General Ophthalmic Services, activity statistics

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1 General Ophthalmic Services, activity statistics England, Published 29 June 2017 General Ophthalmic Services provide preventative and corrective eye care for patients meeting certain eligibility criteria. These services are available ondemand, largely on the high street. Key findings 13.0M NHS-funded sight tests were carried out in , a 0.1% increase from % of all NHS-funded sight tests were provided to those aged 60 and over 1 (6.3 million tests) 4% of patients who received an NHS funded sight test, did so in their own home as they were unable to attend a high street practice unaccompanied 1. Patients may qualify for an NHS funded sight test on more than one criterion, but can only be recorded against one criterion on the GOS1 form. Patients are more likely to be recorded according to their clinical need rather than their age, e.g. a patient aged over 60 with glaucoma is likely to be recorded in the glaucoma category, not the aged 60 and over category; eligibility counts are therefore approximate. Author: Primary Care Domain, NHS Digital Responsible Statistician: Gemma Ramsay Copyright 2017 Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital.

2 Contents Key findings 1 Introduction 3 Changes for Removal of National Statistics status 3 Data quality 3 GOS activity data 3 Population estimates 3 Chapter 1: NHS sight tests 5 Chapter 2: NHS optical vouchers 13 Chapter 3: NHS vouchers for repair or replacement 15 Appendix A: contents of annex files 17 Appendix B: Users and uses of the data 18 Appendix C: Related publications 19 ISBN This publication may be of interest to members of the public and other stakeholders to gain a picture of General Ophthalmic Services in England, and to make local and national comparisons. Copyright 2017, Health and Social Care Information Centre. 2

3 Introduction The objective of General Ophthalmic Services (GOS) is, through community opticians practices, to provide preventative and corrective eye care for children, people aged 60 and over, adults on low incomes and those suffering from, or predisposed to, eye conditions and diseases. This annual publication includes information on NHS sight tests, NHS optical vouchers and NHS vouchers for repair or replacement. This written report presents information at national level; further breakdowns of data are available in the annexes (see Appendix A). All data are final, and cover financial years, April March. Changes for NHS Digital access ophthalmic activity data via the Central Ophthalmic Payments System (COPS). The existing payment system is being shut down and a new provider is developing a new system which is not yet available. Until the new system is available, the data NHS Digital are able to analyse and publish are limited in scope; the number of breakdowns that can be provided is much reduced (as detailed in the Data Quality section, below). Details of this issue were first communicated via the NHS Digital website at in March Removal of National Statistics status As a result of the changes described above, these statistics no longer meet the highest standards of trustworthiness, quality and public value; therefore, the National Statistics badging has been removed. Once the new data source is available, it is anticipated that future publications could be considered for National Statistics status. Data quality GOS activity data The total numbers of NHS sight tests, optical vouchers and vouchers for repairs and replacements are available via COPS, and are included in this release. These figures have been presented in all releases to date. Robust breakdowns of the optical vouchers and vouchers for repairs and replacements by eligibility (e.g. by age band) are not currently available, and are therefore not presented in this release. The available raw data for these breakdowns are provided in Annex B for reference, but these should be interpreted with caution in light of the known issues with the data collection, and the small sample sizes they represent. Population estimates 2014 mid-year population estimates are used to calculate rates for and ophthalmic activity data. The data available in COPS provide the ophthalmic activity figures at Area Team level. Since Area Teams no longer exist, ONS do not provide mid-year Copyright 2017, Health and Social Care Information Centre. 3

4 population estimates at this aggregation, and no mappings exist to aggregate to Area Team level from lower levels. Therefore, 2014 mid-year estimates are used; users of these data should take this into account when comparing rates over time. This affects data in table 1.3, figure 1.2 and table 4.2. Copyright 2017, Health and Social Care Information Centre. 4

