Fee for the delivery of eye care in special schools is “insufficient” says the OFNC

The fee proposed by NHS England for the delivery of eye care for children through the special schools eye care service is “insufficient” the Optometric Fees Negotiating Committee (OFNC) has said.

The signed regulations, dated 20 December, detail that the general ophthalmic services (GOS) sight test fee payable for eye care delivered within a special educational setting is £85.

In a statement issued last week, the OFNC labelled the newly proposed fee as “insufficient to provide the unique, ongoing care that is required.”

“We urge NHS England to reconsider the fee for this important service as a matter of urgency,” it added.

The OFNC, which is the recognised negotiating body for GOS fees and grants for community optometry, highlighted that is has voiced it concerns about the fee to NHS England “on many occasions.”

“We feel those concerns have not been heeded,” the statement emphasised.

In the statement, the OFNC explained that while NHS England has said that it considers the service delivered in the special schools setting to be similar to the traditional domiciliary sight testing service, it believes there are important differences that must be acknowledged.

“This service was meant to provide ongoing care for a cohort of patients with unique challenges,” the OFNC stated. “At the inception of the Special Schools Eye Care Service, there was a recognition that to provide the best possible level of care, things had to be done differently to a standard sight test, that practitioners may need to visit these patients on multiple occasions to build a rapport and gain their trust so that a successful examination could be undertaken,” it added

The OFNC expressed that the fee will “only allow for a simple, single visit type examination.”

“We fear this will mean that either a huge unfunded burden will be placed on those delivering the service, making it unsustainable, or the service as delivered will not match that which was intended and evaluated during the proof of concept,” the OFNC emphasised.

Speaking to OT, SeeAbility said “the 27% cut in fee to £85 is entirely arbitrary.”

Lisa Donaldson, SeeAbility head of eye care and vision, told OT: “It does not reflect the unique nature of the service and the successful outcomes the proof of concept model has delivered over the past three years, nor the previous years of planning and evidence base.

"It is plainly much more than a domiciliary service and for £116 it had been delivering a one stop shop of care and support for many children. These children were otherwise not receiving any eye care, or were receiving it from overstretched hospital services, which costs much more and which present challenges in attendance or adherence to treatment for this vulnerable population.”

Donaldson warned: “Proposed changes to the model could mean it fails to achieve the outcomes of the tried and tested model. We are deeply worried that continuity of care, the ability of hospitals to discharge to the service, and ultimately children being able to see throughout their special education could be lost, and that is even if there are providers willing to deliver the service at all – which everyone is beginning to question. Ultimately the promise of a service could ring very hollow.”

”We are urging the Minister to bring everyone around the table again now he has seen the service for himself.”

The publication of the fee comes after NHS England confirmed last year that free eye examinations would be rolled out to children in a special schools setting in England from 2025.

The October announcement came following a successful pilot of the service, which, since 2021 has seen children in 83 special schools in England receive eye examinations from specially trained optometrists and dispensing opticians.

The rollout of the service means an estimated 165,000 children will benefit from eye examinations in their school settings.