A short while ago I took part in a practice inspection prior to granting of an NHS contract. The preparation for this visit was intriguing. It appeared that far more preparation time was spent making sure the bureaucratic paperwork was correct rather than any emphasis on the quality of the sight care that would be delivered under that contract.
However, it is not the never-ending paperchase that I wish to concentrate on in this month’s column. Rather, I would like to concentrate on a conversation that arose during the examination of the quality of the record card keeping. I am pleased to say that in the main there was no fault found but it was the issue of recall intervals that arose at this point. While the record card showed the time interval recommended by the optometrist before the next visit it was pointed out that no actual reason for that time interval was written down. In response to the comment that there was no legal requirement to justify in writing the recall interval it was pointed out that in the current climate that was not really the issue. The record being discussed was of a 74-year-old patient and the record stated ‘retest one year’. A practice member pointed out that as the patient was over 70 the minimum sight test interval was one year and hence this was deemed appropriate. But as we all know that one year interval is a minimum test interval. The understanding of this is of vital importance to all NHS contractors. It is very clear that the vast majority of contractors do not, and never have, really grasped the concept of an NHS sight test.
A lot of people, not least our professional bodies, seem to think that NHS sight testing is about eye health. I am afraid to say that nothing could be further from the truth. NHS sight testing has never primarily been about eye health, just another reason why the GOS is such a useless tool in a modern age. The NHS Contract regulations concerning a sight test state: ‘A contractor shall, having accepted an application from or on behalf of a patient for the testing of sight – (a) secure the testing of the patient’s sight to determine whether the patient needs to wear or use an optical appliance; and (b) in so doing, shall secure the fulfilment of any duty imposed on a tester of sight by, or in regulations made under, section 26 of the Opticians Act.’ That section of the Opticians Act states, “when a registered medical practitioner or registered optometrist tests the sight of another person, it shall be their 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.”
To put this in lay terms, the contract regulations mean that the primary reason for a sight test is for the purpose of correcting or remedying a defect of sight and then while you are at it you can also check the eyes are healthy. It is really important to grasp the meaning of this because what this makes very clear is that the NHS GOS sight test is definitely not a vehicle to monitor a person’s eye health even though they may be at increased risk. The driver for an NHS sight test is, and always must be, symptom led by symptomatic change in the level of vision. To review a person over 70 at one year intervals just because they are over 70 is in contravention of those regulations.
What does this all mean in reality? Let me say that I think the regulations as they stand are crass and simply highlight just how out of date and unworkable they are. But they are what they are and we need to make sure we do not fall foul of them and cause a PPV visit resulting in huge repayments by practitioners. Anyone seeing patients on a routine basis due to sending their patients a reminder letter because they want to check eye health is skating on very thin ice indeed. Testing any patient’s eyes using a GOS1 form when that person is not reporting a problem with the clarity of their vision is in direct contravention of the NHS regulations and puts the practice and that practice’s NHS contract at risk. This is a serious problem for us all
and is a major obstacle to eye health care under the NHS.
In this year of 2020 when we should be focusing on eye health there is a very urgent need for our professional bodies to get this totally unworkable contract changed to reflect a modern eye healthcare service or to suspend all NHS work until the risks that this contract exposes us all to are removed from the contract. Firstly though, it is vital that they seek formal clarification of what the prime purpose of an NHS sight test is. Until this is done most, if not all, NHS contractors are running a huge risk.