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Eye care in the UK

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Our members provide primary and community eye care services across the UK, and increasingly also work in hospital settings.

These pages help new providers and those that are expanding services understand and keep up to date with how eye care is delivered across the UK. It covers:

  • Setting up and expanding your practice
  • Taking on an existing practice
  • Health profession regulators
  • Regulation of health provider organisations
  • Providing NHS care (including GOS)

Members can get additional advice whenever they need it. Get in touch [email protected] or 020 7298 5151.

Members often contact us for advice about setting up a new practice or taking over a practice as part of expansion plans. In this section we provide an overview of options and resources you might find useful. 

Options

If you are considering setting up your first practice or expanding, you have a range of options, including:

  • Starting a new practice from ground zero 
  • Taking over an existing independent practice
  • Taking on a new or existing franchise or joint venture practice

You might also want to explore new models of care, for example partnerships with ophthalmologists, audiologists and other health care professionals.

We are always on hand to talk with members about these and other options in more detail, so just get in touch. Whichever option you choose, it is helpful to cover the basics off to help mitigate risk and maximise your chances of success.  

The basics

Whatever model you choose, make sure you are familiar with health professions regulation for all the professionals you employ or engage in your practice (e.g. both opticians and audiologists). Also ensure you're familiar with health provider regulation and the provision of NHS eye care in the country in which you want to operate. 

You must make sure you understand the importance of having appropriate medical malpractice insurance in place.

You will need to decide what form your business takes and register it with the HMRC. Typically, practice owners register as limited companies, while some opt to register as limited liability partnerships or sole traders. Learn more.

If you plan to use a protected title in your trading name - e.g. optometrist, dispensing optician, ophthalmic optician, and optician - and set up as a limited company or limited liability partnership at Companies House, then you must first register with the General Optical Council as body corporate.

You will also need to ensure you comply with:

  • Employment law
  • Health and safety requirements
  • Tax and VAT rules and regulations
  • Data protection
  • GOC business standards if you are a body corporate - we also recommend non-registered providers comply with these standards
  • Applicable NHS contract requirements
  • Other regulations that apply to your practice - e.g. Consumer Rights Act 2015, Equality Act 2010 and more

As a FODO member you can access support and guidance to aid compliance in your practice owner's hub, using our guidance and contacting us directly: [email protected] and 020 7298 5151.

If you are not yet a member you can also access free advice funded by the government:

You can join us and get the support you need from day one. Find out more. 

If you are taking on an existing practice then in addition to your normal business due diligence and financial analysis, you should ensure you assess:

  • Standards of practice
  • Clinical issues
  • NHS contractual issues

This can smooth the transition when taking ownership of a practice and help to further mitigate clinical and commercial risks. Some examples include:

  • The practice might have a General Ophthalmic Services (GOS) contract allowing the current owner to offer NHS funded eye examinations. This contract might have been granted before changes to premises requirements and change of ownership could pose a risk of not being granted a new GOS contract without a significant investment in premises and equipment
  • Issues that arise from past eye examinations and treatments will become your responsibility when you take over the practice. This includes complaints, clinical negligence claims and NHS reclaims for things that happened before you took on the practice. That is why you should check and have confidence in existing standards, systems and processes and that appropriate insurance is in place.

It is always best to only take on a practice after your extended due diligence checks are completed. This can also prevent your overpaying for a practice which has operated in a way you would not.

FODO members thinking about taking on a practice are encouraged to contact us for a chat by emailing [email protected]. We offer this to all members because our experience has shown it helps members avoid the significant costs and stress involved as a result of not getting the basics right first time.

If you are thinking about setting up your own practice or expanding the services you offer, this overview of health professions regulation in the UK will help.

There are 10 statutory regulators in the UK. FODO members increasingly work in multidisciplinary teams, so we provide a brief description of the health professions regulation that a typical eye care provider in the UK will need to know.

