COVID-19: College updates

The Westminster government has confirmed that optical practices are unaffected by the instruction for all non-essential retail shops to close, and should remain open to provide essential and urgent primary eye health care.

It is an individual decision for each practice owner to make as to whether or not to remain open in this difficult climate. If a practice owner does decide to remain open, they should ask all patients to telephone the practice, before attending, for remote triage to ascertain whether the patient needs essential eye care before being seen. If practices in a local area wish to close, they may choose to join with other practices to provide a local hub where essential services can be provided. This could be done on a rota basis where appropriate. Patients should be clearly signposted as to how to access the care they need. 

Updated: 1 April 2020

The Westminster government has defined key workers as: ‘…including but not being limited to ‘doctors, nurses, midwives, paramedics, social workers, care workers, and other frontline health and social care staff including volunteers; the support and specialist staff required to maintain the UK’s health and social care sector…’

The government has now confirmed that optometrists, and optical practice staff, who are required to maintain essential services, fall within this definition, and their children should be allowed to attend school and childcare settings where no home-based childcare options are possible.

Updated: 1 April 2020

The optical bodies are currently negotiating with the UK governments and health services about the role of optometrists in this unprecedented situation.  We understand that everyone wants answers as soon as possible, and will update the website with more information as soon as it is available.

The valuable contribution that optometrists can make to meeting patient care needs in the context of COVID-19 is being recognised. Members wishing to explore how they can help out in the NHS in England should use this link.

The College is working with other partners to develop guidance on the issues involved. This includes ensuring clarity for members on the implications of contributing to care (including in a paid capacity) if their substantive employment is suspended and they are in receipt of government support packages.

We’re keen to promote the valuable role that optometrists can play, and will be contributing to material that helps to do this. We’ve asked for the NHS link to be updated so that it includes optometrists and recognises the important role that the profession has to play. 

Updated: 1 April 2020

Routine eye examinations by optometrists have been suspended in all parts of the UK and procedures put in place to continue urgent or emergency and essential eye care. 

We are pleased to see that NHS England, along with the other nations, recognizes the important role that optical practices play in providing services to patients.  Following the letter we sent to the Minister for Prevention, Public Health and Primary Care, Jo Churchill MP, on 1 April 2020, NHS England confirmed some financial support for contractors. We are now working with the Optical Fees Negotiating Committee (OFNC) to better understand the details of this and its implications for practices and our members.

In the meantime, the OFNC has answered some questions about the changes to primary eye care in England.

Updated: 3 April 2020

Yes. As well as the poster advising patients not to attend if they have symptoms of COVID-19 we have designed a new poster to display to let patients know that you are only available to provide essential and urgent eye care services: 

COVID-19 in-practice posters (PDF, 130KB)

Poster pack for England

Resource pack for Scotland (direct download 21MB)

Update: 25 March 2020

Domiciliary visits have been suspended by the Scottish, Northern Ireland and Welsh governments. There is currently no formal advice on domiciliary eyecare visits in England, but NHS England has stated that clinical support to social care, care homes and domiciliary care should continue.

In view of the advicethat people should not visit patients at risk who are in care homes, we advise that optometrists should only provide essential services to domiciliary patients who are in the high risk groups (over 70, those with a pre-existing health condition or those who are pregnant).

Updated: 24 March

We understand the difficulties you face in running a practice with staff who have been advised to self isolate. The Welsh Assembly Government has agreed to pay practices a monthly income based on the practice average NHS claims over the previous three year period, and similar provisions have been made in Scotland. Northern Ireland has also made arrangements for financial support for contractors. 

The Optical Fees Negotiating Committee is currently meeting with NHS England to agree what financial support will be available to practices in England. This page will be updated when more information is available. 

The Westminster government has announced a support package for businesses. In the meantime, there is advice from other organisations to support your business. For example:

• http://www.acas.org.uk/coronavirus 
• https://www.fsb.org.uk/resources-page/advice-to-small-businesses-and-fsb-members-about-the-novel-coronavirus-covid-19.html

Updated: 1 April 2020

This is a very difficult time, particularly for those who are unable to work from home. You should discuss with your employer what support they can give you. If you are ill, Statutory Sick Pay will now be paid from day one, instead of day four, for those affected by coronavirus. Check current government advice. The CBI have advised that while there is still legal uncertainty about whether preventative self-isolation qualifies for Statutory Sick Pay (SSP), the Westminster government has announced its intention for the law to apply in this way. 

The Westminster government has announced a package of support measures for workers.

Updated: 1 April 2020

The Westminster government has now announced support for self-employed people in a similar vein to that for those who are employed. 

In addition, the College is urging NHS England to provide the same level of financial support to primary care optometry practices in England during the COVID-19 pandemic as in the rest of the UK.

