If you have the equipment on order but it is not yet in the practice, you just have to prove that it is on its way.

6.                  Will there be any changes to the spectacle voucher value?

Not because of this new contract.  The agency responsible for establishing spectacle/contact lens voucher values has UK jurisdiction.  The level of voucher values has not been part of the new NHS Eye Examination negotiations in Scotland .

7.                  Why has the SEHD opted for increasing our role and fees?

The SEHD and Parliament have eventually recognised the potential value of optometric service. They have accepted that optometry represents an efficient, professional and cost effective eye health service, which, once the new recommendations come into force, provides the people of Scotland with world-class preventative care.

8.                  What are the potential savings to the NHS, the SEHD and the public?

The cost of managing someone with severe visual impairment is significant. There is a cost to society, Social Care Services, and to the rest of the family unit.

Proper utilization of the optometric service will ensure that many more people get better professional care close to where they live by a competent, trained professional in well-equipped premises. This will help with the early detection and diagnosis of many eye conditions before they develop to a level of concern for the individual. This will help reduce the incidence of avoidable visual impairment across Scotland .

Other savings will result from fewer visits by people with eye problems to GPs, and a significant reduction in inappropriate referrals to the acute sector.

In actual fact the full financial costs of introducing this new service is fairly small in comparison with other professions including dentistry, pharmacy and medicine.

9.                  How are we going to manage all these people that come through the door?

The new contract will need some new ideas around diary management as not all of our patients will be coming for the same elements of service as we see at present.  We will need to introduce greater flexibility into how we manage our diaries. This is especially the case with patients over the age of 60 years who will be offered dilated fundoscopy during their eye examination.

The GIES scheme in south Glasgow has shown that up to 80% of GP eye referrals can be managed in the community by the Optometrist and the GP working together. In addition there are a considerable number of patients who routinely attend hospital who could attend community Optometrists such as stable Glaucoma patients. Optometrists are also able to see patients for more of the Cataract Care Pathway than they do at present. This Shared Care is already in operation in the South West of Scotland. Diabetic retinal screening and monitoring could also be performed in Optometric practices.

Therefore we are likely to see an increasing number of different patients in routine day-to-day practice.

Specific training for ancillary staff carrying out certain tasks will help deal with some of the additional workload.

10.              Will the new service be promoted to the public?

The SEHD will encourage NHS Boards to promote the new service, especially to vulnerable groups such as young people, the elderly and those in ‘at risk’ groups. It is expected that there will be a number of eye health advertising campaigns to support this.

11.              Is there a limit to the number of patients we will be expected to see in a day?

Yes.  The SEHD will put a nominal limit of twenty on the number of Eye Examinations that you can provide on an average working day. Allowances will have to be made for shortened or extended working hours and pre-registration optometrists working with supervisors.

12.              Is the upper limit of 20 primary examinations a day per Optometrist or per practice?

The new regulations state that it is estimated the time involved in undertaking the new Eye Examination will increase with the time spent on most patients being around 30 minutes for those patients who attend for routine examinations with no specific symptoms and no prescription for glasses/contact lenses. This extra time may be due to extra tests, more complex tests, or simply more time for symptoms, history, co-morbidity, investigations and advice. How much extra time will be spent on other patients will depend on their particular circumstances. Due to the increased time involved in each Eye Examination, the number of tests that an optometrist/OMP will be allowed to undertake under the 2006 Regulations in a working day will be limited to 20. A working day is defined as a period of 7 hours 30 minutes on any day of the week, usually between the hours of 9.00am and 5.30pm with a 1-hour lunch break.

 The limit of 20 examinations is a combined total of Primary and Supplementary Examinations and is any combination thereof, is pro rata for a 7.5-hour day and is per optometrist. For pre-registration optometrists, add on what the College of Optometrists allows them to do as their training year progresses.

Yes 20 x 30 minutes is 10 hours not 7.5 hours, but that is to allow you some Supplementary Examinations and emergencies.

13.              Regarding pre-reg's, how are their eye-test numbers to be regarded i.e. are they added to their supervisor's numbers?

 

A Pre-Registration Optometrist is only allowed 4 examinations per day during the 1st quarter, 8 during the second quarter and 12 thereafter.

 

14.              How will the pre-reg patients be accounted for?

 

They will count towards the supervisor’s total as the supervisor signs the forms, but NSS/CSA HQ at the Gyle will know if you have a pre-reg and should take account of that

 

15.              Will self employed optometrists have to register with each practice or just with the local health board/ trust?