General Optical Council

The General Optical Council (GOC) regulates:

  • Optometrists
  • Dispensing opticians
  • Student opticians
  • Optical providers (businesses)

The Opticians Act 1989 (the Act) gives the GOC powers to regulate registrants. The Act also makes it a criminal offence to:

  • Test sight, fit contact lenses, or carry out any dispensing which is a protected function if you are not registered with the GOC. This means as a provider you must have systems in place to ensure the qualified staff you employ or locums you use are registered with the GOC and maintain their registration. You can do this by checking the GOC register.
  • Supply spectacles or contact lenses (optical appliances) which do not meet "sale and supply of optical appliances" as described in Section 27 of the Act. As a provider you must ensure your local processes and protocols comply with the Act.
  • Use any of the protected titles (unless registered with the GOC): optometrists, dispensing optician, ophthalmic optician, and optician(s). So, as well as ensuring you have processes in place to make sure that all your optometrists and dispensing opticians maintain registration with the GOC, if you are planning on setting up as a body corporate (e.g. Limited Company) you will need to register with the GOC if your organisation uses a protected title in its name.

You should also make sure that all your GOC registrants have appropriate medical malpractice insurance in place. You can obtain this insurance by joining us.

Health and Care Professions Council

The Health and Care Professions Council (HCPC) regulates 16 professions, including:

  • Orthoptists
  • Audiologists registered as clinical scientists
  • Audiologists registered as hearing aid dispensers

With more eye care providers offering non-NHS hearing aid services, it is important to note that only audiologists registered with the HCPC as a Hearing Aid Dispenser (HAD) can provide this service. That is because they perform protected functions, and it is a criminal offence for somebody that is not a registered HAD to perform them.

If you choose to offer more services to your patients, you should ensure the audiologists you employ or engage as locums are qualified and appropriately registered. You can do this by checking the HCPC register.

You should also make sure all hearing care professionals you employ or engage as locums have appropriate medical malpractice insurance in place. You can get this insurance for your audiologists by joining us. We can also obtain quotes for orthoptists on a case-by-case basis.

Nursing and Midwifery Council

The Nursing and Midwifery Council (NMC) regulates all nurses, including ophthalmic nurses, midwives in the UK and nursing associations in England. 

Eye care providers that employ or engage ophthalmic nurses as locums, should therefore ensure they are qualified and appropriately registered. You can do this by checking the NMC register.

General Medical Council

The General Medical Council regulates:

  • GPs
  • Ophthalmic Medical Practitioners (OMPs)
  • Ophthalmologists

Eye care providers that employ or engage GMC registrants should have processes in place to check they are and remain registered. You can do this by checking the GMC register.

It is also important to ensure GMC registrants have appropriate medical malpractice insurance in place. In some cases, we can provide this cover, but it is considered on a case-by-case basis and by testing the insurance market on your behalf. Members can contact us directly for more information.

Need more help and support?

Members should contact us on [email protected] or 020 7298 5151 

Regulation of eye care provider organisations can vary depending on where they are based in the UK and which services they offer. This is a brief overview of important regulators and regulations. 

UK

England

  • Care and Quality Commission (CQC). By law you must register with the CQC for each regulated activity your organisation provides in England.
  • Care provided within the scope of practice of an optometrist is exempt from CQC registration - with a CQC exemption for "Primary ophthalmic services (for example, high street optometrists) or ophthalmic services that are of the same kind as those provided by high street optometrists." (Ref. CQC, 2015, The scope of registration).
  • Surgical procedures and medical care are likely to be regulated activities, unless there is an exemption, and providers offering these services in England might need to register with the CQC. Learn more about regulated activities.
NHS Improvement (Monitor). Since February 2013, some providers have had to obtain a 'provider licence' from NHS Improvement to offer NHS care in England.

Primary eye care providers do not require a licence. This is because they are not required to register with the CQC.

Providers that are required to register with the CQC and have turnover from NHS services of more than £10 million a year can consult NHS Improvement about whether they need to obtain a provider licence.

Northern Ireland

Regulation and Quality Improvement Authority (RQIA)

  • Coming soon

Scotland

Health Care Improvement Scotland

  • Coming soon

Wales

Care Inspectorate Wales

  • Coming soon

Need more help and support?

Members should contact us on [email protected] or 020 7298 5151. 

