Clinicians’ FAQs

Continuity is essential with this group of patients. We will therefore be matching one optometrist and one DO to each school. We are expecting most providers to be providing this role 1-2 days per week – this will vary by provider and by school. Applicants should share their availability with NHS England.

As a guide, a population of 100 children equates roughly to one day a week in school term time for each clinician.

At least one day per week – in school term time (around 36 weeks/year). The actual time will vary depending on the number of students within each school.

Yes, that is the expectation. Not just because of the respective skills they bring, but they can work much more efficiently and get more done by working together. NHS England can also match independent interested clinicians so there doesn’t need to be a joint application necessarily.

Yes, only a qualified DO/Optometrist can supply spectacles to children and/or patients who are sight impaired or severely sight impaired. The DOs role will be to dispense spectacles ensuring they meet the child’s needs which includes aftercare, ie. repair and adjust as required.

The DO will also be expected to provide ongoing support with adapting to spectacles as well as clinical advice on visual abilities in the classroom, eg. best positioning/use of spectacles with communications devices such as eye gaze, etc.

Both the Optometrist and DO need to be able to work autonomously in a busy environment. The fee structure and pathway has therefore been based on a DO providing this element of the service alongside an Optometrist.

No – a key area of this pathway is the trust and relationship that is built by the special school providers with school staff and patients, so continuity of staff is a key requirement. DOs bring a very specific skill set and play a fundamental role in the delivery of the service so alternative arrangements will not be considered.

There is presently no limit, but we will inevitably reach an upper limit as we start to mobilise the service. There are circa 1,000 special schools in England, accommodating over 120,000 children, so we don’t expect to be thinking about limiting numbers for some time.

The service will be offered as an opt-out, ie. all children will be given appointments unless their parents opt out of the service. In practice this means the provider will need to liaise with a lead contact at the school to arrange opt-out consent to be shared and history information gathered from parents (using paper or digital history forms). Parents will then need to be notified of appointment times and invited to attend if they wish. In existing SeeAbility services, parents attend around 10% of appointments – sometimes commenting that their attendance may be disruptive because of the impact it has on the child’s behaviour (who often associate their presence in school with home time).

Basic Makaton signing will form part of the training for interested clinicians, as will an introduction other non-verbal communication methods.

Casual, Jeans and T-Shirt in keeping with school staff. Formal clothing may scare some children and is impractical as you are likely to need to get down their level/move around quickly.

Yes, providers will be allocated a school(s).

The provider should attempt everything appropriate to the child set out in the Framework for Special Schools Eye Care. Where tests are not possible, they should be attempted again and if no results can be obtained, the reason clearly recorded (eg. child became distressed/pushes me away). Guidance on this has been issued by NHS England.

Of course, if you cannot do a test, wherever possible a suitable alternative should be attempted. If no results were possible with a Kay vision test for example, you should evidence you have tried Cardiff Cards and/or Bradford Visual Function Box (and record negative tests as well as positive).

Up to date copies of the documentation mentioned here can be obtained from mailto:england.specialschooleyecareservice@nhs.net

The case referred to was very different to this service. Opt-out has been discussed extensively with all stakeholders throughout the development phase of the service framework and is recommended in the Framework for Special Schools Eye Care.

How opt-out is delivered is included within the school and parent communication plans, with key stakeholder’s input. In an opt-out scenario, all patients would be eligible unless the parent/guardian opts out of the service.

We have approached the GOC to comment on the opt-out approach and are currently awaiting their considered response, but initial discussions have been positive.

Initial engagement with parents will be necessary to get history and symptom information. The use of drops or supply of spectacles would usually require verbal parental consent to be gained.

All providers will need to have a contract in place with NHS England. The regional teams will support any prospective providers with the contract application process. At this stage we do not know the number of applicants that this may apply to. We are considering drop-in sessions to support anyone who may be applying for a contract for the first time.

The NHS Performers list includes all opticians that are registered by NHSE to provide General Ophthalmic Services (GOS). As the new service will be funded through GOS, optometrists providing the service will need to register onto the performers list. The following link provides further information and will allow you to make an application to join the NHS performers list pcse.england.nhs.uk/services/performers-lists/

Contractors will be responsible for holding contracts with NHS England and NHS Improvement to deliver this new service and can be optical practices, Acute Trusts, Universities or even providers.

This service is fully funded by NHS England and NHS Improvement and will eventually be commissioned through the General Ophthalmic Services (GOS) framework. The contractor fee per episode is £116 to cover the cost of an optometrist and dispensing optician for a full day (we anticipate between 6 – 8 sight tests per day). The fee takes into account all other non-clinical elements of the service such as teacher training, preparing reports for each child, etc.

