Domiciliary sight tests - Guidance for care and nursing home staff

The NHS pays for people who are in an eligible group, including everyone aged 60 years or overto have their eyes tested. Normally people attend high street opticians but the General Ophthalmic Services Regulations enable some opticians to visit people in their own home, at a residential centre or at an approved day centre.

A “day centre” is defined asan establishment in the locality of the PCT attended by persons, including eligible persons, who would have difficulty in obtaining sight-testing services from practice premises because of physical or mental illness or disability or because of difficulties in communicating their health needs unaided.

A “residential centre” means an establishment in the locality of the PCT for persons, including eligible persons, who normally reside in that establishment and who are unable to leave the establishment unaccompanied because of physical or mental illness or disability;

  1. The sight test must be requested by the patient, a relativeor any other adult who has the care of that person. It’s not appropriate for day centre staff or a warden at a sheltered housing complex to arrange for an optometrist to attend without specific requests from clients or if appropriate the person’s relative or primary carer. There is unlikely to be an obligation on day centre staff or wardens at sheltered housing complexes to arrange sight tests for all attendees/residents.
  1. The sight test form requires the patient to give a reason why they cannot attend a practice. Whenever possible it is preferable that people attend an optical practice as the facilities will be more appropriate,especially the lighting, and the equipment used will be more comprehensive. Even where people do not go out on their own having a friend or relative take them to an optical practice will always be preferable.
  1. Care and nursing home staff should not sign NHS forms unless they are explicitly authorised to do so. If they do sign they must read the form carefully and understand what they are signing for. If the optometrist does not see evidence of entitlement to an optical voucher the form must be annotated with a cross in the roundel on the form and it may be checked. If a patient is not entitled to receive the optical voucher it can be reclaimed and a penalty charge imposed. The person who signed the form would then be implicated.
  1. Background information. The optometrist needs background information about the patient’s health, spectacle wearing habits, date of last sight test, visual requirements, eye history (own and family), home environment, etc, in order to do a full sight test. Information about financial status is also required to establish eligibility for help towards the cost of glasses. As patients attending a Day Centre may be confused or may suffer from memory loss thestaff should do their best to ensure such background information is available. The optometrist may provide a questionnaire which can be completed by a relative or carer prior to the sight test. If not, something similar to the first few pages of the SeeAbility leaflet ‘Tell the optometrist about me’ would be helpful; it is available on:
  1. Cooling off period– The optical representative bodies have recently issued guidance about the Cancellation of Contracts made in a Consumer’s Home or Place of Work etc Regulations 2008. Under these regulations domiciliary providersmust give a 7 day cooling off period before ordering spectacles unless written permission is given to proceed with the order. This applies to orders over £35 and includes spectacles provided at NHS optical voucher value as the lowest voucher is currently £36.20. In future the visiting optician will have to provide each patient with written notice of their right to cancel and a cancellation form. Patients can request in writing that any spectacles are ordered before the cancellation period has expired but they should not be coerced into this by the provider.
  1. Free spectacles – Please be aware that eligible patients’ optical vouchers will be claimed from the NHS for the ‘free’ glasses supplied so there is always a cost. New spectacles should only be prescribed when necessary which is one reason why any old spectacles should be made available to the optometrist and their use evaluated. There is no automatic right to a voucher towards the cost of new spectacles unless there has been a change in prescription or current spectacles are broken or badly damaged. Patients should check whether or not they are covered by insurance for lost spectacles. The residential or day centre may also have some responsibility and liability regarding a person's possessions. NHS vouchers are monitored and instances where patients are found to have received duplicate or frequent vouchers will be investigated.
  1. Domiciliary code of Practice – The visiting optician should abide by this document and it is advised that care and nursing home staff, day centre managers and wardens at sheltered housing complexes are also familiar with it.

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