Providing NHS care (including GOS)

Since 1998, healthcare in the UK has been increasingly devolved to each country. So now, although some things are similar across the UK, there are also significant differences. The advice below is broken down by main contractual arrangements and country. We also help members get the information they need according to where they are based or where they want to provide NHS care in the future, so if you need any additional support email [email protected]

General Ophthalmic Services 

NHS England commissions General Ophthalmic Services (GOS) based on an NHS England national contract.

Getting started

If you want to provide GOS in England, then as a provider you will need a contract(s) with the appropriate NHS Local Area Team(s) depending on the location of your practice(s).

There are three types of contract in England:

1.    Mandatory: which all practices providing NHS GOS must provide

2.    Additional services: which practices can choose to provide and currently only includes domiciliary and mobile GOS

3.    Enhanced services, which are commissioned locally using the NHS Standard Contract (long or short form) - e.g. glaucoma co-management, MECS etc (see NHS provision of other eye health services in England below.

If you want to provide NHS funded domiciliary eye care you must enter into a GOS Additional Services Contract. Under this contract you can provide an NHS sight test for a person who cannot leave home unaccompanied because of physical/mental illness or a disability. You can only provide the service at the person's normal place of residence or at an approved centre. 

NHS England's Policy Book for Eye Health provides more detail on GOS.

We as the OC with LOCSU have also produced guidance on the GOS contract application process . You might also find it useful to read 2008 GOS guidance for England  for background information.

Continuing compliance

Once you have a contract, you must comply with it. You must make sure:

  • Your optometrists are registered with the General Optical Council and on the Performers List, so they can perform GOS tests
  • You have appropriate clinical governance in place. You can achieve this by using Quality in Optometry  (QiO)
  • You have a complaints process for GOS. 
  • Your claims for NHS funding are accurate and compliant. The best way to do this is by using Making Accurate Claims in England.

NHS support - making claims and more

Primary Care Support England (PCSE) provides:

  • GOS claims and other stationery
  • GOS form provision
  • CET payments
  • Performers List applications

PCSE is also doing more online, which should help reduce your operating costs in the future.

Need more help and support?

Members should contact us on  [email protected] or 020 7298 5151 

The HSC Business Services Organisation (BSO) is responsible for payment, inspecting premises and maintaining the Ophthalmic List, and holding information on optical policies and services in Northern Ireland. 

Getting started

If you want to provide GOS in Northern Ireland, then as a provider you will need to register with the appropriate Health Board(s)depending on your practice(s) location.

If you want to provide NHS funded domiciliary eye care in Northern Ireland, you will need to register under part two of the Ophthalmic List - making a statement with your application that you want to provide a mobile service. You will need to do this in the Health Board where you want to provide this service.  

Continuing compliance

Once you are registered you must comply with the conditions of your registration. You must make sure:

  • Your optometrists are registered with the General Optical Council and on the Northern Ireland Ophthalmic List, so they can perform GOS tests
  • You have appropriate clinical governance in place
  • You have a compliant complaints process for GOS
  • Your claims for NHS funding are accurate and compliant. The best way to do this is by using Making Accurate Claims in Northern Ireland 

NHS support - making claims and more     

GOS claims (in paper form) should be submitted to the BSO by the 10th of each month. Electronic claim submission is through OCS and must occur by the 21st of each month to be included in that month's payment. Further information is available on the BSO website and from the GOS memorandum.

Need more help and support?

Members should contact us on [email protected] or 020 7298 5151 

The NHS in Scotland provides universal access to a primary eye care service as part of General Ophthalmic Services (GOS) Scotland.  The GOS primary eye examination (PEE), supplementary eye examination (SEE) and enhanced supplementary eye examination (ESEE) are available nationally. This enables you to provide patients with routine, chronic or emergency eye conditions with the care and support they need and then to appropriately triage as clinically necessary.

Getting started

If you want to provide GOS, then as a provider you will need to register with the appropriate NHS Board(s)depending on your practice location.

If you want to provide NHS funded domiciliary eye care, you must be registered under part one of the Ophthalmic List. Practitioners must contact their appropriate NHS Board to apply to join the list. Once added to the list, the Primary Services Division (PSD) will allocate you a list number.

