Opticians follow this guidance to provide services safely during the amber phase.
Practices are required to:
- prioritise the safety, health and well-being of the public and optometrists, dispensing opticians and the wider practice workforce (e.g. reception staff)
- adhere to all UK wide and Welsh Government regulations, Legislative Directions, Welsh Health Circulars and other appropriate guidance, including, specific COVID19 PPE guidance and training
- adhere to all social distancing measures (see section below)
- provide more services remotely e.g. via telephone or video link where possible
- minimise the contact time with each patient in confined spaces (wherever possible this should be to 15 minutes); in line with prudent principles consider the non-critical elements of the patient journey
- adhere to additional hygiene standards for waiting areas and maintain current equipment hygiene standards
- review current administration processes to limit the amount contact time between patients and the workforce
Social distancing measures
Social distancing will feel significantly different for the optometry workforce and patients. The practical measures outlined below are to ensure contact time between the patient and the workforce is reduced to an absolute minimum.
Practices are required to:
- ensure all optometrists complete the nationally agreed WOPEC COVID19 training module to ensure understanding of when, and how to use PPE
- offer patients remote service as a first-choice option where appropriate
- triage patient appointments, via telephone or video, with consideration of those at greatest risk of sight loss
- ask patients to attend appointments alone; the exception will be when safeguarding patients at risk of harm and those patients under 16 years of age
- ensure patients waiting for their appointment to stand or sit 2 meters away from other patients; this may require patients to queue outside the practice
- use clear identifiable markings for patients and the workforce to see where a patient should sit or stand to wait for their appointment
- consider offering patients home delivery of spectacles and contact lenses as a first-choice option, supported by a remote follow-up appointment to patients
Appointment booking and triage
Practices are required to:
- ask all patients if they or anyone in their household has a fever, a new persistent cough, or any other symptoms related to Covid-19 in a telephone triage, and again at the point of attending the appointment. it is essential that all patients attending a practice for any reason are symptom free to reduce the risk of disease transmission
- offer patients remote service as a first choice option; discuss with the patient if telephone/video consultation is appropriate, or if a physical consultation is required
- explain the protocols for attending an appointment at the practice and clarify the new measures and subsequent new ways of working (see section about pre-appointment consultation below);
The pre-appointment consultation process should be completed at the time of booking the appointment and again on arrival at the practice, specifically, to
- ensure patient adherence to the new measures, specifically, explain to the patient what to expect, what to bring with them to the appointment and what they will need to do if there is a queue at the practice when they arrive
- validate the patient information already captured and to ask the patient any additional questions e.g. patient contact details; GDPR consent
- confirm the appropriate journey for the patient
- confirm the appropriate examinations for the patients journey
- confirm the appropriate questionnaire e.g. lifestyle questionnaire and/or CL questionnaire
- update the History and Symptoms section of each patient record
- confirm all of the patient information gathered with the patient and discuss and agree the patients dispensing requirements, including, explaining the options and costs involved;
The GOC relaxed restrictions on the supply of spectacles during the Covid-19 pandemic and current guidance sets out the following.
- There are no legal restrictions on the supply of spectacles by, or under the supervision of GOC registered optometrists and dispensing opticians, including for users aged under 16 or registered sight-impaired / severely sight-impaired (section 27 of Opticians Act). If there is no clinical need for a patient to attend an optical practice, practices managers should consider posting or delivering spectacles to the patient.
- If the patient reports no changes in vision and the optometrists has no concern, the DO should consider dispensing of spectacles and/or contact lenses via remote services e.g. telephone or video consultation.
- Consider home delivery adhering to the new social distancing measures.
- Consider an aftercare call for patients.
- Consider the need for a staff member/gate keeper to be positioned at the practice entrance to welcome/meet and greet everyone that approaches and check the reason for the visit. The gate keeper must ensure it is safe for people to attend their appointment and check they are free from coronavirus symptoms and haven’t had contact with anyone who has symptoms (COVID19 confirmed or not).
- The gate keeper will consider the number of people in the practice at any one time, and enable the flow of people in and out of practices, adhering to the social distancing measures (as seen in supermarkets across the UK). The gate keeper role will be crucial as the volume or people increases.
- Consider setting up a triage area near the front of the practice. This space should be used to triage people adhering to the social distancing measures. If there are 2 entrances to the building, and if safe to do so, consider using one as an entrance and one as an exit.
- Explain to the workforce and the patients that the primary focus is to keep both patients and
staff safe whilst in the practice.
- Explain to the workforce and the patients that the floor markings, use of PPE and cleaning routines adhere to the social distancing measures.
