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General Ophthalmic Services

Eye Care

NHS National Services Scotland ISD Scotland & NHS National Services Scotland

Introduction

In Scotland, the NHS General Ophthalmic Service is provided by eye care professionals who are contracted to use a wide range of tests and procedures to examine both the eyes and vision of a patient during a routine examination, provide eye glasses, contact lenses, repairs or replacements to damaged glasses. ISD collects information on NHS General Ophthalmic Service activity in Scotland, as performed by eye care professionals.

These data are collected on a series of forms referred to as GOS (General Ophthalmic Services) forms.

If a patient is entitled to free or subsidised eye care (excluding eye examinations), they must present evidence of this to the eye care professional (Exemption categories).

The contractor submits a claim form for the services provided, which is signed by both the contractor and the patient. This claim forms are sent to Practitioner Services (PSD; now part of Practitioner & Counter Fraud Services) for processing the payments. The forms are scanned and their information is stored in a database called OPTIX. ISD then collates these data to provide annual tables of eye examinations and vouchers claimed under GOS activity. The data exclude NHS Hospital Eye Services and optical service provided privately.


Legislative Background

POLICY RELATING TO EYE EXAMINATION/SIGHT TESTS:

On 1 April 2010 the NHS (General Ophthalmic Services) (Scotland) Regulations 2006 were amended to provide that primary eye examinations should only be undertaken in line with set frequencies for different categories of patients, i.e. 1 or 2 years. Other eye examinations required at shorter intervals than these frequencies are undertaken as supplementary eye examinations.

On 1st April 2006, the NHS (General Ophthalmic Services) (Scotland) Regulations were established. Everyone in Scotland became eligible for a fully-funded comprehensive NHS primary eye examination. The traditional NHS "sight test" was replaced by a comprehensive eye examination appropriate to the patient's needs. An initial eye examination could be carried out (primary eye examination) and where necessary a second eye examination (supplementary eye examination). The recommendation was that a primary eye examination would be carried out at least every two years for all patients. However, certain groups of patients were eligible for an annual primary eye examination.

  • Children < 16 years
  • Persons > 60 years
  • Patients with Diabetes
  • Patients with Glaucoma
  • Patients > 40 years, closely related to someone with Glaucoma**

Note ** relates to first generation (e.g. Mother, Father, Sister, Brother, Son, Daughter).

Prior to 2006, the only people eligible for NHS/GOS sight tests were:

  • Children < 16 years (eligible annually)
  • Adults < 19 years in full-time education (eligible every 2 years)
  • Pensions > 70 years (eligible annually)
  • Patients with Diabetes (eligible annually)
  • Patients with Glaucoma (eligible annually)
  • Patients > 40 years, closely related to someone with Glaucoma** (eligible annually)

Note ** relates to first generation (e.g. Mother, Father, Sister, Brother, Son, Daughter).

POLICY RELATING TO VOUCHERS TOWARDS THE COSTS OF GLASSES:

In October 2003, a new category of "pension credit guarantee credit" was introduced.

In April 2003, "Working Family Tax Credit" and "Disabled Person's Tax Credit" were replaced by new tax credits. Those named on, or entitled to, an NHS tax credit exemption certificate are entitled to a fully-funded NHS eye examination and voucher towards the cost of glasses or contact lenses.

On 1st July 1986, the NHS spectacle voucher scheme came into effect. Entitlement to a voucher is, with the exception of children and those who require complex lenses, based on income.

Form Types

General Ophthalmic Service (GOS) forms are completed by the Contractor for services rendered. Detailed information on the form types used in the production of the data on these web pages is provided below.

  • GOS(S)1 forms are used for claiming the appropriate fee for an NHS eye examination.
  • GOS(S)2 forms are issued by ophthalmic practices following a patients eye examination detailing the patient's optical prescription and any other details as deemed appropriate.
  • GOS(S)3 forms are referred to as 'vouchers' and are used to provide eye glasses/contact lenses.
  • GOS(S)4 forms are vouchers used for repairs and replacement of eye glasses/contact lenses.
  • HES(S)1, HES(S)3 and HES(S)4 are issued by the hospital eye services (HES). HES is responsible for meeting the ophthalmic needs of hospital outpatients and, where necessary, for making arrangements for this work to be undertaken by GOS Contractors. The Hospital Eye Service will normally sight test and provide optical appliances from within its own resources. Where this is not practical, hospital administrators may be asked to contact the local Area Optical Committee, which represents local GOS Contractors, to ascertain whether a local optometrist(s) would be willing to visit the hospital concerned and undertake sight testing and dispensing of glasses for patients requiring them. A hospital outpatient is not required to pay statutory charges for lenses and frames.

Exemption Categories

Prior to the introduction of fully-funded NHS eye examinations for everyone on 1st April 2006, there were several exemption categories for those who did not need to pay for their sight test.

