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General Ophthalmic Services, Activity Statistics

England, 2013/14

Published 16 July 2014

General Ophthalmic Services, Activity Statistics: England, 2013-14

2 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.

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health and social care.

Author: Prescribing and Primary Care Team Health and Social Care Information Centre

Responsible statistician: Gemma Ramsay, Section Head

Version: V1.0

Date of publication:

16 July 2014

This publication may be of interest to members of the public and other stakeholders to make local and national comparisons and gain a picture of General Ophthalmic services in England.

www.hscic.gov.uk

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@hscic

http://www.hscic.gov.uk/

mailto:[email protected]

General Ophthalmic Services, Activity Statistics: England, 2013/14

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 3

Contents Executive Summary 5

Key Findings 5

Introduction 6

Use and usage of these data 6

Feedback 6

Data Quality 2013/14 7

NHS Sight Test Data 7

Other Data 8

NHS Sight Tests 9

Domiciliary Sight Tests 14

Private Sight Tests and Private Domiciliary Sight Tests with Partial Help 16

NHS Optical Vouchers 17

NHS Vouchers for Repair or Replacement 21

Annexes 26

Technical notes regarding sample based data 27

Other Publications 27



This is a National Statistics publication

The United Kingdom Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Official Statistics.

Designation can be broadly interpreted to mean that the statistics:

meet identified user needs;

are well explained and readily accessible;

are produced according to sound methods; and

are managed impartially and objectively in the public interest.

Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed.

Find out more about the Code of Practice for Official Statistics at www.statisticsauthority.gov.uk/assessment/code-of-practice



Executive summary

This yearly report, General Ophthalmic Services, Activity Statistics: England, 2013/14, includes information on NHS sight tests, NHS optical vouchers, NHS vouchers for repair or replacement and workforce.

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 pre-disposed to, eye diseases.

All data are final and represent financial years, April to March. This report presents a summary of information about GOS activity in England for the current year, 2013/14 and a time series from 2004/05. A time series back to 2002/03 is available in Annex A.

Most data included in our publication are collected through the Central Ophthalmic Payments System; some eligibility data are submitted through our OMNIBUS system. For more detailed information on data collection, please refer to our Beginners Guide.

The report presents information at a national level, further breakdowns of data are available in the Annexes.

Key findings NHS sight tests rose by approximately 448,000, which represents a 3.6 per cent

increase; the largest seen since 2009/10. There were about 24,000 sight tests per 100,000 population.

The number of NHS optical vouchers increased 2.2 per cent (approx. 100,000) from 2012/13 to 2013/14, with approximately 9,000 processed per 100,000 population.

The maximum potential expenditure from NHS optical vouchers is approximately £199 million1.

There were approximately 495,000 vouchers for repairs and replacements reimbursed during 2013/14.

Sight tests have steadily increased from 10 million in 2004/05; with the most pronounced rises in 2007/08 and 2009/10. The rate of increase has varied, and the reasons behind these fluctuations are unknown. Patients aged 60 and over have remained the dominant eligibility category in terms of the share in the number of tests carried out.

NHS optical vouchers have risen by almost a third since 2004/05. The period between 2007/08 and 2009/10 saw the most rapid growth, and whilst the growth had appeared to be slowing down over the last few years, this year has seen the largest relative increase since 2009/10.

NHS vouchers for repair or replacement have had an overall rise of 23 per cent since 2004/05, although with less stability than either sight test or vouchers. Having risen steadily from 402,000, vouchers for repair or replacement initially peaked at 467,000 in 2008/09; decreasing until 2010/11 and has since continued to increase, to its highest peak this year, with a total of 495,000.

1 Estimates are calculated using the maximum redeemable value for each voucher type set out in: http://www.nhsbsa.nhs.uk/Documents/HealthCosts/HC12_April_2013.pdf Estimates are ‘maximum potential’ as vouchers may not have been redeemed to their maximum value and/or may not have been issued during the previous year and redeemed at that year’s price levels.

http://www.hscic.gov.uk/pubs/gosactivity1314

http://www.nhsbsa.nhs.uk/Documents/HealthCosts/HC12_April_2013.pdf



Introduction

This report presents a summary of NHS Ophthalmic activity, which includes NHS sight tests, NHS optical vouchers and NHS vouchers for repair or replacement. The data reflects activity in England, as well as a time series from 2004/05.

All tables and charts provided in this report are available in Excel format in Annex A. An additional two years of data (2002/03 and 2003/04) are provided in the time series.

Detailed tables at Area Team level for the information contained in this report and some national level historical years are provided in Annex B.

Annex C contains ‘flat files’ of unformatted data for 2013/14 at Area Team and Region level. This is suitable for analysis by local and regional analysts.

Users should be aware of the Data Quality Statement which accompanies this report and is

available at: www.hscic.gov.uk/pubs/gosactivity1314

For more information on this publication and the ophthalmic data published by the Health and Social Care Information Centre (HSCIC), we recommend our Beginners Guide to Eye Care Publications available at: www.hscic.gov.uk/pubs/gosactivity1314

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.

