Common questions about coronavirus

Information for members about Novel Coronavirus (COVID-19). Updated 4 May 2020

Coronavirus

These FAQs are designed to address the most common questions that the AOP has received around COVID-19. It is not an exhaustive list, but we will be reviewing and updating them as new information becomes available.

1. Should I be wearing a face mask or personal protective equipment (PPE)?

The PHE guidance clearly states a risk assessment should be conducted. Aprons and masks are very hard to argue against. 

You might decide that with a large slit lamp shield, goggles aren’t needed, also gloves don’t negate good hand hygiene and unless you have an open wound, you might decide they aren’t essential. These are personal decisions and should not be forced upon you. 

2. Where do I get PPE? Can I access the NHS supply chain?

There is a shortage of PPE on a national level and it is important that those with the greatest need, that is, those treating patients with active disease are prioritised. There are a number of modified breath shields being made.
  
If members choose to not follow guidance on the use of masks, they should take all practical steps to minimise time spent in close proximity while still delivering suitable patient care.  
 

The AOP, in conjunction with other sector bodies, is in constant touch with the NHS about PPE, which is a challenge for all healthcare providers not just optometry.

3. Can I refuse to see patients who are ill or are returning from a high risk area?

Yes. Optical practices should remain open to provide urgent and essential care.

Patients who are symptomatic are being advised to self isolate by the government. Therefore it is reasonable to refuse to see these patients until they have recovered and are no longer considered contagious. If their concern is potentially slight threatening they should be directed to contact the hospital for advice.

4. I'm pregnant. Am I or my baby at greater risk?

The government has advised that pregnant women are in the at risk category and within days will be asked to stay at home for 12 weeks.

For the latest guidance from The Royal College of Obstetricians and Gynaecologists, see: Coronavirus (COVID-19) Infection in Pregnancy

5. Should I close the practice/should we be seeing any patients?

The Welsh, Scottish and Northern Ireland governments have all issued advice on the care that optical practices should continue to provide during the COVID-19 crisis. NHS England has belatedly said that all routine care should stop, but that practices may remain open to provide essential or urgent care. Where possible this should be done remotely, only seeing face to face those who cannot be helped in other ways. 

Urgent and essential care has been defined by NHS England as:

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 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.

Urgent or emergency eye care where a contract is held with a CCG to deliver urgent clinical advice or intervention e.g. for 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. 

Guidance in Wales roughly mirrors that of England, but urgent and emergency care is delivered via EHEW Band 1 and Band 3. 

Guidance in Scotland has been updated to say that face to face in normal practice is no longer allowed and that practices should direct any one requiring a face to face appointment to the nearest Emergency Eyecare Treatment Centre (EETC). 

6. I've seen reports that viral conjunctivitis is a presenting symptom. Is that correct?

Viral conjunctivitis does not currently form part of the case definition for COVID-19. However, as with any upper respiratory tract infection patients may develop viral conjunctivitis as a secondary complication of COVID-19. Based upon current information, while it is possible to acquire COVID-19 from the aerosolised tears of someone infected, it is unlikely that someone will present with viral conjunctivitis secondary to COVID-19 without the common symptoms. If the patient has cold, flu or any upper respiratory tract symptoms they should be self-isolating and should not be seen in optometric practice. 

7. Is my employer liable if I catch coronavirus?

Employers have an obligation to take reasonable steps to ensure staff are safe. As long as they do this they would not be liable. In this instance, that would be checking patients do not have symptoms of coronavirus infection. Practices should be asking screening questions when the patient books and reiterating them at any reminder calls. If patients are asymptomatic there is currently no reason not to see them.          

External advice on employment matters can be found on the ACAS site - see Coronavirus (COVID-19): advice for employers and employees

8. Am I liable if I give a patient coronavirus?

If you do not self isolate when required to do so and knowingly place patients at risk, then potentially. However if you were asymptomatic yet contagious, it is unlikely that you would be held responsible.

9. Can I refuse to see patients who are at a high risk of having coronavirus after being around people who have been diagnosed?

Patients without symptoms can be seen if it meets the definition of essential or urgent care above. However, if they have been in contact with someone with a confirmed case, it is our advice that they should wait seven days since that contact before attending for a routine appointment.

10. Should we refuse to see at risk groups such as the over 70s for routine appointments?

Routine care has been suspended in all parts of the UK. Therefore only those meeting the definition or essential or urgent care should be seen.

11. Can I claim a for a home visit (GOS 6) and see the patient at home if they are self-isolating?

Currently well but self-isolating patients would not be a reason for a GOS 6 to be used. The patient should be advised to book an appointment at a later date, or if they need spectacles a telephone consultation may be suitable.

12. Can I supply glasses or contact lenses by post to patients who can’t attend the practice due to risk factors associated with coronavirus?

The GOC has published a statement about this: see General Optical Council (GOC) statement on supply of spectacles and contact lenses during COVID-19 emergency.

They make it clear that as long as it is in the best interests of the patient that you can provide contact lenses or spectacles to an expired specification or prescription.

The AOP has worked with other sector bodies to develop interactive forms for this process, to minimise risk to patients. See: Telephone-based consultancy for replacement glasses and contact lenses - guidance and templates.

13. What do I do if a patient needs referral?

Given the current pressures on secondary care due to coronavirus, it is our view that routine referrals should now be advised that here may be a significant wait to be seen. To avoid patients being lost it may be appropriate to follow up the patient on a shorter recall before referring them. This would only be appropriate for routine referrals, where the risk to the patient is low. 

14. Are optometrists key workers?

In our view all essential optical staff involved in offering urgent and essential care will meet the Government definition of a key worker for the purpose of access to schools and transport. ABDO has published an ‘essential workers’ template letter for optical practices to help their staff demonstrate this to schools. Key workers should only place children in school where absolutely necessary at this time.

15. I have been informed that my practice insurance does not cover business interruption due to coronavirus (COVID-19). Could that be correct?

Yes. As outlined on the Association of British Insurers’ website, almost all practice insurance policies in the market will not have made provisions for this unprecedented COVID-19 outbreak. This principle applies to the Lloyd & Whyte policy for optical practices. 
 
We understand it is unlikely that the government would classify COVID-19 in a way that would force insurance companies to pay claims when the terms of the policy have not been met. But, in light of the unprecedented level of strain the situation is having on businesses, the government has announced that it is reviewing other funding solutions to support small to medium sized businesses as a priority. The AOP team will continue to provide guidance for members as soon as the government announces any updates.

16. Will it affect my NHS grant if I apply for a government Bounce Back Loan for my business?

As it is a loan and not a payment, your NHS grant will not be affected if you apply for a Bounce Back Loan

The Bounce Back Loan scheme helps small and medium-sized businesses to borrow between £2,000 and £50,000.

The government guarantees 100% of the loan and there won’t be any fees or interest to pay for the first 12 months. Loan terms will be up to six years. 

Members should seek their own financial advice if they wish to apply for the loan.