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22 February 2021
The Clinical Council for Eye Health Commissioning (CCEHC) has released a series of recommendations aimed at tackling a vision screening backlog that has developed in the wake of the COVID-19 pandemic.
The CCEHC recommends that parents of children who started their reception year in 2019 or 2020 but missed out on vision screening should be advised to have an NHS sight test if the resumption of the local vision screening programme is not imminent.
The CCEHC has produced a template letter as a starting point for local agreement on how advice could be presented to parents.
Alongside recommendations for those in charge of screening provision and specialist eye services, the CCEHC has produced guidance on the responsibilities of optical practices.
Optical practices should provide NHS sight tests under General Ophthalmic Services for children whose parents present with a vision screening letter.
These sight tests should be aligned with professional practice guidance, which recommends the assessment of crowded logMAR letter acuity and optometrists should provide a GOS2 statement or prescription to enable parents to report back to the screening programme.
If indicated, children should be referred to secondary care in line with local guidance.
Optometrist Dr Julie-Anne Little, a member of the CCEHC’s vision screening working group, stressed the importance of addressing the screening backlog in order to detect vision loss and amblyopia in children.
She highlighted that optometrists may see an increase in the number of children coming into practice.
“It is important to note that primary care can provide an interim solution to this problem to help alleviate the backlog that the COVID-19 pandemic has caused,” Dr Little said.
She added that the current measures are not a long-term change to the way that screening operates but there is potential to showcase the value of optometry.
“There is opportunity to show primary care could be useful and perhaps lay the ground for future children's vision pathways,” Dr Little emphasised.
The CCEHC recommends that parents of children who started their reception year in 2019 or 2020 but missed out on vision screening should be advised to have an NHS sight test if the resumption of the local vision screening programme is not imminent.
The CCEHC has produced a template letter as a starting point for local agreement on how advice could be presented to parents.
Alongside recommendations for those in charge of screening provision and specialist eye services, the CCEHC has produced guidance on the responsibilities of optical practices.
Optical practices should provide NHS sight tests under General Ophthalmic Services for children whose parents present with a vision screening letter.
These sight tests should be aligned with professional practice guidance, which recommends the assessment of crowded logMAR letter acuity and optometrists should provide a GOS2 statement or prescription to enable parents to report back to the screening programme.
If indicated, children should be referred to secondary care in line with local guidance.
Optometrist Dr Julie-Anne Little, a member of the CCEHC’s vision screening working group, stressed the importance of addressing the screening backlog in order to detect vision loss and amblyopia in children.
She highlighted that optometrists may see an increase in the number of children coming into practice.
“It is important to note that primary care can provide an interim solution to this problem to help alleviate the backlog that the COVID-19 pandemic has caused,” Dr Little said.
She added that the current measures are not a long-term change to the way that screening operates but there is potential to showcase the value of optometry.
“There is opportunity to show primary care could be useful and perhaps lay the ground for future children's vision pathways,” Dr Little emphasised.
Comments (3)
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Anonymous25 February 2021
I agree with the comments made below. Also, I have concerns over how much more optical practices are expected to absorb. CUES, repeat IOP’s, pre and post cataract appointments and now children’s screening? Which, like already stated, will not be a 'screening'.
As great as the idea may sound to promote Optometry and increase footfall, the greater concern for me is:
- the inability to accommodate an influx of children's appointments due to the backlog from the pandemic,
- the risk to businesses, of seeing a large number of Reception aged children, most of whom will be emmetropic; This also risks independents dropping GOS offerings and going fully private;
- the risk that some parents may not be organised/free enough to take their child for an eye exam, thus the few children that do have problems will be missed;
Why not organise the current screening set-up, seeing as all children in a class, are part of one bubble, thus it seems logical for the screener to go in to a school and carry out a screening, as opposed to numerous children AND parents attending an optical practice, where a full exam followed by a thorough cleaning will be required.
If there is not adequate NHS staffing for this, Optometrists could be hired to do this across various schools?
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Anonymous25 February 2021
Yet again our College appears to be agreeing to something that does not take into account financial consequences of its actions and I am sorry that they have pushed it back to the LOCs to pick up the pieces. Our NHS GOS contract does not allow us to discriminate against children and refuse to see them nor does it allow us just to “screen" these children. A full longer sight test including ophthalmoscopy and refraction would have to be performed on every child unlike the current school screening protocol.
At the moment due to social distancing many practices are working with reduced chair capacity to some extent the cost of this has been offset by only seeing those with essential needs resulting in a increase in takings per test. Adding hundreds of children locally of whom only a very small percentage would require spectacles is again another nail in the coffin for English NHS GOS. It risks those with essential, urgent and emergency needs not getting an appointment as required.
There is maybe a possibility if HES Departments, the current school screening contract holders and LOCs can jointly work on a less time consuming optometric children screening pathway (we have tried for years) that then seamlessly moves on to GOS refraction for those that require it. But screening needs separate funding and protocol to GOS. Without this yet again I can see HES DEPTS setting up their own preferred pathway, without money following the patient and ignoring the requirements of local optometric primary care.
An added concern should be HES would not stagger these reminders over the year as they would have seen schools but send out a whole years plus reminders in bulk now!
Remember 100s of emmetropic kids are also more likely to have pre -presbyopic emmetropic parents so the idea that if you get the kids, you get the parents is also flawed in this scenario.
Only this last week I was reading a forum posting from a resident working in a multiple who was being stressed by the practice managers because 4 of the 10 patients they had seen that day, were no Rx children which had skewed the practices conversion rates to head office. Imagine what the pressure will be like with 1000’s of more No Rx in England.
I hope LOCs will quickly engage with CHFT and make them aware what has been suggested is not acceptable and would not be supported as it has been suggested.
Report Like 226
Anonymous25 February 2021
Yet again our College appears to be agreeing to something that does not take into account financial consequences of its actions and I am sorry that they have pushed it back to the LOCs to pick up the pieces. Our NHS GOS contract does not allow us to discriminate against children and refuse to see them nor does it allow us just to “screen" these children. A full longer sight test including ophthalmoscopy and refraction would have to be performed on every child unlike the current school screening protocol.
At the moment due to social distancing many practices are working with reduced chair capacity to some extent the cost of this has been offset by only seeing those with essential needs resulting in a increase in takings per test. Adding hundreds of children locally of whom only a very small percentage would require spectacles is again another nail in the coffin for English NHS GOS. It risks those with essential, urgent and emergency needs not getting an appointment as required.
There is maybe a possibility if, HES departments - the current school screening contract holders and LOCs can jointly work on a less time consuming optometric children screening pathway (we have tried for years) that then seamlessly moves on to GOS refraction for those that require it. But screening needs separate funding and protocol to GOS. Without this yet again I can see HES / ORTHOPTISTS setting up their own preferred pathway, without money following the patient and ignoring the requirements of local optometric primary care.
An added concern should be HES would not stagger these reminders over the year as they would have seen schools but send out a whole years plus reminders in bulk now!
Remember 100s of emmetropic kids are also more likely to have pre -presbyopic emmetropic parents so the idea that if you get the kids, you get the parents is also flawed in this scenario.
Only this last week I was reading a forum posting from a resident working in a multiple who was being stressed by the practice managers because 4 of the 10 patients they had seen that day, were no Rx children which had skewed the practices conversion rates to head office. Imagine what the pressure will be like with 1000’s of more No Rx in England.
I hope LOCs will quickly engage with HES / NHS ENGLAND and make them aware what has been suggested is not acceptable and would not be supported as it has been suggested.
Report Like 239