 

Locums do have to register with each Health Board as they do just now, but once they have gone through the first Health Board listing, all the others should be quick and automatic as the original data is passed on (note that automatic sharing of listing information has still to be confirmed). The listing arrangements are changing on the 1^st April 2006 and details will be on the Optometry Scotland website as soon as possible. Mention has been made that the competency certificate has to be sent to each Health Board that you are listed with, but Optometry Scotland is checking this out. 

16.              What is so different from the old GOS sight test?

There is no provision for supplementary procedures to be performed in the old GOS sight test.

In addition, the new GOS Eye Examination will allow all practitioners to fully exercise their professional freedom when managing patients.  There will be no constraint to carry out tests that are not appropriate for the patient, other than the core eye health check. All other procedures will be needs driven and might or might not include a refraction.  The content of the examination will be dependent on the presenting signs and symptoms.

Techniques such as slit lamp biomicroscopy, applanation tonometry and automated visual field testing will become more commonplace with the new contract as the profession meets the clinical needs of the public.

This is not to say that we turn our back on the good work that we do at present with the current sight test, spectacle dispensing or contact lens fitting. It should be possible to introduce this new way of working without causing too much disturbance to the vital services we already provide.

A good example would be a patient presenting with a red eye or flashes and floaters. The Primary Eye Examination would allow you to adequately examine the patient and the Supplementary Examination would allow you to see the patient again for follow up and perhaps check that their spectacles or contact lenses are still appropriate.

If you look at the Ophthalmology Care Pathways (see link on this site), more of this work can be performed via the new GOS contract than could have under the old rules. It would be neither practical nor sensible for Hospital departments to push all patients out to optometrists. However there is now considerably more flexibility for Health Boards to consider Primary Care optometry options for patient care, management, and service funding to develop the best method of meeting various service, waiting time and waiting list targets. 

17.              Is this not just a free eye test for those who can afford to pay? Do we need to ask this question considering what is said above?

The new NHS Eye Examination shifts the emphasis away from just an eye test for spectacles and allows us to perform tests that are appropriate to patients’ symptoms. For the simpler cases where someone just needs a new prescription, we will still be checking their eye and general health in a more appropriate way. For the others optometrists will be able to perform the appropriate tests without the mandatory refraction and actually get paid by the NHS.

18.                     Are there any concerns that by removing the compulsory refraction element we could end up with a move to de-regulate the eye-test to enable refraction by those other than optometrists/ medical practitioners?
 

The rules contained within the Opticians Act still apply across the 

UK
.  The "sight test" as defined within the Opticians Act, whether GOS or private, requires an optometrist or medical practitioner to carry out an external and internal examination of the eye and following refraction, issue a spectacle prescription or statement. Therefore any “sight test” must include refraction and a health check element as it does just now.  This still applies to the new Scottish contract, as it does anywhere in the 

UK

 

The difference is that Scottish optometrists will have the option to carry out an examination other than a sight test as appropriate to a patients needs, e.g. you would not carry out a refraction for someone presenting with a corneal ulcer but you would want to examine the anterior eye and manage the condition appropriately including referral.
 

The Scottish legislation that governs us is The Smoking, Health and Social Care (

Scotland
) Act. We have been careful to keep  “Sight Test” in this Act, which is why it says an “Eye Examination that may include a Sight Test”.
 

19.              Are the Primary and Supplementary tests on the same form?

Yes they are, along with domiciliary claims.  Primary and Supplementary claims can be made on the same form, or on separate forms depending on the length of time between the different examinations.  The Primary and Supplementary examinations could even take place on the same day, but at different times. It is not just one examination.

20.              Can a Supplementary Examination be done without having carried out a Primary Examination?

A Supplementary Examination can normally only be undertaken following a Primary Eye Examination, with the exception of referrals from HES. There is one further exception to this for the 6-month period from 1 April 2006 and that is where you have tested someone before the 1^st April, and asked him or her to come back for a further check.  In this case you should claim a Supplementary fee.  In these cases, please mark in the “Remarks” section of the GOS 1 form the date of the first test (NHS or private) pre 1 April 2006.

21.              What is the guideline for frequency of re-examination, for a normal patient?

The old retest intervals remain the same with one change.  Everyone over 60, rather than 70, will be able to have an Eye Examination every year without coding the forms.  The intervals really apply to routine refraction eye examinations.  If a patient comes in with an emergency problem such as red eye or flashes and floaters, then an Eye Examination will take place that is unlikely to include refraction.  This should not therefore affect the normal refraction reminder times.