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.

The HSCIC 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 report, as well as any suggestions for future reports. Your comments can be submitted by email to: [email protected]



mailto:[email protected]?subject=GOS,%20Activity%20Statistics%20-%20Feedback



Data quality 2013/14

NHS sight test data In all area teams, the number of sight tests recorded on Exeter Payments System will be accurate. It is possible that any data fields which do not form part of the payments methodology or are not under regulation, for example patient eligibility, suffer from under-reporting or data quality issues.

Over recent years we have increased the use of Exeter to extract eligibility data to reduce the burden for organisations. In the spring of 2014, we carried out an investigation into the quality of this data with the aim of reducing the burden further.

We sent Area Teams a summary of their sight test eligibility data, held on Exeter, for the first six months of the year (April – September). They were asked to confirm whether the data was representative of their Area Team population.

Background

Some providers e.g. Specsavers have a computer system that links to the Exeter system, this means we receive their eligibility data automatically through Exeter. As these providers are predominantly based in high street town centres, they are not necessarily representative of the population as a whole. In order to ensure the data on Exeter is representative and to add quality, Area Teams supplement these figures by manually entering forms they receive for providers into Exeter. Some providers have stated this is most forms they receive; others enter in every 20th or 50th form.

Others do not enter any data manually but collate a sample of forms throughout the year (typically around 2%) and send the overall bulk figures through to us when we request it, via an online collection system Omnibus.

Results

Fourteen of the twenty five Area Teams, confirmed their data as representative and eleven did not. We therefore only asked for a manual sample from those eleven. One of those did not provide a sample. It was decided that, for this area team the sample of eligibility data stored on Exeter was large enough to justify the use of the Exeter data. Two further Area Teams were unable to supply a sample based on 12 months worth of data. We agreed that they could base their sample on 6 months and gross this up to make a 12 month sample before they submitted it to us.

There are still ongoing concerns regarding patient eligibility for sight tests, particularly when the data area based on small sample sizes. Therefore this data will continue to be monitored for future publications.



Other data West Yorkshire Area Team did not provide patient eligibility or voucher type breakdowns for NHS optical vouchers, although the total numbers of vouchers were available. For this Area Team, no breakdowns are available, only totals.

Data quality has improved since 2011/12, when a range of issues impacted on eligibility breakdowns, and also on national level totals for optical vouchers and vouchers for repair and a replacement. However, these issues should be considered, especially when comparing 2012/13 with 2011/12.

Area Team Data

collectionNotes

Cheshire, Warrington & Wirral Manual

A 2 per cent sample is collected each month for Central & Eastern Cheshire, Western Cheshire

and Warrington. At the year end the figures are collated to provide a one sample for the area

team.

Durham, Darlington & Tees Manual A minimum 2 per cent sample is collected daily. At the year end, this data is collated to provide

an annual sample of sight test eligibility.

Greater Manchester Exeter

Lancashire Exeter

Merseyside Manual A 2 per cent sample is collected monthly. At the year end, all months are aggregated and

submitted to the HSCIC.

Cumbria, Northumberland, Tyne & Wear Manual A minimum 2 per cent sample is collected daily. At the year end, this data is collated to provide

an annual sample of sight test eligibility.

North Yorkshire & The Humber Manual The sample provide is based on 12 months worth of data.

South Yorkshire & The Bassetlaw Exeter

West Yorkshire Exeter

Arden, Herefordshire & Worcestershire Manual The sample provided is based on the first 6 months of the year (April-September). The sample

was doubled, and submitted to the HSCIC at the year end.

Birmingham & The Black Country Exeter

Derbyshire & Nottinghamshire Exeter

East Anglia Exeter

Sight test data from Exeter was confirmed as unrepresentative. No sample was provided through

the Omnibus system and therefore, the final figures are grossed up from those extracted from

Exeter.

Essex ManualThe sample was provided from a pilot study the area team had been a part of, and is based on 12

months worth of data.

Hertfordshire & The South Midlands Manual A 2 per cent sample is collected each month. This is collated to provide an annual sample for

sight test eligibility.

Leicestershire & Lincolnshire Exeter

Shropshire & Staffordshire Exeter

London Manual

The data varied across London, most Primary Care Support Teams provided 6 months data but

some gave full year. Where 6 months data was provided, the sample was doubled to provide an

annual figure. In one case, it was not possible to provide any sample. An estimate was made by

the area team from data received for the surrounding CCGs

Bath, Gloucestershire, Swindon & Wiltshire Exeter

Bristol,N.Somerset,Somerset & S.Gloucestershire Exeter

Devon, Cornwall & Isles Of Scilly Exeter

Kent & Medway Exeter

Surrey & Sussex Exeter

Thames Valley Exeter

Wessex Manual Two agencies for the Wessex Area Team collect a 2 per cent sample over 12 months. At the

year end these are aggregated to provide one sample to the HSCIC.