- Consider the use of hand sanitiser for the work force and patients.
- Ask patients to go to the triage area for unscheduled appointments/visits and the
appropriate location for booked appointments.
Diagnostics and pre-screening
- Ensure the workforce wear the appropriate PPE to the task/service being delivered (on GOV.UK).
- Clean each piece of equipment before each patient enters the consulting room. Explain and conduct diagnostic tests
- auto–refraction (where appropriate)
- visual fields (where appropriate)
- OCT (where possible)
- cigital retinal photography (where possible)
- NCT (dependent on current professional advice)
- Remove and dispose of or disinfect PPE, as appropriate, after each patient appointment
- Consulting rooms to have a strict one-patient policy, except where a child or vulnerable adult requires a guardian or companion.
- Wherever possible, the time spent in the consulting room with patients should be minimised and limited to 15 minutes to reduce the risk of transmission of coronavirus.
- Practices should ensure all optometrists keep up to date with the latest industry guidance on specific aspects of the examination.
- Consider the examination flow:
- Optometrist reads and enters patient information about history, symptoms and lifestyle as well as diagnostic results into patient record, before inviting the patient into the consulting room.
- Optometrist to put on new or disinfected PPE for each patient before they enter the consulting room.
- Clean each piece of equipment between patients.
- Complete examination and if the measurement of intra-ocular pressure is indicated, use contact tonometry following hygiene control
- Update records on system (after patient has left the consulting room)
- Optometrist to remove and dispose of or disinfect PPE after each patient.
- Consider how much dispensing can be discussed with the patient in the pre visit consultation process remotely via telephone or video link.
- Dispensing Optician or optometrist to put on appropriate PPE.
- Clean and wipe each spectacle frame after the patient has tried it on before putting it back on the display rack.
- Wipe down dispense desk, chairs and any instruments used in the dispensing process.
- Record all necessary measurements for a successful home delivery
- Arrange collection – preferably home delivery
- Consider an aftercare call for patients
- Clearly mark an appropriate area for patients to stand when they make a payment (e.g. floor markings like in supermarkets). Remind patients to pay by card. Avoid taking cash where possible. Ensure all staff wash or sanitise their hands after payment transactions, specifically, after handling money.
- Wipe down card payment terminal before presenting it to each person
- Wipe down card payment terminal after each person completes the payment transaction (except contactless).
- In light of the current COVID-19 environment, the UK payments industry has taken the decision to increase the contactless limit to £45 from £30. This increase in the limit for contactless transactions in-store is another measure to reduce the spread of COVID-19 via cash handling. Practices must apply to their suppliers to make the necessary arrangements.
Temporary changes in regulations surrounding the provision of spectacles mean that
- Practices can offer home delivery to everyone, including under 16's
- Please use your professional judgement when extending the service and review the latest clinical guidance
- It is recognised that home delivery is not suitable for everyone. Practices should apply the same triage process to balance the need to limit visits to practice versus the risk and decide on a case-by-case basis.
In practice collections
Practices to consider the collections flow:
- Complete the meet, greet and triage process
- Clean and wipe the dispense desk and chair before the patient sits down
- Staff to sanitise their hands and ask patients to do the same when collecting spectacles
- Staff to put on the appropriate PPE
- Clean and wipe the frames and case in front of each person
- Ensure the frame fits correctly. Check comfort and vision
- Clean and wipe frames again before putting them in the case and handing them to the person
- Clean and wipe each piece of equipment and then remove and dispose of, or disinfect PPE
The GOC issued the following statement in relation to the supply of contact lenses during the Covid-19 pandemic: If there is a clinical need, or the specification has expired, then during this emergency period, registrants should consider the risk of requiring a patient to attend an optical practice and potentially contracting or spreading coronavirus compared to any clinical risk of supplying contact lenses on an expired specification and use their professional judgement to decide on the best course of action.
Consider if telephone or video health checks should be the norm and not the exception. If you determine that the patient:
- has previous practice records
- is over 16
- is a soft CL wearer but not using lenses as extended wear
Consider also if contact lens teach appointments can be provided remotely via video consultation.
Adjustments and repairs
A patient who calls (telephone) with concerns about the fit/vision of a recently purchased pair of spectacles should be triaged to decide whether a return to practice/spectacles return is needed
- if possible, a remote video consultation should be used to assess the fit and potentially talk a patient through minor adjustment if needed
- if the patient needs to return to practice, a dispensing appointment should be booked to control patient volume and ensure an appropriate member of staff is available
- if a patient returns to the practice with concerns about the fit/vision they should be triaged at the entrance to the practice