22.              How do we check if a locum has completed their competency in advance of them turning up to do a clinic? I understand that optometrists who have been declared competent have been given a signed slip of paper.  Is there a list of validated Optometrists that we can use to check our locum database?

Although SCO, and eventually OS, will hold a list of everyone who has been signed off as competent, the best person to contact will be the Ophthalmic Officer in each Health Board i.e. Janine Glen for Glasgow .  The reason for this is that the optometrist may be signed off by SCO as competent, but may still not be registered to work in your Health Board, and if they are not, then one of your other optometrists then has to sign the GOS 1 and take full legal responsibility for the patient. That is not recommended.

23.              Can I do photography in the new GOS?

Not at present.  Photography is not a GOS procedure.

24.              What exactly is meant by referral refinement?

The definition of referral refinement has not yet been agreed with the SEHD.  For just now, we suggest that it is "the repetition of tests to refine a referral or for the further investigation of suspicious test results".

25.              Can patients who have had an old sight test in the last few months have a new Eye Examination straight away?

No, the sight test intervals have been carried over exactly into the new Eye Examination intervals with the same coding structure. There are minimum intervals for patients of certain ages and for patients with certain conditions. These intervals are detailed in 2006PCAO4.  These intervals will be applicable from the date of the patient's last test, regardless of whether that test was pre or post 1 April 2006. 

26.              Where is the cut off between GOS and Level 2?

This is still under discussion apart from what is already in 2006PCAO4.  Essentially GOS will provide 2 appointments to sort out a problem and then the Optometrist should refer the patient to Level 2 Optometric activity, a GP or a Hospital department.

27.              Can the Supplementary fee be claimed for basically writing a referral letter?

A referral letter is part of the Primary or Supplementary exam, but is not sufficient on its own to claim the fee.

28.              I am being asked more and more to carry out diabetic screenings in the Glasgow area for patients who are housebound, but under the Greater Glasgow regulations cannot do so in the house. Is there anyone we can speak to or any way round this?

I am registered to carry out diabetic screenings for Argyll and Clyde (who are being disbanded from the 1st April into Greater Glasgow ).  Does this mean I can no longer carry out screenings in the Renfrewshire/Greenock Area when doing home visits?

This is a complex issue. Shortly all optometrists will NOT be involved in any diabetic screening work apart from Ayrshire and Arran .

Proper Diabetic Screening as part of the Diabetic Retinal Screening Service in Scotland requires

1)      Photography

2)      Dilated slit lamp biomicroscopy for those who fail photography

3)      Submission of a report to the Diabetic Retinal Screening Service

4) Clinical audit and Quality Assurance of the person who does the screening, usually by an ophthalmologist.

 If all of these things are not performed in that order, then you are not doing Diabetic Screening. You are just doing a sight test on a diabetic patient, or you are doing a bit extra.

 Under the new GOS eye exam, all diabetic patients should receive an examination appropriate to their needs and this should include dilated slit lamp biomicroscopy or, where that is not possible, dilated head mounted biomicroscopy, or where that is not possible, dilated hand held indirect ophthalmoscopy, or dilated hand held direct ophthalmoscopy.

You may therefore be conducting a thorough examination but it is NOT Diabetic Retinal Screening.

29.              I readily accept the role of optometrists in the care of Ocular Hypertensives in the community, and feel we are able to provide this service.    Can Ocular Hypertensives be seen within GOS if they have not been discharged from the Hospital Eye Service?  The HES may only want visual fields screened and the patient to report back to HES for further treatment.

This is a grey area, and I think the easiest way to think of it is, Ocular Hypertensives are GOS, and you should perform a routine Primary Eye Examination, whether or not the patient goes back to HES (although really why should they?). Ocular Hypertensives are a GOS issue that is firmly in our new NHS contract. Patients can go where they want, and all practices can provide this service. Optometry Scotland expects that Ocular Hypertensives should be discharged from hospital as they are receiving a service there that is also available now in every GOS optometry practice.

The scenario for diagnosed and treated Glaucoma patients is different as they are under closer active management by the hospital department. If HES wants us to monitor diagnosed Glaucoma patients then this is a Level 2 service that the Health Board would have to contract with Optometry.