NHS sight tests

This section presents information on NHS sight tests and excludes private tests given to patients who are not eligible for an NHS test. Patients with an HC32 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 ‘Private Sight Tests and Private Domiciliary Sight Tests with Partial Help’ section of this report. For more information on the eligibility criteria for an NHS sight test, see our Beginners Guide.

Optometrists comprise an increasing proportion of the ophthalmic workforce3, and this is reflected in the proportions of sight tests carried out by Optometrists and Ophthalmic Medical Practitioners (OMPs). Optometrists undertake more sight tests per practitioner than OMPs (table 1.5), which is likely to be a reflection of the more specialist nature of OMPs, compared with Optometrists. 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). OMPs are qualified doctors specialising in eyes and eye care. In addition to their medical skills, they are qualified to test eyesight and prescribe spectacles; OMPs are registered with the General Medical Council (GMC). As at 31 December 2013, there were 11,164 Optometrists (97.4 per cent) and 293 OMPs (2.6 per cent).

In the year ending 31 March 2013:

12.8 million sight tests were provided to patients in England during 2013/14, an increase of 448,177 (3.6 per cent) from 2012/13. This continues the established trend of year on year increases in the number of sight tests, although at a higher rate of growth than recent years. There were 23,905 sight tests per 100,000 population.

After a steady growth in the aged 60 and over category since its introduction in 1999, the proportion of sight tests delivered have fallen for the second consecutive year; 5.6 million were delivered in 2013/14, a 43.6 per cent share of all sight tests. Sight tests per 100,000 population for those aged 60 and over has, for the most part, increased progressively since 2004/05, suggesting that growth in this category is attributable, in part, to a greater uptake by these patients.

The number of children aged 0-15 receiving an NHS sight test has increased 8.2 per cent to 2.5 million. Following a steady decline in recent years, the number of sight tests per 100,000 rose to 25,095.

Optometrists continue to conduct the vast majority of NHS sight tests, with a 99.8 per cent share of NHS sight tests, at a rate of 1,143 per Optometrist. The remaining 0.2 per cent were carried out by OMPs.

As a demand led service, with largely only sample-based data for patient eligibility, it is difficult to establish specific drivers for the fluctuations in the rate of increase in sight tests and changes in share of activity among the eligibility groups. The number of practitioners per 100,000 population has increased over the last ten years3, which suggests greater provision of services. In addition, eligibility categories such as Diabetics/Glaucoma sufferers have received an increasing proportion of sight tests, suggesting an increasing demand from these patients or an increase in diagnosis.

2 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. 3 General Ophthalmic Services, Workforce Statistics – England and Wales, 31 December 2013: http://www.hscic.gov.uk/pubs/genophworkfstatsdec13


http://www.hscic.gov.uk/pubs/genophworkfstatsdec13



Table 1.1 Number of NHS sight tests, in England, during the specified financial years

Figure 1.1: Number of NHS sight tests, in England, during specified financial years

April-Sept Oct-March April - March

Change April -

March

Percentage

change April -

March

2004/05 5,131,694 5,017,284 10,148,978 303,719 3.1

2005/06 5,191,490 5,163,191 10,354,682 205,704 2.0

2006/07 5,321,953 5,162,969 10,484,922 130,240 1.3

2007/08 5,523,000 5,525,000 11,048,000 562,968 5.4

2008/09 5,641,406 5,637,068 11,278,474 230,584 2.1

2009/10 6,052,100 5,759,551 11,811,651 533,177 4.7

2010/11 6,132,035 5,806,494 11,938,529 126,878 1.1

2011/12 6,039,974 6,265,753 12,305,727 367,198 3.1

2012/13 6,231,831 6,107,422 12,339,253 33,526 0.3

2013/14 6,445,283 6,342,147 12,787,430 448,177 3.6

Source: Health and Social Care Information Centre

Note:

1. Figures presented are rounded. Calculations have been carried out using unrounded figures, w hich are

available in the annexes.

Number & Per cent

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14

NH

S S

igh

t T

ests

(000s)

Year



Sight test eligibility data, presented in table 1.2, are sample based. In 2013/14, none of the Area Teams were able to provide a complete set of data. For 15 Area Teams, data stored on the Exeter Payments System were used (14 confirmed the data were representative); the proportion of eligibility data available was used as the sample base. For the remaining 10 Area Teams, data on Exeter were not representative, and the HSCIC undertook a manual 2 per cent collection of eligibility data. Further details about the collections process are included in our Data Quality Statement and Beginners Guide. See Annex B for a list of sample sizes returned by Area Team.