5 Chapter 1: NHS sight tests This chapter presents information on NHS sight tests and excludes private tests given to patients who are not eligible for an NHS test. Patients with an HC3 1 certificate, as part of the low income scheme, are entitled to partial funding towards a private sight test. Figures relating to HC3 certificates are presented later in the chapter, in the section Private sight tests and private domiciliary sight tests with partial help. For more information on the eligibility criteria for an NHS sight test, see the Beginners Guide which is available at In the year ending 31 March 2017: 13.0 million NHS sight tests were provided to patients in England, an increase of 15,750 (0.1 per cent) from (table 1.1, figure 1.1) There were 23,925 NHS sight tests provided per 100,000 population (table 1.3) per cent of NHS sight tests were provided to patients aged 60 and over (table 1.2). 6.3 million NHS sight tests were provided to patients aged 60 and over (table 1.3) 2.5 million sight tests were provided to patients aged 0-15 (table 1.3). There were 50,293 NHS sight tests provided per 100,000 population aged 60 and over (table 1.3) 2,3 There were 24,273 NHS sight tests provided per 100,000 population aged 0-15 (table 1.3) 2,3 1 HC3 certificates provide income related help to people who are not exempt from charges, but who may be entitled to partial help if they have a low income. 2 Based on mid-year 2014 population estimates 3 Patients may qualify for and NHS sight test on more than one criterion. However, they would only be recorded against one criterion on the form. Patients are more likely to be recorded according to their clinical need rather than their age. For example, a patient aged over 60, with glaucoma is likely to be recorded in the glaucoma category only. The counts for these age groups may therefore be underestimates. Copyright 2017, Health and Social Care Information Centre. 5

6 Table 1.1: Number of NHS sight tests England, to Apr - Sep Oct - Mar Apr - Mar Numbers and percentages Year-on-year change (number) Year-on-year change (percentage) ,523,000 5,525,000 11,048, , ,641,406 5,637,068 11,278, , ,052,100 5,759,551 11,811, , ,132,035 5,806,494 11,938, , ,039,974 6,265,753 12,305, , ,231,831 6,107,422 12,339,253 33, ,445,283 6,342,147 12,787, , ,413,065 6,351,420 12,764,485-22, ,554,718 6,425,044 12,979, , ,506,913 6,488,599 12,995,512 15, Figure 1.1: Number of NHS sight tests England to NHS sight tests, thousands 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Year Copyright 2017, Health and Social Care Information Centre. 6

7 Table 1.2: NHS sight tests by eligibility England, to Percentages Numbers Aged 60 and over ,651,025 6,262,242 Children ,672,490 2,501,001 Students , ,624 Adults receiving income support , ,722 Adults receiving tax credits , ,352 Adults receiving JSA , ,142 Low income certificate holders (HC2) ,370 81,979 Adults receiving UC 3 z z z z z z , Registered blind/partially sighted ,528 6,656 Diabetics/Glaucoma sufferers ,141,727 1,108,335 Need complex lenses ,190 64,774 Close relatives 40 & over of Glaucoma sufferers , ,105 Prisoner on Leave 5 z Total ,979,762 12,995,512 Notes: z denotes not applicable 1. Income Support includes patients receiving Pension Credit Guarantee Credit (PCGC) and also Income-related Employment and Support Allowance (ESA), which was introduced in October Job Seekers Allowance. 3. Universal credit is replacing 6 existing benefits. It is being phased in from April 2013 and it is planned that it will have been fully introduced by April See for more 4. Patients may qualify for an NHS sight test on more than one criterion. However, they would only be recorded against one criterion on the form. Patients are more likely to be recorded according to their clinical need rather than their age. For example, a patient aged over 60, with glaucoma is likely to be recorded in the glaucoma category only. The count by eligibility is therefore approximate. 5.The Prisoner on Leave category was introduced in October See our Beginners Guide to NHS Eye Care Publications for information on eligibility categories. 7. The numbers relating to eligibility data for previous years can be found in Annex B. Copyright 2017, Health and Social Care Information Centre. 7