30.              4-year-old children are currently screened by orthoptists in my area. I feel that this would be appropriate for optometrists to do, but realise that a reasonable percentage of optometrists are not too keen on seeing large numbers of young children. If we restrict the number of optometrists that 4 year olds can attend, possibly by accreditation or training, does this cease to be GOS? Or if all optometrists had the right to attend such training or accreditation would this still be restrictive on those who didn’t attend or would GOS be appropriate since all who wanted to and were competent were included?

 Pre-school children are GOS, and the new contract covers their examination, but...some practitioners may not feel confident with / may not want to see children and so they will politely refer these children onto another colleague who is better placed (much like contact lenses, or LVAs). Training would help those who are planning on accepting children, but we are not compelled to see every type of patient that presents. Screening however is not GOS.

31.              Is the new examination interval always from Primary Examination to Primary Examination, regardless of whether the patient has a Supplementary Examination?

Yes if the Primary Examination includes refraction.

If a patient has a Primary Examination for flashes and floaters symptoms, and refraction is not performed, then that should not affect their routine interval until their next Primary that does include refraction.

32.              What does CHI number stand for on the new GOS 1 form?

CHI is the unique NHS identifier number that is used within the Hospital and GP service for patient ID.

The patient identifier number on the present GOS 1 is the same thing BUT we don't actually use or collect either at present, though it is hoped we might do in future

33.              Parts 2A and B of the GOS1 form have some tick boxes about entitlement. The first tick box is easy to understand, but the second talks about "categories of exemption from NHS charges as set out in the NHS (Charges to Overseas Visitors) ( Scotland ) Regulations 1989. Can you tell me what this means, and who might fall under this category?

These are detailed in 2006PCAO4. We will ask for some simplified advice covering this topic.

34.              If the patient comes in for a Primary Examination, and returns for their Supplementary Examination more than 6 months later, does this count as another Primary Examination?

There are instances when a Supplementary Examination should be within a week or two from the Primary Examination, but there are other instances when you will want the Supplementary to be 6 months or so from the Primary Examination.

35.              What is happening re domiciliaries?

There are minimal changes at present to the domiciliary scheme. This will be reviewed later in the year by Optometry Scotland and the Scottish Executive Health Department.

36.              I am confused about the condition specific tests on page 3 of the Circular 2006PCAO4.  Does this mean these patients cannot have a Supplementary test? Yet the list of example of Supplementary tests includes dilated exam e.g. diabetics etc?

The main point on Page 3 is that some people (e.g. F/H glaucoma) need certain tests like pressures. The test will be done as part of the Primary Examination.  If the reading is suspect a recall can be made so the same test will now be done as part of a Supplementary Examination.

If a diabetic dilated (primary - no extra fee) examination shows a small haemorrhage or exudates, you may recall them in three months for a repeat. This will get a Supplementary fee.

If you think a cataract requires an operation, the Primary Examination will be dilated.  However you can use the "referral refinement" reason for a Supplementary Examination and claim the fee for assessment and discussion of risks (exfoliation, cataract type, co-morbidity) and offering advice to the patient regarding the operation procedure.

37.              In the New GOS 1 form there are several options available under "The reason for the Supplementary examination was:". Can the user select more than one option here? For example, is it valid for the user to mark "Cycloplegic refraction" and "Paediatric follow up"? 

Similarly, under "The Patient:", is it valid for the user to mark "is visually impaired" and "has cataracts"?

The first section of “Reasons for Supplementary examinations” would probably always just have one box ticked, but it is possible that more than one box can be ticked.

The second section of Patient conditions will often have more than one box ticked, and we would like optometrists to tick ALL that apply for the purposes of data collection and information that can be used in future negotiations and discussions with the SEHD.

38.                     Optometry Scotland advice for anyone examining eyes or testing sight for all contract work, whether this is corporate employees needing Safety Spectacles or VDU tests, and including patients visiting your practice with some sort of Eyecare voucher helping them with the cost of an Eye Examination or Sight test, and providing help towards the cost of spectacles.
 

The most important issue at the start is to establish whether the patient is one of your practice patients or not.
 

If a Corporate patient is also one of your normal practice patients then you may be able to examine or test them in the normal way, using the same NHS eligibility criteria as you have in the past. You would therefore claim a Primary Eye Examination fee.
 

In addition you may need to perform some specific VDU tests in terms of Intermediate distance refraction and muscle balance tests. The employer or the corporate eyecare scheme voucher should pay you for this work.
 