Table 1.2: Percentage of NHS sight tests by patient eligibility and number, in England, during the specified financial years

Per cent Number

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2013/14

Aged 60 and over 42.4 43.0 43.1 44.0 44.5 44.0 44.4 45.0 44.4 43.6 5,576,957

Children 0-15 21.7 20.9 20.2 20.8 20.5 20.8 20.5 20.0 19.0 19.9 2,542,137

Students 16-18 4.6 4.5 4.7 4.6 4.6 4.5 4.5 4.2 4.4 4.1 517,913

Adults receiving income support110.8 10.5 11.2 10.1 9.8 9.2 9.1 8.5 9.0 8.1 1,040,400

Adults receiving tax credits 5.2 5.2 5.4 6.0 6.0 5.8 5.8 5.6 5.5 5.5 706,858

Adults receiving JSA21.9 2.1 2.3 2.0 2.1 2.7 2.6 2.5 2.6 2.7 339,534

Low income certificate holders (HC2) 1.5 1.4 1.3 1.2 1.1 0.9 0.8 0.7 0.8 0.8 102,256

Adults receiving UC3.. .. .. .. .. .. .. .. .. 0.0 50

Registered blind/partially sighted 0.2 0.2 0.3 0.2 0.2 0.2 0.1 0.2 0.1 0.1 12,813

Diabetics/Glaucoma sufferers 5.8 6.2 5.7 5.4 5.4 6.0 6.1 6.9 7.4 8.0 1,019,685

Need complex lenses 0.7 0.7 0.8 0.7 0.7 0.5 0.6 0.6 0.7 0.5 67,933

Close relatives 40 & over of Glaucoma sufferers 5.2 5.2 5.1 5.0 5.2 5.5 5.4 5.8 6.0 6.7 860,373

Prisoner on Leave5.. .. .. .. 0.0 0.0 0.0 0.0 0.0 0.0 522

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 12,787,430


Notes:

1. Income Support includes patients receiving Pension Credit Guarantee Credit (PCGC) and also Income-related Employment and Support Allow ance (ESA), w hich w as introduced in October 2008.

2. Job Seekers Allow ance.

3. Universal Credit is a benefit that has started to replace 6 existing benefits. It started to be introduced from April 2013. See w w w .gov.uk/universal-credit for more information.

4. Patients may qualify for an NHS sight test on more than one criterion. How ever, they w ould 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, w ith glaucoma is likely to be recorded in the glaucoma category only. The count by eligibility is therefore approximate.

5. .. Not applicable.

6. See our Beginners Guide to NHS Eye Care Publications for information on eligibility categories.




Table 1.3: NHS sight tests per 100,000 population, in England, during the specified financial years

Figure 1.2: NHS sight tests per 100,000 population, during the specified financial years

Number

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Children 0-15 22,632 22,336 21,856 23,816 23,934 25,350 25,084 24,515 23,200 25,095

Adults 60+ 40,977 41,835 41,905 43,925 44,270 44,985 45,164 46,569 45,410 46,207

All Sight Tests 20,254 20,518 20,654 21,618 21,915 22,798 22,856 23,171 23,067 23,905


Notes:

1. Patients may qualify for an NHS sight test on more than one criterion. How ever, they w ould 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, w ith glaucoma is likely to be recorded in the glaucoma category only. The counts for these age

groups may therefore be underestimates.

2. Figures are calculated from the Office for National Statistics' (ONS) mid-year population estimates of the f irst year show n, ie. f igures for 2006/07 use the ONS mid-2006 population

estimate. Since the previous publication, ONS has released estimates for 2012. Information for 2012/13 has been recalculated using these new estimates and w ill therefore differ from

previously published.

3. 2013/14 figures use the ONS' mid-2012 population estimates as these are the latest available. 2013/14 figures w ill therefore be subject to recalculation in future reports once 2013 mid-

year population estimates are available.

4. 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.

5. 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 f igures depending on their clinical need.

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14

NH

S S

igh

t T

ests

Year

0-15

60+



Table 1.4: Number and percentage of NHS Sight tests, by practitioners, England, during the specified financial years

Figures in Table 1.5 exclude private sight tests. Figures in the time series have been affected by changes in the average number of working hours by practitioners. Time series figures are calculated using workforce numbers for the respective years. Workforce numbers have been affected during the period by various changes in regulations, as detailed in the footnotes.

Table 1.5: Number of NHS sight tests conducted per practitioner, in England, during the specified financial years

Number & Per cent

Optometrists OMPs Total Optometrists OMPs Total

2004/05 9,856,000 293,000 10,149,000 97.1 2.9 100.0

2005/06 10,075,000 280,000 10,355,000 97.3 2.7 100.0

2006/07 10,297,000 188,000 10,485,000 98.2 1.8 100.0

2007/08 10,878,669 169,221 11,047,890 98.5 1.5 100.0

2008/09 11,181,039 97,435 11,278,474 99.1 0.9 100.0

2009/10 11,767,625 44,026 11,811,651 99.6 0.4 100.0

2010/11 11,905,963 32,566 11,938,529 99.7 0.3 100.0

2011/12 12,277,754 27,973 12,305,727 99.8 0.2 100.0

2012/13 12,316,310 22,943 12,339,253 99.8 0.2 100.0

2013/14 12,765,781 21,649 12,787,430 99.8 0.2 100.0


Notes:

Number Per cent

1. Figures presented are rounded. Calculations have been carried out using unrounded figures, w hich are available in the annexes.