Continuing compliance

Once you are registered you will need to comply with the conditions of your registration. You must make sure:

NHS support - making claims and more

eOphthalmic covers claims. It includes guidance on claiming and regulations and other resources.

Need more help and support?

Members should contact us on [email protected] or 020 7298 5151 

Seven Local Health Boards (LHBs) are responsible for securing health care services in Wales, including General Ophthalmic Services (GOS). 

Getting started

If you want to provide GOS, then as a provider you will need to be included on the Ophthalmic List with each LHB where you have a practice.

If you want to provide NHS funded domiciliary eye care, you must be registered under part two of the Ophthalmic List to provide ophthalmic services. To provide domiciliary services, you should include a statement to that effect in your application along with an undertaking to follow the terms of service for mobile services.

Continuing compliance

Once you are registered you will need to comply with the conditions of your registration. You must make sure:

  • Your optometrists are registered with the General Optical Council and, if not on the Ophthalmic List, they are on the Supplementary List, so they can perform GOS tests
  • You have appropriate clinical governance in place
  • You have a compliant complaints process for GOS
  • Your claims for NHS funding are accurate and compliant. The best way to do this is by using Making Accurate Claims in Wales 

NHS support - making claims and more

Primary Care Services provides GOS contracts, list management, payment processing and post-payment verification.

Need more help and support?

Members should contact us on [email protected] or 020 7298 5151

NHS provision of other eye health services

As well as nationally commissioned General Ophthalmic Services, the NHS commissions eye health services locally.

The NHS commissioning system is changing, but Clinical Commissioning Groups (CCGs) remain responsible for commissioning almost all local NHS eye health services. NHS England also commissions specialist eye care services. The NHS Standard Contract is used to provide these services.

Local Eye Health Networks (LEHNs)are regional eye health professional networks established to help the NHS with clinical, service improvement and clinical support at a local level. The Local Optical Committee Support Unit (LOCSU) also helps Local Optical Committees maintain and improve local eye care services.

Need more help and support?

Members should contact us on [email protected] or 020 7298 5151

In addition to GOS-funded eye examinations, the Health & Social Care Board has commissioned a number of regional enhanced services aimed at improving access and outcomes and delivering care closer to home. Enhanced services include regional acute eye, glaucoma and cataract pathways. Glaucoma pathways can include repeat measure, enhanced case finding, and OHT monitoring. This has been made possible by eReferral, access to Electronic Care Record and Project ECHO. A NI Eyecare Network is also now constituted to make regional decisions, with a mandate to advise on prioritised investments across primary and secondary eyecare.

Local Health and Social Care Trusts provide HES and report to the HSCB.

Need more help and support?

Members should contact us on [email protected] or 020 7298 5151 

People in Scotland benefit from a comprehensive NHS funded primary eye care service which is made up of the primary eye examination (PEE), supplementary eye examination (SEE) and the enhanced supplementary eye examination (ESEE). These are available nationally and provide equitable access to care (see Scotland GOS above).

Optometrists also provide enhanced services, which are commissioned locally as level 2 services, learn more.

As well as nationally commissioned General Ophthalmic Services Scotland, 14 NHS Boards in NHS Scotland are responsible for the Hospital Eye Service (HES). 

Need more help and support?

Members should contact us on [email protected] or 020 7298 5151

As well as nationally commissioned General Ophthalmic Services, NHS Wales has improved access to eye care in primary care and community settings through the Wales Eye Care Service (WECS). This allows optometrists in primary care to offer enhanced services and care, and follow-up examinations and repeat tests. This means more people can be managed locally and do not have to be referred to hospital unless they need to be. Eye Health Examination Wales (EHEW) is a fundamental part of WECS and nationally commissioned, taking administrative costs out of the system so more NHS resources can be spent on frontline services.

Also, seven Local Health Boards in Wales provide a Hospital Eye Service (HES).

Need more help and support?

Members should contact us on [email protected] or 020 7298 5151    

Remember, this is just information to help members get started and if you need more support you can contact us on [email protected] or 020 7298 5151.

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