If your patient is not due an NHS Eye Examination, then you may either just dispense the spectacles based on the previous Eye Examination, or you may have to conduct a VDU refraction and muscle balance test to determine the prescription specifically for VDU purposes. The employer or the corporate eyecare scheme voucher should pay you for this work.
 

If a corporate patient does not normally attend your practice for their eyecare, then you should not be interfering in their normal NHS eyecare. The exception would be a patient with an acute eye problem requiring investigation that entitles them to an NHS eye examination. Normally they will only attend your practice because their employer sends them, and therefore any tests or procedures you perform should be private and paid for by the employer or the corporate eyecare scheme voucher. You must decide whether you give them a full Eye Examination plus an intermediate refraction or only perform the intermediate refraction and muscle balance.
 

If, at the end of their examination, a patient asks you for a VDU report for their employer, provision of that report is not part of the GOS examination and the employer or the corporate eyecare scheme voucher should pay you for this report.
 

39.              In Part 3 of the GOS 1 form there is a data capture section that asks, inter alia, if the patient “is over 40 and the father/mother/son/daughter of someone with glaucoma”.  Why is there no reference to sibling?

This is a mistake on the form and sibling should have been included.  Please tick the box if this applies to the patient.

40.              What steps need to be taken to arrange appropriate holiday cover by optometrists who do not normally work in Scotland ?

All optometrists who work in Scotland after 31 March will need to be listed with the Health Board for the area in which they are working.  Consequently they will need to have passed the competency tests.  In future, non-Scottish optometrists who move to Scotland to work or who want to do locum work in Scotland will need to arrange to sit the competency tests, for which payment will be necessary.  Although the Pre-registration Optometrists this year will have to undergo the competency process, Optometry Scotland has been assured by the College of Optometrists that next year’s students will have completed and demonstrated these practical competencies as part of the College examinations.

41.              Will I have to sign a new contract to conduct GOS tests after 1^st April 2006?

Contrary to what we thought, optometrists will not have to literally sign a new contract. However it is conditional on the Health Boards seeing your OS-SCO competency certificate, that you remain listed and able to provide GOS services. The very fact that an optometrist/OMPs name remains on the Health Board list means that they have to adhere to the new Regulations, which include the new GOS Terms of Service. 

Finally, on training.  It is a Terms of service requirement that optometrists/OMPs providing GOS must undertake certain core procedures and that they must have the SCO-OS training certificate confirming that they have undertaken these procedures.  If an optometrist/OMP currently on a list does not provide such a certificate to the NHS Board’s in whose areas they are providing GOS, by 30 June 2006, then they will be breaching their Terms of Service and could be referred for disciplinary procedures.  If an optometrist/OMP cannot undertake these procedures then he/she cannot provide an NHS Eye Examination and cannot therefore provide GOS.  He/she could, however, continue to practice privately. 

                               Site map

42.                  Is dilation of a patient who is over 60 a primary or a supplementary examination?

Dilation is normally part of the primary examination for everyone 60 & over. It has to be considered by the Optometrist as clinically beneficial for a patient on a particular visit, then offered to the patient, and the offer has to be accepted by the patient.

43.                  Is dilation of a diabetic a primary or a supplementary examination?  Does the age of the patient make any difference?

Dilation should be a supplementary procedure for all those under 60 - including diabetics. However the Regulations at present state that all diabetics should have dilated ophthalmoscopy as part of the Primary examination. Although this is not what was intended when OS was negotiating with the SEHD it is in the Regulations at present. Hopefully this will be changed in the near future.

44. Can I get some clarity on the dilation of under 60's diabetics? I was under the impression that this could be done and a supplementary claimed for the dilation.

All diabetics are supposed to have dilation as part of the primary according to the GOS Regulations as published, but that was not the intention in our negotiations. We hope to persuade the SEHD to put dilation for diabetics under 60 back into Supplementary procedures.

45.                  If fields or dilation is done on the examination day is this a supplementary examination or not? Is it only supplementary if it is repeated or refined?

IOPs and fields and dilation (on a screening basis) are performed on some people as routine, for some as required, and for some not at all, and this is part of the Primary exam. If something is picked up as abnormal and you want to recheck it then you will do applanation IOPs, full threshold visual fields, dilated volk bio as a Supplementary examination.  2006PCA(O)04 gives you the patient groups and who gets what and when.

The day when the repeat tests are performed is irrelevant.

46.                  On part 3 of the last page of the new GOS (S) 1 form states, "The patient (please put a tick in each applicable box) is visually impaired". Is there a definition of visually impaired?