  • Those under 16 years old.
  • Full-time students aged 16 to 18.
  • Those aged 60 and over.
  • Those on income support.
  • Those on income-based job seeker's allowance (JSA).
  • Those named on, or entitled to, an NHS Tax Credit Exemption Certificate.
  • Those with pension credit guarantee credit.
  • Those registered as blind or partially sighted.
  • Those with diagnosed glaucoma.
  • Those aged 40 or over who are the parent, brother, sister, son or daughter of a person with diagnosed glaucoma.
  • Those with diagnosed diabetes.
  • Those at risk of glaucoma.
  • Those with an HC2 or HC3 Certificate. These certificates are means-tested, and the claimant needs to apply for the certificate with evidence of their income. They are primarily for low earners who do not fall into any of the other categories. HC3 certificates require an individually determined patient contribution towards the costs.

There are also some patients who are entitled to help with the cost of optical appliances. Those who qualify for help are listed below.

  • Those under 16 years old.
  • Full-time students aged 16 to 18.
  • Those on income support.
  • Those on income-based job-seeker's allowance.
  • Those name on, or entitled to, an NHS Tax Credit Exemption Certificate.
  • Those with pension credit guaranteed credit.
  • Those who require complex lens prescriptions.
  • Those with an HC2 or HC3 certificate.

Eye Care Professionals

Optometrist
Historically referred to as ophthalmic opticians, optometrists are trained professionals who are able to examine your eyes, give advice on visual problems, prescribe and fit glasses, contact lenses or visual aids and recognise eye disease. An optometrist with the letters FCOptom or MCOptom after their name is a fellow or member of the College of Optometrists and adheres to high standards of clinical practice. It's a mark of quality.

Ophthalmic Medical Practitioners (OMPs)
OMPs are medical doctors specialising in eye care. Like optometrists, they examine eyes, diagnose abnormalities and prescribe suitable corrective lenses.

Clinical Assistant
Individuals trained by an Optometrist or Ophthalmic Medical Practitioners to perform duties on their behalf.

Dispensing Opticians
These are trained members of the healthcare profession who advise on, fit and supply the most appropriate spectacles, after taking account of each patient's lifestyle and needs. Some are qualified to fit and dispense contact lenses.

Ophthalmologists
These specialise in eye diseases and treatment such as surgery. Medically qualified, they work mainly in eye hospitals and hospital eye departments.

Orthoptists
Orthoptists work with ophthalmologists, assessing squints, double vision and other abnormalities of binocular vision prior to treatment and are then involved in monitoring the treatment's success.


Eye Examinations

Eye care professionals review a patient's medical history and use a wide variety of tests and procedures to examine a patient's eyes during routine eye examinations. The tests range from straightforward (e.g reading an eye chart) to complex (involving high-powered lenses to visualise tiny structures inside the eye). Eye examinations tend to last from half an hour to an hour. This can be dependent on the number and complexity of tests required for your eyes. Depending on the results of the tests there are there are three possible outcomes. These are:

  • no medical or corrective action needs to be taken
  • a prescription for glasses needs to be issued
  • a medical procedure may be required by the patients General Practitioner (GP) or a hospital specialist.

On 1st April 2006, a new NHS eye examination was introduced and entitlement was extended to all in Scotland. The traditional NHS "sight test" has been replaced by a comprehensive eye examination appropriate to the patient's needs. An initial eye examination is carried out (primary eye examination) and where necessary this is followed by a second eye examination (secondary eye examination). The recommendation was that a primary eye examination would be carried out at least every two years for all patients.

On 1 April 2010 the NHS (General Ophthalmic Services) (Scotland) Regulations 2006 were amended to provide that primary eye examinations should only be undertaken in line with set frequencies for different categories of patients, i.e. 1 or 2 years. Other eye examinations required at shorter intervals than these frequencies are undertaken as supplementary eye examinations.


Voucher Claims

Eligible patients can receive help towards the cost of glasses or contact lenses using a voucher GOS(S)3. The voucher can only be issued by the Optometrist or Ophthalmic Medical Practitioner following a valid GOS(S) eye examination.

GOS(S)4 vouchers can be used by ophthalmic practices to claim payment for repair/replacement to glasses for eligible patients.

Voucher categories depend on the prescription for the lens. Single vision vouchers are categorised from A to D and bifocal vouchers are categorised from E to H. The voucher category increases as the cost of manufacturing increases due to the prescriptions becoming more complex.

ISD publishes annually, information on the number of voucher claims made by the type of voucher and also by the type of claimant. Information is provided for NHS Board for financial year ending 31 March 2014.


© ISD Scotland 2010
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NHS National Services Scotland,
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Tel: 0131 275 7777
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