Children rarely attend a hospital eye department for a sight test out of choice – it’s usually because they don’t have access to alternative services. By making this service available in special schools, we reduce the need for patients to attend hospital for a sight test. This service will lead to a greater number of patients being tested and subsequently referred to hospital. We expect the numbers in hospitals will be stable but the case mix may change.

NHS England has designed the service to be flexible and able to adjust to the specific environment and needs of each school. We are already engaged with schools who have existing orthoptist-led services providing visual assessments to understand how the addition of sight tests and dispensing can be included to complement and enhance the service already in place. Funding streams for the existing and new service will remain separate so it is more a practical matter of how the services can be combined.

Yes, we often don’t use cyclo. Ironically, poor accommodation in this group of children has historically been missed because of cyclo protocols and actually dry retinoscopy can be relied upon as accommodation is often inactive/easy to control.

We often use ‘functional retinoscopy’ to ascertain the child’s functional refractive state. It’s really important to compare the reflexes between the eyes and move fluidly between the eyes to avoid inducing anisometropia by refracting the eyes in isolation. Full aperture loose lenses held up binocularly enable reliable ret.

The use of dynamic retinoscopy is vital for all children to check for accommodative weaknesses which around half of this population will have. Much more detail on retinoscopy techniques can be found in our recent OIP paper accessible to College members.

Not at present. We have tested various portable auto-refactors but have yet to find one which is reliable off axis, where we get consistent reliable measurements with children who are often very active/risk of being off axis. Retinoscopy is a vital skill!

No – there are a number of suppliers currently being used in the Eye Care Service: Tomato, Centrostyle, Swissflex, Erin’s World, Continental.

All physical costs for repairs will be met by NHS England. The pathway allows each child to have 2 pairs of spectacles to reduce the possibility of them being without their spectacles should one pair become damaged/unusable. The sight test fee includes the cost of a DO for a full day and subsequently covers all labour costs associated with the service including repairs.

NHS England will fund the cost price for all spectacles supplied within the service. This ensures that every patient receives spectacles that best meet their needs. We are currently considering a number of options and will be able to provide further information in due course.

NHS England have a budget to support new providers and schools with Set Up costs. This may include equipment, training, and ’familiarisation days’ between schools and providers. Set Up requirements are likely to be different for each provider, so requests will be considered on an individual basis.

ABDO has been a key stakeholder in the development of the framework alongside AOP, College of Optometry and FODO. ABDO is a member of the NHSE Training and Accreditation Working Group responsible for developing clinical training for the service so have contributed to all discussions. ABDO hosted a national webinar on 8 December 2020 which included a session on the special school service. Further details can be found Professional Toolbox area of the ABDO website.

ABDO has been commissioned to produce 8 model paediatric heads, each representing a different facial characteristic or age; and we are in discussion with them regarding the need/possibility of developing a bespoke training programme specifically for DOs (in addition to the material outlined above).

Yes – NHS England are developing the training plan. This will include shadowing SeeAbility colleagues in existing settings to allow clinicians to get first-hand experience, plus a ‘Familiarisation Day’ with partnering schools. We are closely monitoring the situation in respect of COVID as this is likely to impact our training delivery plans.

We have already developed a non-clinical training package with Health Education England which can be accessed here.

We are also in discussion with the College of Optometrists regarding the development of an enhanced clinical training programme with the support of all 4 professional bodies (CoO, RCOphth, ABDO, BIOS). We expect a further 2 x 2-hour clinical training session and some case record reviews with an experienced mentor to complete the training.

Additional material is available from the following sources:
• DOCET Learning Disability eye care – although this is currently available to optometrists, NHS England are working to make this available to DOs
• LOCSU / WOPEC People with Learning Disabilities – contact your LOC for a code to access this course which is currently being updated.

Please provide as much information about your existing service (if applicable), ie., name and location of school, number and age range of pupils, details and frequency of existing services, etc, and contact NHS England and NHS Improvement at england.specialschooleyecareservice@nhs.net

In the first instance, please contact NHS England and NHS Improvement at england.specialschooleyecareservice@nhs.net

We may already be recruiting clinicians in your locality, but if not, we can engage with the local optical community to seek expressions of interest. Please note that the pace of the roll out of this service will in part be influenced by the need to train new primary care providers, so it may take several months before we can implement the service in any schools you may already be supporting.

All optometry services have become Covid safe services with the use of PPE and regular cleaning. Clinicians providing this service would need to wipe down equipment and toys with 70% alcohol wipes between patients.

Practitioners will use PPE and the clean down procedure as per ABDO/College/AOP guidance. Clear masks can be used to reduce the potential for anxiety amongst the children, but in the main they have responded very positively to the PPE – more so than we might have imagined.
Currently, children are being booked in ‘bubbles’ so on the same day, a group of children who are all in close contact with each other during the school day are seen.