Readiness for responding to a second wave of COVID-19



Publications approval reference: 001559 / C0785


  • Regional directors
  • Regional optometry commissioners
  • Local eye health chairs

26 October 2020

Dear Colleague

Thank you for the commitment and support that you and your teams have shown to provide high quality and safe optical care at this time.

1. Latest standard operating procedures

The current Standard operating procedure (SOP) for optical practice in the context of coronavirus (COVID-19) continues to apply.

2. Prioritisation of activity

  • Practices should continue to restore activity to usual levels where clinically appropriate, and reach out proactively to clinically vulnerable patients and those whose care may have been delayed
  • Optometrists should continue to refer patients to MECS/CUES/secondary care using the usual pathways and to base judgements around urgency of need on usual clinical thresholds (taking into consideration need for non-face-to-face consultations, likely delays in restarting routine elective activity, and communicating likely delays to patients at point of referral).

3. Resumption of optical services in England: financial and contractual arrangements

On 17 June NHS England and NHS Improvement wrote to optical practices to confirm the resumption of provision of GOS services in a way that is safe, and where practices assess that they have the necessary infection prevention and control (IPC) and personal protective equipment (PPE) in place. We also confirmed we would cease the current temporary contract arrangements at 30 June 2020 and were working with the Optometric Fees Negotiation Committee (OFNC) regarding reimbursement for GOS forms from 1 July 2020.

This letter sets out the arrangements for financial support and management of contracts both mandatory and additional service contracts.

Financial support

All contracts (July 2020)

NHS England and NHS Improvement extended the average monthly payments across contracts until 31 July 2020 for all practices declaring themselves as open.

Mandatory contracts (August and September 2020)

Average monthly payments will end on 30 September 2020 for mandatory contract holders. Qualification for average monthly payments in August and September requires each individual practice location to complete and transmit to Primary Care Services England (PCSE) all GOS 1 claims for the months of August and September that are equivalent to a minimum of 40% of historic average monthly claims. Average monthly claims will be calculated from activity during the period March 2019 through February 2020. In addition, NHS England and NHS Improvement will seek assurance from each location that the contract is adhering to contractual hours and maintaining, as a minimum, their pre COVID ratio of NHS to private appointments.

Mandatory contracts in higher risk areas (October to December 2020)

NHS England and NHS Improvement recognises the importance of supporting and maintaining access to services for communities at greater risk. Additional financial support may therefore be made available up to December 2020. We will contact practices located in the top quintile of areas of deprivation, based on the index of multiple deprivation in England, to assess whether the service is dependent on GOS income and is in greater need of support.

To be eligible practices will need to demonstrate the following criteria:

  • Practices must be able to evidence from management accounts a minimum of 40% GOS contribution towards total practice income.
  • Practices must deliver the minimum pre-COVID GOS 1 activity levels set out below in each month to qualify for average monthly payments.
  • An historic minimum level of monthly GOS income of at least £2,500 – practices generating less than this amount are not considered to be GOS dependent practices and are therefore out of scope for this programme of support.
  • A declaration must be submitted to confirm that any financial hardship is as a result of COVID-19 impact on the practice.

Subject to the above requirements being met, top up payments will be applied to take GOS income up to 90% of the average monthly payment on delivery of the following minimum GOS 1 activity levels:

  • October: 55% of pre-COVID GOS 1 activity
  • November: 65% of pre-COVID GOS 1 activity
  • December: 80% of pre-COVID GOS 1 activity

In recognition that some practices may fall outside the above parameters but are reliant on GOS income and can demonstrate hardship as a direct consequence of COVID-19, applications may be made to NHS England and NHS Improvement for inclusion in the scheme.

Additional service contracts

We recognise that domiciliary contractors continue to face challenges gaining access to care homes, and in some cases, patients’ own homes. To address this, domiciliary contract holders will receive average monthly payments for August and September as a matter of course with no requirement for minimum activity levels.

We also propose to implement a financial support model to all domiciliary providers, but with no requirement to deliver minimum activity levels across the following months:

  • October: average monthly payment of 60% of pre-COVID GOS income
  • November: average monthly payment of 45% of pre-COVID GOS income
  • December: average monthly payment of 30% of pre-COVID GOS income

Reduction for variable costs

Our letter of 1 April 2020 advised that we would work with the OFNC to agree a fair reduction for any variable costs associated with service delivery (e.g. in recognition of reduced consumable costs associated with dispensing of frames and lenses) to be applied to all reimbursements.

All contracts that have been in receipt of average monthly payments across 1 April to 17 June 2020 will have the following reductions applied to reflect variable costs not incurred:

  • 6.43% for mandatory contracts and
  • 7.86% for additional service contracts.

Deduction of these amounts will begin at a date to be confirmed by NHS England and NHS Improvement with all monies repaid by 31 March 2021.

Contract arrangements

If public health measures require it, it may be necessary to return contracts to the operating model utilised in the period 1 April 2020 to 17 June 2020.

In recognition of the fact that practices have experienced additional costs associated with provision of services during COVID-19, NHS England and NHS Improvement is seeking to reimburse contractors for additional PPE expenses. We are currently in discussion with OFNC to agree a mechanism for this and will provide more information once a process has been agreed.

4. PPE access via portal

The Department of Health and Social Care (DHSC) has published its strategy for supplying PPE over the next phase of the pandemic and confirms that COVID-19 related PPE will be provided free to all primary care providers; this is a step change in the use of the portal where previously it was for emergency use PPE only.

Please ensure that you are registered with the PPE portal, so that we can make sure that supplies of PPE can be distributed to your practice or service. Further information on the portal supply can be found on the DHSC guidance page. If providers have any queries or have not received an email invitation please contact the DHSC PPE portal customer services at: 0800 876 6802.

5. Risk assessment processes for staff

We recognise the ongoing efforts across primary care to offer and complete risk assessments for staff, ensuring particularly Black, Asian and minority ethnic (BAME) and other ‘at risk’ groups are kept safe.

Where assessments have not yet been completed, we strongly encourage that these reviews are conducted rapidly and kept under review as required. Where necessary, please do speak to commissioners where support is needed, or to discuss available steps to mitigate risks.

6. Primary care bulletin

Please subscribe to our primary care bulletin as this is the quickest and most effective way to access the latest information you will need:

Previous issues are on our website: bulletin/

7. Look after you too

Please remember to keep yourself safe and seek help if you think you need any. Staff can access free wellbeing support, free coaching and access volunteer support by calling 0808 196 3646.

Kind regards

Ed Waller | Director of Primary Care

Dr Nikita Kanani | Medical Director for Primary Care