Number

Optometrists OMPs All Practitioners

2004/05 1,246 519 1,198

2005/061 1,230 628 1,199

2006/07 1,202 491 1,172

2007/082 1,178 429 1,147

2008/09 1,215 286 1,182

2009/10 1,216 128 1,178

2010/11 1,181 99 1,147

2011/12 1,171 86 1,139

2012/13 1,137 75 1,108

2013/14 1,143 74 1,116


Notes:

1. New GOS regulations commenced in England on 1 April 2005, w hich introduced the Supplementary Lists in addition to the

existing Ophthalmic Lists.

2. New regulations w ere introduced in England on 1 August 2008 replacing the Supplementary Lists and Ophthalmic Lists w ith a

contractual regime for providers, and Performers Lists for clinicians. The new regulations mean that data at a local level are no

longer comparable w ith data collected under the old regulations, due to a change in the basis of the information. With the

introduction of the Performers Lists, NHS England Area Teams w ere asked to validate their data. This validation may have had an

effect on w orkforce f igures reported for 2008 at both a national and local level.

3. The figures presented are affected by the extent to w hich the GOS guidelines relating to maintaining lists have been follow ed.

NHS England Area Teams may remove a practitioner w ho has not provided GOS in the past six months from its lists. The

procedure for removing inactive practitioners is through an agreement betw een the PCT(2003-2012)/AT(2013) and optician.

4. Figures are calculated on the basis of headcounts for w orkforce numbers.

5. Figures presented are rounded. Calculations have been carried out using unrounded figures, w hich are available in the

annexes.



Domiciliary sight tests In 2013/14, the majority of NHS sight tests were conducted at ophthalmic medical practitioners’ premises; however, 3.3 per cent were conducted away from ophthalmic premises. These are known as domiciliary sight tests. 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.

Over the last 10 years, the number of domiciliary sight tests has risen by 46.3 per cent (135,447). Whilst tests reimbursed at the higher rate4 have increase by a substantial 74.6 per cent, those at the lower reimbursement rate5 have increased by 15.8 per cent.

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. However, no data are collected on the eligibility of users of domiciliary services. Without these data we can only speculate on the drivers for increasing use of services. It is possible that an ageing population, with increasing numbers of elderly patients seeking access to sight tests in their own homes accounts for some of this growth, but there are no data to directly support this. The increasing share of higher rate tests may support this idea.

Table 1.6: Number and percentage of domiciliary sight tests by type, in England, during the specified financial years

4 Domiciliary visits made either to a single patient at the address or where the patient is first of second to be seen are reimbursed at the higher rate. 5 Sight tests carried out on a domiciliary visit to a third or subsequent patient, at the same address, are reimbursed at the lower rate.

Number & Per cent

Total Sight Tests Dom Lower Rate Dom Higher Rate Dom Total Dom Lower Rate Dom Higher Rate Dom Total

2004/05 10,148,978 140,865 151,797 292,662 48.1 51.9 100.0

2005/06 10,354,682 135,221 158,673 293,894 46.0 54.0 100.0

2006/07 10,484,922 139,651 170,100 309,751 45.1 54.9 100.0

2007/08 11,047,890 142,761 186,604 329,365 43.3 56.7 100.0

2008/09 11,278,474 147,893 198,591 346,484 42.7 57.3 100.0

2009/10 11,811,651 154,817 218,898 373,715 41.4 58.6 100.0

2010/11 11,938,529 157,085 222,782 379,867 41.4 58.6 100.0

2011/12 12,305,727 161,802 234,398 396,200 40.8 59.2 100.0

2012/13 12,339,253 154,926 252,069 406,995 38.1 61.9 100.0

2013/14 12,787,430 163,107 265,002 428,109 38.1 61.9 100.0


Number Per cent

Notes:

1. Totals may not equal the sum of component parts due to rounding.

2. Domiciliary visits made either to a single patient at the address or w here the patient is the f irst or second to be seen are reimbursed at the higher rate. Third or subsequent

patients visited at the same address are reimbursed at the low er rate.




Figure 1.4: Number of domiciliary sight tests, in England, during the specified financial years

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14

Do

mic

ilia

ry S

igh

t T

ests

(p

er

cen

t)

Year

Dom Higher Rate

Dom Lower Rate



Private sight tests and private domiciliary sight tests with partial help Patient 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 10 years, there has been a 75.9 per cent decrease in the number of patients receiving partial help with private sight tests, with 1,703 patients receiving help in 2013/14.

Table 1.7: Number of private sight tests and private domiciliary sight tests where partial help was given, in England, during the specified financial years

Number

Private Sight

Tests

Private

Domiciliary

Sight Tests

2004/05 7,059 103

2005/06 5,355 90

2006/07 4,471 72

2007/08 3,783 209

2008/09 3,349 202

2009/10 3,191 226

2010/11 2,698 218

2011/12 2,526 178

2012/13 2,169 120

2013/14 1,703 112




NHS optical vouchers

The NHS optical voucher scheme was introduced in July 1986. Under the scheme, patients who had previously been eligible to have NHS spectacles were given NHS optical vouchers to put towards buying their own choice of spectacles, or having new lenses fitted to their existing frames. From April 1988, NHS optical vouchers could also be put towards the cost of contact lenses. Patients may receive a voucher for more than one pair of spectacles.

