussed. In the absence of that, we need to make some assumption regarding how that might affect the real average GOS payment. We’ve developed a table for members showing the potential NHS reduction for consumables, per £1000 GOS income.

Examples of things to consider based on common business structures

Sole trader optometrist £50k+ profits

Is furlough available for the optometrist/s?

No*

Is there eligibility for the self-employed support scheme?

No

Comments

As the two main schemes cannot be accessed GOS income is likely to be better than nothing. 

*Although furlough support might not be available for the optometrist. It would apply to any other staff paid through PAYE. 

Sole trader optometrist <£50k profits

Is furlough available for the optometrist/s?

No*

Is there eligibility for the self-employed support scheme?

Yes

Comments

If the drop in profits due to your private sales and non-GOS services enables you to claim self-employed support, you should. However, you must ensure that this claim relates to the loss of non-GOS income. If it does you would still be able to claim GOS funding support.

*Although furlough support might not be available for the optometrist. It would apply to any other staff paid through PAYE. 

Limited company single optometrist director, no employed optometrists. Director paid small wage through PAYE with larger dividend at end of year

Is furlough available for the optometrist/s?

Yes (only on the PAYE wage)

Is there eligibility for the self-employed support scheme?

No

Comments

Unless the GOS income is less than the 80% furlough grant of the small wage, you are likely to be better off staying open for GOS.

Limited company single optometrist director, no employed optometrists. Director paid normal optometrist wage through PAYE with dividend at end of year

Is furlough available for the optometrist/s?

Yes (only on the PAYE wage)

Is there eligibility for the self-employed support scheme?

No

Comments

You should compare the GOS payment to the cost of staff wages required to stay open. You should consider if there are other cheaper staff who can provide GOS care and whether you can hire a locum to cover any face to face appointments that might be needed. 

Limited company multiple optometrists. Directors paid small wage through PAYE with larger dividend at end of year

Is furlough available for the optometrist/s?

Yes, for employed optometrists (directors - only on the PAYE wage)

Is there eligibility for the self-employed support scheme?

No

Comments

This will depend on the wage levels; you may be able to furlough a number of optometrists and one of the directors can provide all of the essential care. This is likely to improve income, especially as with multiple optometrists GOS income is likely to be a significant amount. 

Limited company multiple optometrists. Directors paid normal wage through PAYE with dividend at end of year

Is furlough available for the optometrist/s?

Yes (on the PAYE wages)

Is there eligibility for the self-employed support scheme?

No

Comments

With multiple optometrists it is likely that the GOS income is a significant amount. It is also likely that even with the cost of an optometrist, you are better off staying open. 

Partnership at least one optometrist each partner £50K+ profits

Is furlough available for the optometrist/s?

No*

Is there eligibility for the self-employed support scheme?

No

Comments

As the two main schemes cannot be accessed GOS income is likely to be better than nothing. 

 

*Although furlough support might not be available for the optometrist. It would apply to any other staff paid through PAYE. 

Partnership at least one optometrist each partner <£50K profits

Is furlough available for the optometrist/s?

No*

Is there eligibility for the self-employed support scheme?

Yes

Comments

This will depend on the relationship of the partners and the level of profits. If they are related the consideration becomes one of which gives the highest household income. 

If the decrease in profits due to your private sales and non-GOS services enables you to claim self-employed support, you should. However, you must ensure that this claim relates to the loss of non-GOS income only. If it does you would still be able to claim GOS funding support. 

*Although furlough support might not be available for the optometrist. It would apply to any other staff paid through PAYE.