Visual Impairment is both a replacement for Blind or Partially Sighted people in the old GOS 1, and a category for anyone who is 6/18 or worse binocularly.

47.                  I may wish to dilate a patient's pupils during a primary exam but this might be inadvisable because they are driving. If I bring them back for a dilated fundoscopy, can the second visit then be a supplementary examination?

Also, I may dilate a patient's pupils during a primary exam and then decide I need to do a visual fields test that would need to be done on a different occasion. Is this then be a supplementary examination?

If a person is over 60 then dilation is part of the normal Primary eye examination, irrespective of when the dilation is actually performed. If you need to repeat dilation then it is a Supplementary. If a person is under 60 you can claim a Supplementary eye examination fee following direct ophthalmoscopy in which you have found an abnormality needing further investigation.

Screening threshold fields would be part of the Primary examination when you think it is required. If an abnormality was found then a Supplementary examination fee can be claimed for Full threshold fields.

48.                  I have a query about NHS entitlement for someone who has recently had a private test, say for example in the last 6 months.  Are they entitled to an NHS test even if they have no symptoms requiring investigation?  The only reason for presenting for a test is because of the publicity for the new NHS test.  Do they have to wait the appropriate period of time after last private test or can someone have a private test and then an NHS one?

It would be an inappropriate use of GOS, as the Regulations do state as they always have, that the Optometrist should determine before the test or examination, that the patient is 1) actually eligible and 2) actually requires a test or exam,

So if the patient just comes in but with no reason, then I would say NO. If there are any symptoms then it should be a YES. Their eligibility regarding time since their last test / exam only relates to their last NHS provision, not any Private Sight Test or Eye Examination they might have had.

49.                  When level 2 testing gets rolled out, will it be funded locally or will funding come centrally from the SEHD?

Level 2 is funded locally and it may not be "rolled out" but rather developed locally on the basis of local demographics or need. Level 2 will be agreed locally with Health Boards based on need, although OS accepts £96 per hour as the fee rate for any Level 2 work.

50.                  Are there discussions on a Scotland-wide GIES equivalent to be funded centrally?

We are looking at how far GOS will spread but GIES will not be widely introduced for some time yet. A lot more education and workshops might help that along and we are speaking to SEHD agencies about that now.  We hope that a key recommendation from the SEHD in the final 'Primary Eyecare Review' document will be that Level 2 optometry be introduced across Scotland . It would then be up to the NHS Board to fund and implement it.

51.              Screening of Pre-school children - I was very disappointed to see that the screening of pre-school children is listed as not appropriate under the new GOS. I would be interested to have some input as to why.

It is important that GOS is an Examination. Screening is certainly not that and therefore all types of screening, whether children, diabetic retinopathy or other should be excluded. In many cases screening is fine, but it is not a substitute for a proper examination.

If children come into the practice, and you examine them, as per the new GOS regulations, then yes that would be appropriate under GOS, and OS is firmly of the opinion that all children, particularly where there is any family history of eye problems, should have a regular eye examination by an Optometrist

52.              Is there going to be standard referral procedure for GP/pharmacy referral to an Optometrist?

There is no standard referral form for GPs or Pharmacists for sending patients to you. These professional groups would normally use a verbal referral or a hand written note, possibly with the patient’s brief medical history attached. However, if anyone has any proposals for a referral form then OS will consider it. OS is proposing a new GOS referral form from Optometry to other Eyecare professionals and details of that should be out for consultation soon.

53.              If a patient, who is not one of our patients, comes into the practice with a sore eye or some such concern and is likely to have been a private patient, can I claim the examination as a supplementary? Do I need to find out when they were last tested and if it was a private or NHS examination?

In the situation you describe, you do need to know when the last NHS test or exam was performed and by whom. When you see the patient it is a Primary examination for this sore eye. A Supplementary examination would only be claimed if you see the patient again in a short space of time for a follow-up examination.

Remember to code the GOS 1 form if the Primary examination is under the usual time interval from the last test.

Under normal circumstances, seeing a new patient with a sore eye or similar condition/complaint or an existing patient with a condition/complaint that is new to the patient will be a Primary examination rather than a Supplementary examination.

54.              Could you tell me what box to tick on the GOS 1 form if someone has No Rx as there is no place for this on the form?

This option has mistakenly been omitted from the new GOS 1 form. A box for "No Rx; statement issued" should be reinstated soon, but in the meantime tick the box "No change in prescription".