8 Table 1.3: NHS sight tests per 100,000 population, by eligibility recorded as age band England, to Numbers Number of NHS Sight Tests Population Estimates Number of NHS Sight Tests per 100,000 Population Children 0-15 Adults 60+ All Sight Tests. Children 0-15 Adults 60+ All England Children 0-15 Adults 60+ All Sight Tests ,299,159 4,860,912 11,047,890 9,654,027 11,066,457 51,106,181 23,816 43,925 21, ,313,500 5,015,536 11,278,474 9,666,342 11,329,355 51,464,646 23,934 44,270 21, ,460,089 5,191,773 11,811,651 9,704,432 11,541,135 51,809,741 25,350 44,985 22, ,449,831 5,305,177 11,938,529 9,766,314 11,746,490 52,234,045 25,084 45,164 22, ,458,850 5,537,930 12,305,727 10,030,130 11,891,958 53,107,169 24,515 46,569 23, ,350,219 5,480,711 12,339,253 10,130,226 12,069,402 53,493,729 23,200 45,410 23, ,542,137 5,576,957 12,787,430 10,209,238 12,244,950 53,865,817 24,900 45,545 23, ,732,370 5,507,932 12,764,485 10,303,556 12,451,639 54,316,618 26,764 44,981 23, a 2,672,490 5,651,025 12,979,762 10,303,556 12,451,639 54,316,618 25,938 45,384 23, a 2,501,001 6,262,242 12,995,512 10,303,556 12,451,639 54,316,618 24,273 50,293 23,925 Notes: 1. Population figures are Office for National Statistics (ONS) mid-year population estimates. Unless otherwise stated, mid-year estimates are for the first year shown (e.g figures use the 2006 mid-year estimates). As mid-year estimates are released approximately one year in arrears, figures may be recalculated between publications. 2. Patients may qualify for an NHS sight test on more than one criterion. However, they would only be recorded against one criterion on the form. Patients are more likely to be recorded according to their clinical need rather than their age. For example, a patient aged over 60, with glaucoma is likely to be recorded in the glaucoma category only. The counts for these age groups may therefore be underestimates. 3. The recall period for NHS sight tests varies according to patient eligibility. Not all groups are entitled to an NHS sight test every 12 months. Further details are contained in our Beginners Guide to NHS Eye Care Publications. 4. The information presented here is based on the number of NHS sight tests and is not necessarily a count of individuals. Individuals may qualify for an NHS sight test at shorter recall periods and therefore be counted more than once in the figures depending on their clinical need. a mid-year estimates are used in and , users should interpret these figures with caution. Population estimates are no longer available at Area Team level, but GOS activity data are still supplied at Area Team level. To enable comparison of Area Team level rates to national level rates, mid-year 2014 population estimates have been used. Copyright 2017, Health and Social Care Information Centre. 8

9 Figure 1.2: NHS sight tests per 100,000 population, by eligibility recorded as age band England, to NHS sight tests per 100,000 population 60,000 50,000 All Sight Tests Children 0-15 Adults ,000 30,000 20,000 10,000 0 Notes 1. The rates are based on the population counts for the given age groups mid-year estimates are used in and , users should interpret these figures with caution. Population estimates are no longer available at Area Team level, but GOS activity data are still supplied at Area Team level. To enable comparison of Area Team level rates to national level rates, mid-year 2014 population estimates have been used. Year Sight tests can be carried out by optometrists and ophthalmic medical practitioners (OMPs). Optometrists comprise an increasing proportion of the ophthalmic workforce; on 31 December 2015 there were 11,891 optometrists and 245 OMPs in England 4,5. The majority of NHS sight tests are carried out by optometrists (table 1.4). 4 General Ophthalmic Services, Workforce Statistics England and Wales, 31 December 2015: 5 Optometrists are qualified to test eyesight and to prescribe and dispense spectacles, their training enables them to recognise abnormalities and diseases of the eye; they are registered with the General Ophthalmic Council (GOC). Ophthalmic medical practitioners are qualified doctors specialising in eyes and eye care. In additions to their medical skills, they are qualified to test eyesight and prescribe spectacles; they are registered with the General Medical Council (GMC). Copyright 2017, Health and Social Care Information Centre. 9

10 Table 1.4: Number of NHS sight tests conducted per practitioner, by practitioner type England, to Sight tests Number of practitioners 1 Number of sight tests per practitioner Optometrists Ophthalmic medical practitioners (OMPs) All. practitioners Optometrists OMPs All. practitioners Optometrists OMPs All. practitioners ,878, ,221 11,047,890 9, ,632 1, , ,181,039 97,435 11,278,474 9, ,540 1, , ,767,625 44,026 11,811,651 9, ,023 1, , ,905,963 32,566 11,938,529 10, ,409 1, , ,277,754 27,973 12,305,727 10, ,806 1, , ,316,310 22,943 12,339,253 10, ,137 1, , ,765,781 21,649 12,787,430 11, ,457 1, , ,749,584 14,901 12,764,485 11, ,827 1, , ,970,612 9,150 12,979,762 11, ,136 1, , ,988,183 7,329 12,995,512 12, ,458 1, ,043 Notes: 1. Workforce data are sourced from the General Ophthalmic Services, Work force Statistics, England and Wales publications. The latest publication for can be found at: 2. New regulations were introduced in England on 1 August 2008 replacing the Supplementary Lists and Ophthalmic Lists with a contractual regime for providers, and Performers Lists 3. The figures presented are affected by the extent to which the GOS guidelines relating to maintaining lists have been followed. NHS England Area Teams may remove a practitioner who has not provided GOS in the past six months from its lists. The procedure for removing inactive practitioners is through an agreement between the PCT( )/AT(2013) and optician. 4. Figures are calculated on the basis of headcounts for workforce numbers. 5. Figures presented are rounded. Calculations have been carried out using unrounded figures, which are available in the annexes. Copyright 2017, Health and Social Care Information Centre. 10