FODO has developed some guidance that you may find useful.

Updated: 1 April 2020

Our patient information on a range of conditions, including AMD, blepharitis and flashes and floaters, is available for free on lookafteryoureyes.org  – our public website. We recommend that you direct your patients here for phone- and desktop-friendly information during the lockdown period.
 
You can also link straight through to lookafteryoureyes.org from your practice website.
 
Our printing company are unable to fulfil orders for printed patient leaflets at this time, so we have also temporarily made our patient leaflets available online. Members can fill in our form to receive PDF versions to use for the duration of the lockdown only. The PDF versions were not designed for use on websites, so please direct your patients to lookafteryoureyes.org in the first instance.

Public health England updated its guidance to primary care on 2nd April 2020. It is now recommending that clinicians should wear standard fluid resistant face masks when examining or treating patients at a distance closer than 2 meters, such as at the slit lamp. We therefore recommend that optometrists who are seeing patients follow the same advice.

Fluid-resistant face masks are worn to protect the wearer from the transmission of a virus by respiratory droplets, which may be released from the mouth during coughing, sneezing or speaking. They may also reduce the risk of contamination of oral and nasal mucosa by accidental touching of your mouth or nose with a contaminated hand. They can be worn for sessional or single-use and must be fitted properly around the nose, but do not require a ‘fit test’.

Gowns are not recommended unless aerosol-generating procedures (AGP) are being conducted which optometrists will not be doing. The RCOphth also recommends that plastic breath shields are attached to slit lamps  and that these are disinfected between patients. This is because studies show that the COVID-19 virus is viable for up to 72 hours on plastic surfaces. They also recommend that ophthalmologists should avoid speaking at the slit lamp.

The same surgical mask may be worn for the whole session or until it becomes damp, but you must be fastidious to avoid transmitting the virus on the front of the mask via your hands or your clothes. Do not take the mask on and off between patients and do not allow it to dangle on your chest.  Instructions on how to put on and take off PPE can be found here:

• COVID-19: infection prevention and control   
• National Infection Prevention and Control Manual: Appendix 6 - Best Practice - Putting On and Removing PPE 

The College is working with the other UK optical bodies to raise this issue with national governments, to ensure that optometrists and other primary eye care staff are provided with appropriate PPE so that they can meet the urgent and essential eye care needs of their patients and protect themselves and their communities.

Updated: 3 April 2020

New guidance has now been released by the National Public Health bodies, endorsed by the Chief Medical and Chief Nursing Officers across the UK nations. Distancing and scrupulous hand-washing remain essential. The new guidance now recommends that clinicians should assess risk of infection to themselves and their patients. If they consider there is an infection risk, then for the direct care or assessment (within 2 metres) of a patient or resident that is not currently a possible or confirmed COVID-19 case they should wear.

• single use gloves
• single use disposable plastic apron
• fluid resistant surgical mask (sessional use, based on risk assessment)
• reusable face or eye protection (sessional use, based on risk assessment)

We recommend all optometrists working within 2 meters of a patient should choose to wear a surgical mask. For further information on assessing risk, see section 7 of the “COVID-19 personal protective equipment (PPE)” guidance.

Primary care practices should not be seeing patients with symptoms of COVID-19. If you work in a secondary care setting where this is the case, please check table 1 of the national guidance.

Reception staff should maintain a 2-meter distance at all times, and as such do not require PPE to be used.

It is still essential to ensure scrupulous hand hygiene at all times. You should also continue to maintain a high standard of infection control every time. Clean the consulting room door handle, computer keyboard, slit lamp joystick and clinical area regularly with an alcohol wipe.

We recommend that, to preserve supplies of PPE and not require people to make visits to the practice unnecessarily, you should conduct a virtual consultation in the first instance. 

We understand that National Public Health bodies are working to arrange supply of PPE to optical practices. When we have further details on this, we will update our guidance.    

Updated: 3 April 2020

PPE should be put on and removed in an order that minimises the potential for self-contamination:
 
Putting on: 1 Hand hygiene 2 Apron, 3 Mask, 4 eye protection, 5 Gloves. (Donning)
 
Removing: 1 gloves, 2 hand hygiene, 3 apron or gown, 4 eye protection, 5 face mask and 6 hand hygiene. (Doffing)
 
Used PPE should be disposed of in the clinical waste stream.

Updated: 3 April 2020

The College has asked national policy makers to provide appropriate PPE for optometrists. In addition, together with the other optical bodies, we have written to NHS England and NHS Improvement, Public Health England and the Academy of Medical Royal Colleges to stress the importance of PPE for optometrists who are providing urgent and essential eyecare services and ask that they ensure that optical practices are provided with sufficient quantities.