Eligibility for vouchers is largely based on income, and therefore differs slightly to the eligibility criteria for sight tests; those aged 60 and over and those suffering from or predisposed to glaucoma/diabetes are not eligible. The type of voucher issued is dependent of the strength of the lenses needed. There are currently 8 voucher values (A-H), ranging from £37.50 (voucher A) to £207.20 (voucher H).

More information on voucher eligibility and voucher type is available in our Beginners Guide.


There were 4.7 million vouchers processed in 2013/14, a slight rise of 2.2 per cent (100,288) from 2012/13

The maximum potential expenditure6 on NHS optical vouchers was estimated to be £199 million; a 3.6 per cent increase on the 2012/13 value of £192 million.

As with sight tests, use of optical vouchers is a demand led service and increases in activity reflect greater uptake of the service. The eligibility criteria for vouchers is largely based on income, and since 2004/05 there has been an increasing share of vouchers claimed by adults receiving tax credits and adults receiving job seekers allowance. We do not know the reasons for these increases, though they could include increased awareness of services and/or increased numbers of patients qualifying for services. Data from the Office of National Statistics indicates a rise in the number of JSA claimants since 20087.

6 Estimates are calculated using the maximum redeemable value for each voucher type as set out in http://www.nhsbsa.nhs.uk/Documents/HealthCosts/HC12_April_2013.pdf 7 http://www.ons.gov.uk/ons/rel/lms/labour-market-statistics/june-2013/statistical-bulletin.html#tab-Claimant-Count


http://www.nhsbsa.nhs.uk/Documents/HealthCosts/HC12_April_2013.pdf



Table 2.1: Number of NHS optical vouchers processed, in England, during the specified financial years

Figure 2.1: Number of NHS optical vouchers processed, in England, during the specified financial years

Number and Per cent

April-Sept Oct-March April-March

Change April-

March

Percentage

change April -

March

2004/05 1,850,000 1,775,000 3,624,000 104,000 3.0

2005/06 1,860,000 1,819,000 3,678,000 54,000 1.5

2006/07 1,923,000 1,841,000 3,765,000 87,000 2.3

2007/08 1,983,389 1,967,518 3,950,907 185,907 5.0

2008/09 2,079,232 2,059,073 4,138,305 187,398 4.7

2009/10 2,260,239 2,159,779 4,420,018 281,713 6.8

2010/11 2,314,782 2,166,170 4,480,952 60,934 1.4

2011/121 2,200,306 2,359,033 4,559,339 78,387 1.7

2012/13 2,305,486 2,273,752 4,579,238 19,899 0.4

2013/14 2,368,165 2,311,361 4,679,526 100,288 2.2


Note:

1. Figures are revised from those originally published, w hich w ere under-reported. Due to limitations of

revised data, only data in table 2.1 and figure 2.1 have been revised.

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14

NH

S O

pti

cal

Vo

uch

ers

(000s)

Year



Table 2.2: Percentage of NHS optical voucher processed by patient eligibility and number, in England, during the specified financial years

Table 2.3: NHS optical voucher processed per 100,000 population, in England, during the specified financial year

Per cent Number

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/127 2012/13 2013/14 2013/14

Children 0-15 27.5 27.1 26.9 27.1 27.0 25.5 25.3 24.8 25.3 26.2 1,224,724

Students 16-18 6.5 6.6 6.9 6.9 6.9 6.6 6.4 6.3 6.4 6.5 306,352

Adults receiving IS1 43.8 44.2 44.2 44.3 43.9 43.4 43.6 40.1 39.1 38.6 1,808,499

Adults receiving Tax Credits 12.1 12.7 13.0 13.5 13.9 14.4 14.9 14.2 14.2 14.7 687,197

Adults receiving JSA2 3.5 3.9 4.3 3.9 4.3 6.3 6.3 6.2 6.5 6.1 287,089

HC2 – full remission 4.3 3.6 3.1 2.8 2.6 2.5 2.4 2.1 2.2 2.0 95,882

Adults receiving UC3 .. .. .. .. .. .. .. .. .. 0.0 400

Complex appliance payment only 1.0 0.9 0.9 0.9 0.9 0.8 0.8 0.7 0.7 0.7 34,945

Prisoner on Leave4 .. .. .. .. 0.0 0.0 0.0 0.0 0.0 0.0 274

Total full vouchers 98.7 99.1 99.2 99.4 99.5 99.5 99.5 94.5 94.3 95.0 4,445,363

HC3 ‒ partial payment of voucher 1.3 0.9 0.8 0.6 0.5 0.5 0.5 0.4 0.4 0.4 17,236

HC3 – complex appliance payment 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1

Total all vouchers6 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 4,679,526


Notes:

1. Adults receiving Income Support and/or Pension Credit Guarantee Credit (PCGC) and also Income-related Employment and Support Allow ance (ESA), w hich w as introduced in October 2008.