11 Domiciliary sight tests All patients who are eligible for an NHS sight test can qualify for a domiciliary sight test, if they are unable to attend a high street practice unaccompanied. In these instances, the ophthalmic practitioner visits the patient at their home, a residential care home or at a day care centre. For more information on domiciliary sight tests, see our Beginners Guide which is available at In , the majority of NHS sight tests were conducted at ophthalmic premises; however, 3.5 per cent were conducted away from ophthalmic premises (table 1.5). The number of domiciliary sight tests carried out has increased over the last ten years from 329,365 in to 454,515 in (table 1.5), an increase of 38.0 per cent. Table 1.5: Number and percentage of domiciliary sight tests by type, and as a proportion of all NHS sight tests England, to Number of sight tests Proportion of domiciliary sight tests Numbers and percentages Proportion of total sight tests Lower rate domiciliary sight tests Higher rate domiciliary sight tests All domiciliary sight tests Total sight tests Lower rate Higher rate All domiciliary sight tests , , ,365 11,047, , , ,484 11,278, , , ,715 11,811, , , ,867 11,938, , , ,200 12,305, , , ,995 12,339, , , ,109 12,787, , , ,537 12,764, , , ,348 12,979, , , ,515 12,995, Notes: 1. Totals may not equal the sum of component parts due to rounding. Calculations have been carried out using unrounded figures, which are available in the annexes. 2. Domiciliary visits made either to a single patient at the address or where the patient is the first or second to be seen are reimbursed at the higher rate. Third or subsequent patients visited at the same address are reimbursed at the lower rate. Copyright 2017, Health and Social Care Information Centre. 11

12 Part-funded sight tests Patients with HC3 certificates as part of the low-income scheme are entitled to varying degrees of financial help with private sight tests. Over the last ten years, the number of patients receiving financial help with private sight tests has decreased from 3,783 in to 804 in (table 1.6). Table 1.6: Number of private sight tests and private domiciliary sight tests where partial financial help was given, by setting England, to Numbers Part-funded private Of which: Private Domiciliary sight tests Sight Tests , , , , , , , , , Copyright 2017, Health and Social Care Information Centre. 12

13 Chapter 2: NHS optical vouchers Under the NHS optical voucher scheme, eligible patients are given vouchers to put towards their own choice of spectacles or contact lenses. Patients may receive a voucher for more than one pair of spectacles. The scheme was first introduced in July 1986 (prior to this, patients were given a pair of NHS spectacles), and the option to use vouchers to put towards contact lenses was introduced in April Eligibility for vouchers is largely based on income, and therefore differs slightly to the eligibility criteria for sight tests. For more information on the eligibility criteria, see the Beginners Guide which is available at In the year ending 31 March 2017: 4.2 million NHS optical vouchers were processed, a decrease of 260,095 (5.8 per cent) from (table 2.1). Table 2.1: Number of NHS optical vouchers processed, and year-on-year percentage change England, to Numbers and percentages Apr - Sep Oct - Mar Apr - Mar Year-on-year Year-on-year percentage change change ,983,389 1,967,518 3,950, , ,079,232 2,059,073 4,138, , ,260,239 2,159,779 4,420, , ,314,782 2,166,170 4,480,952 60, ,200,306 2,359,033 4,559,339 78, ,305,486 2,273,752 4,579,238 19, ,368,165 2,311,361 4,679, , ,343,324 2,269,638 4,612,962-66, ,309,473 2,172,294 4,481, , ,089,471 2,132,201 4,221, , Notes: 1. Figures are revised from those originally published, which were under-reported. Copyright 2017, Health and Social Care Information Centre. 13

14 Figure 2.1: Number of NHS optical vouchers processed England, to Number of NHS optical vouchers (thousands) 4,800 4,600 4,400 4,200 4,000 3,800 3,600 3,400 Year Notes: figures are revised from those originally published, which were under-reported. Copyright 2017, Health and Social Care Information Centre. 14

