As the pandemic has progressed, more patients have eye care needs that count as essential care due to a broadening of its definition.
The Optometric Fees Negotiating Committee (OFNC) highlighted that NHS England’s letter on April 1 enabled practitioners to exercise their professional judgement to determine whether a patient’s needs are essential.
NHS England’s letter said: ‘…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.’
In its latest update, the OFNC recognised that there is now an expanded range of situations where a patient’s needs are likely to be essential.
Tony Stafford, policy director at the Association of Optometrists, said: ‘The bodies that make up the OFNC were seeing a rising level of enquiries about when care qualifies as essential. Given the uncertainty about when the current restrictions will be eased, we felt a short statement highlighting patient needs that can be considered essential would help the sector adopt a consistent approach.’
A range of examples were included by the OFNC, such as patients who require an appointment due to clinical risk factors that are being monitored by the clinician.
‘While in the initial stages of the pandemic deferring these appointments was acceptably low risk and justified when balanced against the risks of providing face-to-face care, the passage of time since the last examination may now have increased the risk to the point where the patient’s needs now fall within the definition of essential care,’ the OFNC said.
Additionally, patients with a minor reduction in vision and patients with broken spectacles that have been “making do” with older spectacles that have an out of date prescription could now also fall under essential care.
The OFNC said that these patients may not have met the definition of essential eye care in the initial stages of lockdown because the patient’s condition may not have had a material effect on sight or wellbeing.
Its update said that as lockdown conditions ease and patients start to undertake more vision-dependent tasks, such as working and driving, it is likely that more of these patients have needs that fall within the definition of essential care.
Patients who are anxious or concerned about their vision, in the absence of clear clinical indications, may now also fall under essential care because of the effect of the pandemic and the lockdown on their wellbeing.
‘This may lead to them developing mental health problems or exacerbating existing mental health problems. As such these patients’ need may now meet the definition of essential care,’ the OFNC statement highlighted.
The OFNC added: ‘All patients should be considered on a case by case basis by the appropriate clinician, using remote triage in the first instance, to determine whether in their professional judgement the patient requires a face-to-face appointment.’
Arrangements for optical practices to provide more face-to-face care are part of conversations between the OFNC and NHS England, following the announcement that dental practices can re-open from June 8.
NHS England announced on May 28 that it was asking all dental practices to commence opening for face-to-face care, subject to having the necessary infection control measures and PPE in place.
In a statement, the OFNC highlighted it was clear that the goal is to resume safe practise for patients and practitioners as soon as possible, with dentists asked to consider urgency of patient need, the unmet needs of vulnerable groups and the capacity to provide care.
‘The OFNC continues to work urgently with NHS England to agree appropriate arrangements for optical practices to provide more face-to-face care as soon as possible. As with dentistry, the need for infection control and social distancing will reduce the number of patients that practices can safely see face-to-face,’ the OFNC said.
It also noted that the current temporary financial arrangements for dentistry are to be maintained initially and it is similarly discussing with NHS England how the financial impact on optical practices of the necessary changes in the way care is delivered can be mitigated.
‘We encourage all practices to continue to prepare for a wider resumption of face-to-face care in the near future,’ the OFNC concluded.