Updated: 1 April 2020

We recognise that PPE is in short supply across the UK and that many optometrists may not always be able to access PPE. In the absence of appropriate PPE, if you consider there to be an infection risk to yourself or your patients, we recommend that you see patients virtually, until your practice is able to provide these essential items of PPE. You can refer the patient to another practice in the area who has appropriate PPE, or onto secondary care if they require urgent treatment. You can continue to provide patients with contact lenses or spectacles by post and if a patient contacts you for advice there are many issues that you can resolve over the phone or by video consultation, including a clinical consultation. More guidance on this will follow.

Updated: 3 April 2020

As routine outpatient appointments in the HES have been suspended, if a patient has symptoms of cataract they will not be seen in the hospital, so there is little point in them coming in for an eye examination until the pandemic is over. Similarly, if a patient has signs of conjunctivitis, although this may normally be treated, it is likely to self resolve. Providing the patient has no symptoms of concern,reassuring them that there is nothing serious wrong and that the condition will resolve itself in a few days time would be all that is required, and would have the benefit of meaning the patient does not need to leave the house. 

If a patient reports a serious eye condition that will require urgent or emergency hospital treatment you should direct them to the HES without asking them to come to your practice. The Royal College of Ophthalmologists advise that patients who need to be seen and treated urgently by the HES include those with suspected: 

• Glaucoma
  • acute glaucoma
  • uncontrolled very high IOP >40mmHg or rapidly progressive glaucoma
• Wet active age-related macular degeneration
• Sight threatening treatable retinovascular disease (proliferative diabetic retinopathy and CVRO)
• Acute retinal detachments (macular on, macular off < 4weeks)
• Uveitis – severe active
• Ocular oncology - active, aggressive, uncontrolled or untreated lesions
• Retinopathy of prematurity (screening and treatment)
• Endophthalmitis
• Sight threatening trauma
• Sight threatening orbital disease e.g. orbital cellulitis, severe thyroid eye disease
• Giant cell arteritis affecting vision

Updated: 3 April 2020 

We recognise that this is a very new situation for optometrists, so we have written guidance to help you consider how best to have a telephone or video consultation with a patient. We have also designed a telephone consultation record sheet which you may choose to use if you wish. It is important to realise that you still need to adhere to confidentiality and data security procedures.

Contact the appropriate local hospital for advice.

Updated: 27 March 2020

We understand that optometrists would like to use their professional judgement on this, and the GOC has issued advice on this. We have a proforma to help you triage patients who have out of date contact lens specifications or spectacle prescriptions. The forms can be used by practioners completing and recording a telephone review and then issuing a temporary supply.

Routine cataract operations are being postponed by the hospital, so it is likely that the number of patients coming to you will cease, and some areas are recommending that you do post-operative reviews remotely. If patients do come to you, use appropriate social distancing and infection control measures as outlined above.

Updated: 27 March 2020

If you need to see patients for essential or urgent eye care, as well as using normal infection control procedures, wearing appropriate PPE and regular and scrupulous hand hygiene, there are things you can do to minimise the risk to you and your patients.

Updated: 3 April 2020 

Yes. Do not use air-puff tonometry as this may also generate aerosols, which may be a source of infection. If you normally use air-puff tonometry you should consider whether you need to do tonometry at this time. For example if the patient has normal discs and visual fields do you really need to measure their IOP at every visit? 

Updated: 1 April 2020

Routine sight tests have been suspended in Scotland, Wales and Northern Ireland. We are still awaiting clarification of the status of routine sight tests in England. In the meantime, we advise that practices suspend performing routine sight tests.  

If a patient is having no symptoms that would indicate that an essential sight test is needed, you should explain to the patient the public health advice on social distancing, and that we all have a part to play in reducing the likelihood of transmission of this disease. You can also explain that routine sight tests have been suspended in Scotland, Wales and Northern Ireland and we are waiting for clarification on the position in England. If you have triaged the patient, you can reassure them that it is safe for them to delay having their sight test until the pandemic is over. If the patient needs new contact lenses you can supply these by post. If the patient has broken their spectacles and needs replacements, and you have appropriate measurements, you may also be able to supply a replacement pair by post.

Update: 1 April 2020

If College advice is followed, patients should not attend the practice if they show signs of COVID-19 infection. However, if COVID-19 is considered possible when an appointment is already in progress, assess a suitable and safe point to bring the consultation to a close, withdraw from the room, close the door and wash your hands thoroughly with soap and water. Refer to the relevant national guidance for next steps.

Updated: 23 March

They should call NHS 111, who will direct them to a regional centre that can provide the eye care, in an environment equipped to manage the infection control risks. Primary care staff should not be seeing patients who have COVID-19.