15 Chapter 3: NHS vouchers for repair or replacement Vouchers for repair or replacement are available to those who are eligible for NHS optical vouchers. For further details regarding eligibility, see our Beginners Guide In the year ending 31 March 2017: The number of vouchers for repair or replacement processed was 585,138, an increase of 41,253 (7.6 per cent) from (table 3.1) Table 3.1: NHS vouchers for repair or replacement England, to Apr - Sep Oct-Mar Apr - Mar Numbers and percentages Year-on-year Year-on-year change change (percentage) , , ,430 35, , , ,259 4, , , ,429-23, , , ,949-11, , , ,802 3, , , ,406 21, , , ,284 37, , , ,193 31, , , ,885 16, , , ,138 41, Notes: 1. Figures are revised from those originally published, which were under-reported. Copyright 2017, Health and Social Care Information Centre. 15

16 Figure 3.1: Number of NHS vouchers for repair or replacement processed England, to Number of NHS vouchers for repair or replacement 700, , , , , , ,000 0 Year Copyright 2017, Health and Social Care Information Centre. 16

17 Appendix A: contents of annex files Annex A: Report tables and charts (Excel workbook) All tables and charts presented in the report are available in Excel format; some additional tables are also included. Where tables include time series data, these are extended to include data from in this annex. Annex B: sub-national summary and national level time series National level time series are available for NHS sight tests and NHS optical vouchers. Summary data for the current year are also presented at Area Team, sub-region and region level. Table Reporting periods covered Geographical granularity Table A1: NHS sight tests by patient eligibility Table A2: Proportion of NHS sight tests by patient eligibility Table A3: NHS sight tests by patient eligibility Table A4: Proportion of NHS sight tests by patient eligibility Table B1: NHS optical vouchers by patient eligibility Table B2: Proportion of NHS optical vouchers processed by patient eligibility Table B3: NHS optical vouchers processed Table C1: NHS vouchers for repair or replacement by patient eligibility National National Area team & region Area team & region National National Area team & region Area team & region Annex C:.csv file Contains data concerning NHS sight tests, NHS optical vouchers and NHS vouchers for repair or replacement for the current reporting year in.csv format, at Area Team level. The file contains raw values and the weighted values used in this report for the data relating to NHS sight tests. The file contains raw values only for data relating to NHS optical vouchers and NHS vouchers for repair or replacement; the sample sizes available for these data are not great enough for reliable weighted values to be calculated (please see the Data Quality section of this report for further details). Definitions of the fields can be found in the accompanying Data Dictionary. Copyright 2017, Health and Social Care Information Centre. 17

18 Appendix B: Users and uses of the data Use and usage of these data This publication informs the Department of Health (DH) and NHS England Area Teams, allowing for the monitoring of the provision of ophthalmic services and planning. The data provide a published reference on the provision of eye care services, such as volume of sight tests and of domiciliary sight tests. Where available, patient eligibility breakdowns provide information about service access by different patient groups. These help inform NHS planning, allowing local commissioners to compare patterns of service provision and assess whether particular eligible groups are accessing services. For example, if the number of sight tests for people aged 60 and over decreases at a time when numbers of people in that age group are increasing, policy teams and commissioners may judge that, in the interest of public health, there should be increased promotion of the availability of these services. NHS Digital also engages with representative bodies such as the Royal National Institute of Blind People, exploring ways in which the current data available can be improved or made more useful for researchers and other users. While we receive little direct engagement from other users of these data, they will be useful for public health observatories, patient representative groups, academics, charities and other members of the public with an interest in the uptake and provision of eye care services across England. Feedback We welcome all feedback on any aspect of this release, as well as any suggestions for future releases. Your comments can be submitted by to enquiries@nhsdigital.nhs.uk, or via the NHS Digital Have your say form, available at Copyright 2017, Health and Social Care Information Centre. 18

19 Appendix C: Related publications A full list of NHS Digital reports produced on eye care can be found at: Our Beginners Guide to NHS Eye Care Publications contains a further list of related publications and data sources: Scotland Note that different regulations are in place in Scotland, with all patients entitled to an NHS eye examination which replaced the NHS Sight Test in April 2006 Wales Data for England are broadly comparable to data for Wales. Collection arrangements may differ between England and Wales; this may impact sample based data. Northern Ireland Ophthalmic data are not currently published, but there are some health and social care data available. Copyright 2017, Health and Social Care Information Centre. 19

20 ISBN This publication may be requested in large print or other formats. Published by NHS Digital, part of the Government Statistical Service Copyright 2017 Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. You may re-use this document/publication (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence visit or write to the Information Policy Team, The National Archives, Kew, Richmond, Surrey, TW9 4DU; or psi@nationalarchives.gsi.gov.uk Copyright 2017, Health and Social Care Information Centre. 20

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