Last month, I suggested that ‘working to contract’ should be a consideration to achieve our service provision aims going forward. But how many of us understand what that would mean? I ask this question because, when talking to many practitioners, they don’t seem to understand what an NHS sight test entails.
This is made even more confusing when our own professional bodies keep reminding us that eye examinations are an important part of an overall comprehensive healthcare regime. But, notice the different wording. A sight test is not an eye examination. Just to add to the confusion, we have organisations referring to ‘eye tests’ in their literature. This term has no meaning at all.
Why do I bring this up this month? Simply because I was handed a reminder letter sent to someone recently and they asked me what the letter actually meant.
This letter very specifically pointed out ‘remember your eye test is paid for by the NHS’. This was because they were aged over 60. The person asked me if they needed to go for a sight test as they were seeing clearly and having no problems with their sight at all. I pointed out that often an eye examination could find other issues that initially might not affect the clarity of vision that the reminder letter also pointed out.
Interestingly, the point that this person made was that I had mentioned the phrase ‘eye examination’, which, semantically was not a sight test. Now, you might say this is splitting hairs but is it really? A sight test is a legally defined term that forms an integral part of the NHS contract to which we are legally bound to comply.
The contract states: ‘The contractor shall, having accepted an application from or on behalf of an eligible person for the testing of sight – 30.1, secure the testing of the patient’s sight to determine whether he needs to wear or use an optical appliance; and in so doing, secure the fulfilment of any duty imposed on a tester of sight by, or in regulations made under, section 26 of the Opticians Act.
And that section states, ‘when a registered medical practitioner or registered optometrist tests the sight of another person, it shall be his duty to perform such examinations of the eye for the purpose of detecting injury, disease or abnormality in the eye or elsewhere as the regulations may require.’
Therefore, it is very clear that an NHS sight test is not primarily designed as a tool to detect eye disease or abnormality, but, rather, to determine whether someone who is having difficulty with the clarity of their vision requires an optical appliance or not. Then, almost as an afterthought, check everything else is okay.
The implications of this are profound indeed because, while we all understand the reason for regular eye health checks, and our professional bodies insist we carry these checks out fully, these eye health checks are not the legal reason as laid out in the NHS contract for an NHS sight test.
In reality, the NHS contract specifically states that only after checking the clarity of a person’s vision should we consider, as an adjunct, checking the eyes are healthy.
So, what does this all mean? Put simply, sending out a reminder for a person to have their eyes checked to see if they are healthy, despite not experiencing any visual problems, may be laudable but such a reason does not constitute a reason to carry out an NHS sight test, and as such, cannot be claimed for as an NHS sight test.
Worse still, is to say in a reminder letter that the NHS will pay for this as patently it is not obliged to do so. This calls into question the whole system of randomly recalling patients for their next eye test, or whatever you choose to call it.
I realise that this may sound pedantic, and indeed ridiculous, but it highlights just how unworkable our current NHS contract is. This contract is hopelessly badly worded and does not reflect good modern healthcare practice. But it is a legally binding document and, as such, could be used by cash strapped NHS bodies as a tool to recoup monies paid out that are not in accordance with that contract.
The contract merely highlights the parlous state that NHS eye care systems are in currently. While I totally support the quest for expanding our scope of services, it is vital that these extensions are added to a house built on rock, not sand, which is where our current contract leaves us.
It is time to tear up this terrible contract and rewrite it fit for a modern service.