2. Adults receiving Job Seekers Allow ance.

3. Universal Credit is a benefit that has started to replace 6 existing benefits. It started to be introduced from April 2013. See w w w .gov.uk/universal-credit for more information.

4. .. Not applicable. Prisoner on Leave w as introduced in October 2008.

5. Totals may not equal the sum of component parts due to rounding.

6. From 2013/14 onw ards, the total of all vouchers is higher than sum of eligibilities as eligibility data w ere not available for all organisations, w hile total data w ere available

7. 2011/12 figures are based on those originally published, not the revised figures show n in table 2.1. This is because revised breakdow ns by voucher type and eligibility are not available.

8. See our Beginners Guide to NHS Eye Care Publications for information on eligibility categories.

Number

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/125 2012/13 2013/14

Children 0-15 10,232 10,264 10,461 11,077 11,548 11,603 11,415 11,068 11,416 12,090

All Vouchers 7,233 7,289 7,416 7,731 8,041 8,531 8,438 8,426 8,560 8,748


Notes:

1. Figures are calculated from the Office for National Statistics' (ONS) mid-year population estimates of the f irst year show n, ie. f igures for 2006/07 use the ONS mid-2006

population estimate. Since the previous publication, ONS has released estimates for 2012. Information for 2012/13 has been recalculated using these new estimates and w ill

therefore differ from previously published.

2. 2013/14 figures use the ONS' mid-2012 population estimates as these are the latest available. 2013/14 figures w ill therefore be subject to recalculation in future reports once

2013 mid-year population esimates are available.

3. See our Beginners Guide to NHS Eye Care Publications contains information on those eligible for NHS vouchers.

4. The information presented here is based on the numbers of NHS vouchers and is not necessarily a count of individuals. Individuals may receive more than one NHS voucher

in a 12 month period and may therefore be counted in the f igures more than once. Our Beginners Guide to NHS Eye Care Publications contains further details.

5. 2011/12 figures are based on those originally published, not the revised figures show n in table 2.1. This is because revised breakdow ns by voucher type and eligibility are

not available.



Table 2.4: Number and estimated potential maximum expenditure of NHS optical vouchers, by voucher type, in England, during 2013/14

The number of NHS optical voucher items by eligibility, and voucher type are provided in Table 2.5 of Annex A.

Pounds Per cent

A 3,279,182 70.1 122,969,335 61.8

B 463,169 9.9 26,400,641 13.3

C 25,838 0.6 2,154,854 1.1

D 14,796 0.3 2,787,534 1.4

E 545,033 11.6 35,318,166 17.8

F 94,970 2.0 7,825,493 3.9

G 2,548 0.1 272,405 0.1

H 2,118 0.0 438,863 0.2

CAP4 Single 24,926 0.5 351,450 0.2

CAP4 Bifocal 10,020 0.2 359,732 0.2

Total54,679,526 100.0 198,878,472 100.0


Notes:

1. Vouchers are issued to eligible patients to use tow ards buying their choice of spectacles (or having new lenses f itted to

existing frames) or to purchase contact lenses. Each voucher type has a different value depending on the strength and type

of lenses prescribed by the practitioner.

2. Potential maximum expenditure is based on the maximum redeemable value for each optical voucher w hich are available at:

http://w w w .nhsbsa.nhs.uk/Documents/HealthCosts/HC12_April_2013.pdf

3. Expenditure is presented as 'estimated potential maximum' as that all vouchers may not have been redeemed to their

maximum value and/or may have been issued during the previous year and therefore redeemed at that year’s price levels.

4. CAP = Complex Appliance Payment.

5. Expenditure on prisms, tints and small frame supplements are excluded from the expenditure total as they incur a

supplementary charge w hich varies w ith lens type.

6. Totals may not equal sum of components due to rounding. Calculations have been carried out using unrounded figures,

w hich are available in the annexes.

7. For 2013/14 total vouchers is higher than sum of types as voucher type data w ere not available for all area teams, w hile

total data w ere available.

Voucher type1 Number Per cent

Estimated potential maximum

expenditure2,3



NHS vouchers for repair or replacement

Repair or replacement vouchers are available to children under 16 and adults who are eligible for NHS optical vouchers. For details regarding eligibility for repairs or replacements, see our Beginners Guide.


The number of NHS vouchers reimbursed for repair or replacement was 459,284, a rise of 37,878 (8.3 per cent) from 2012/13. After declining in 2009/10 and the subsequent year, vouchers for repair and replacement have been steadily rising.