If the patient is in your practice, advise them to contact NHS 111 from an isolated consulting room. If a healthcare professional is required to enter the room to offer assistance or support the 999 assessment, they should wear disposable gloves, disposable plastic aprons and fluid-resistant surgical face mask.

This is up to your professional judgement. We suggest you telephone the patient, explain the situation and ask them if they would like you to make up some spectacles for them. If you have previous details you may be able to do this remotely. For example, if they are happy to post their spectacles to you to reglaze their spectacles and send back to them. If they would prefer to have a new frame, then arrange for them to come into the practice for dispensing and take appropriate social distancing and infection control procedures as outlined above.

Updated: 1 April 2020

There have been several media reports relating to the safety of contact lens use in this pandemic. We have seen no evidence to suggest that wearing contact lenses would increase a person’s chances of contracting COVID-19. Patients can continue to use their contact lenses as normal if they do not have COVID-19 or any of the associated symptoms (fever or a new and continuous cough). 
It is good general advice for patients to reduce their contact lens wearing time if they do not need to wear their lenses and can manage with spectacles, as may well be the case if they are at home more. If they wish to wear their contact lenses you should stress to patients that they should practise good contact lens hygiene as always, and that thoroughly washing their hands before and after handling their lenses is essential. 

We would also advise that if patients are ill, they stop wearing contact lenses until they are better. This applies to all illnesses, including the common cold, influenza and COVID-19.

If you wish, you may advise patients that if they are in the same household as a person with symptoms of COVID19 they may wish to stop contact lens wear until everyone in the house is well.

Updated: 2 April 2020

The GOC advises that it is still important to maintain and develop your knowledge, skills and professionalism, even during this emergency situation, and so the overall current cycle requirements for CET will remain in place to be completed by 31 December 2021.

However, the annual requirement of six CET points, has been waived for 2020.

The GOC will advise of any updates to this change, as the situation develops.

Announcements and updates on the Scheme for Registration and COVID-19 can be found here.

Updated: 27 March 2020

We recognise the expertise of IP optometrists, and that this is likely to be of increasing relevance in the current situation, with patients being diverted from secondary care.

In addition, we are actively addressing the following:  

• Seeking to achieve the required regulatory change to enable IP optometrists to supervise other optometrists on IP placement, rather than a medical practitioner (ophthalmologist) having to take on this supervisory role.
• Working with optometry university departments seeking to increase optometrists’ access to the theoretical component of IP education.
• Optimising how public funding can be drawn upon to support more optometrists undertake IP education.

Through collaboration with different stakeholders, we hope that it will be possible to achieve the required sequence of changes to enable more optometrists to integrate IP into their practice.

Update: 1 April 2020
 

We have received confirmation that the GOC is not currently planning to set up a temporary register, as some other regulators have done in the current exceptional circumstances. Such arrangements, which enable practitioners who’ve retired or stepped away from practice to return, or enable students to progress into practice, are not deemed needed for the optical professions and not to reflect current needs and issues for the professions.

Where other regulators have set up temporary registers, they have expressly excluded IP from their temporary register arrangements. We understand that this is part of their risk management measures.

Although this means that optometrists who have trained for prescribing rights, but not yet obtained them will not be admitted onto the specialist register, we recognise that the broader skills that IP education helps to develop can and should be promoted as part of the broad contribution that optometrists can make to patient care.

Updated: 1 April 2020

We had to cancel delivery of the College’s IP exam, due to have been held on 1st April, to comply with Covid-19 requirements. We will keep under review when it will be possible to deliver the exam in its conventional format. 

We are also exploring how the exam could be run differently. We are looking into the feasibility of the College using software that enables candidates to sit exams securely online, with remote invigilation. We will provide an update once we have fully explored possibilities and their potential application to the particular requirements of our exam, and we can indicate precisely what it is possible for us to do. 

We also recognise that optometrists with IP rights can make a particularly valuable contribution to meeting patient care needs differently, including in the context of more eye care being delivered outside hospital settings where this is safe to do so. We are involved in discussions with the General Optical Council and other partners on how optometrists’ professional skills, including those relating to IP, can be optimised to meet patient care and service delivery needs in the current circumstances and how the profession’s skills and contribution can be promoted. We will provide an update on this shortly. 

Further updates on the Independent Prescribing exam can be found here.

Updated: 27 March 2020

We understand how worrying this unprecedented situation is. MIND has some really useful information on their website. There are also several coronavirus community aid groups being set up for people who are self isolating, who may be able to give you some support locally. 

If you need to talk to someone you can call the Samaritans for free on 116 123.

The World Health Organisation provides a free online course for healthcare professionals which takes about an hour to complete. It may be useful for each practice lead to complete this training, but it is not compulsory.