Table 3.1: Number of NHS vouchers for repair of replacement, in England, during the specified financial years

Number & Per cent

April-Sept Oct-March April - March

Change

April - March

Percentage

change April -

March

2004/05 205,293 197,145 402,438 -8,202 -2.0

2005/06 201,782 205,220 407,002 4,564 1.1

2006/07 210,427 216,446 426,873 19,871 4.9

2007/08 229,992 232,438 462,430 35,557 8.3

2008/09 234,784 232,475 467,259 4,829 1.0

2009/10 226,527 216,902 443,429 -23,830 -5.1

2010/11 219,957 211,992 431,949 -11,480 -2.6

2011/121 207,981 227,821 435,802 3,853 0.9

2012/13 223,652 233,754 457,406 21,604 5.0

2013/14 239,030 256,254 495,284 37,878 8.3

Source: Health and Social Care Information Cenre

Notes:

1. Figures are revised from those originally published, w hich w ere under-reported. Due to limitations of revised

data, only data in table 3.1 and figure 3.1 have been revised.




Figure 3.1: Number of NHS vouchers for repair or replacement, in England, during the specified financial years

Table 3.2: Number of NHS vouchers for frame repair or replacement, in England, during 2013/14

0

100

200

300

400

500

600

04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14

NH

S V

ou

ch

ers

(000s)

Year

No. of Frames Of which SFS1

Front 17,741 66

Side 50,749 318

Whole 357,950 6,069

Total 426,440 6,453


Note:

1. Small Frame Supplement; these figures are included in the

previous column.



Figure 4.1: NHS sight tests per 100,000 population by Area Team, in England, 2013/14



Figure 4.2: NHS optical voucher items processed per 100,000 population by Area Team, in England, 2013/14



Figure 4.3: Ophthalmic Practitioners per 100,000 population, by Area Team, in England, as at 31 December 2013

Workforce data is sourced from the General Ophthalmic Services, Workforce Statistics, England and Wales - 31 December 2013 publication, which can be found at: http://www.hscic.gov.uk/pubs/genophworkfstatsdec13

Rates shown in figures 4.1 to 4.3 are based on the locations in which the activity occurred, rather than patient residence.

http://www.hscic.gov.uk/pubs/genophworkfstatsdec13



Annexes

Annex A: Report tables and charts (excel workbook)

All table and charts presented in the reports are available in excel format. This annex contains a further two years data (2002/03 and 2003/04) than shown in the report.

Annex B: Summary and national level time series (excel workbook)

National level time series are available for NHS sight tests and NHS optical vouchers. Data are also presented at Area Team and Region level.

Annex C: CSV file

Unformatted dataset presenting NHS sight tests, NHS optical vouchers and NHS vouchers for repair or replacement, in CSV format at Area Team and Region level.

NHS sight tests – columns F-AG and start with ‘ST’

NHS optical vouchers – columns AH-BJ and start with ‘OV’

NHS vouchers for repair or replacement – columns BK-CR and start with ‘VRR’

Table

numberTitle Financial Years

Regional

Breakdown /

National Only

A1 NHS sight tests, by patient eligibility 1996/97 - 2013/14 National

A2 Proportion of NHS sight tests, by patient eligibility 1996/97 - 2013/14 National

A3 NHS sight tests,by patient eligibility 2013/14 Area Team & Region

A4 Proportion of NHS sight tests, by patient eligibility 2013/14 Area Team & Region

B1 NHS optical vouchers, by patient eligibility 1996/97-2013/14 National

B2 Proportion of NHS opticl vouchers processed, by patients eligibility 1996/97-2013/14 National

B3 NHS optical vouchers processed, by patient eligibility 2013/14 Area Team & Region

B4 Proportion of NHS optical vouchers processed, by patient eligibility 2013/14 Area Team & Region

B5 NHS optical vouchers, by voucher type 2013/14 Area Team & Region

B6 Potential maximum expenditure NHS optical voucher items, by voucher type 2013/14 Area Team & Region

C1 NHS vouchers for repair or replacement, by patient eligibility 2013/14 Area Team & Region

C2 Proportion of NHS vouchers for repair or replacement, by patient eligibility 2013/14 Area Team & Region

C3 NHS vouchers for repair or replacement, by one lens, both lenses and frames 2013/14 Area Team & Region



Technical notes regarding sample based data

Users should consider the sample based nature of some data in the GOS activity dataset when interpreting changes over time and applying the data to further analysis.

Sight test patient eligibility data are sample based for all Area Team and are derived from different sources. The data for the majority of Area Teams are sourced from the Open Exeter Payments System, for other Area Teams a manually collected, 2 per cent sample of sight test data based on GOS1 forms is submitted through the Omnibus system. We use Exeter data where Area Teams are able to satisfy us that the data provide a representative sample of activity.

Where either the sample source or Area Teams (previously PCTs) processing arrangements have changed over time anomalies can occur in the data, particularly when comparing to other years,

We have undertaken some impact analyses on sight test patient eligibility data, using different volumes of data from Exeter. General Ophthalmic Services Activity Statistics – England, Analysis of sight test patient eligibility data, is available on the HSCIC website8.

Following this analysis, we do not believe that the changes to sight test eligibility data sources is detrimental to the data set or how it can be used, providing users understand that all sample based data are inherently less robust than complete data collections, and that this can result in fluctuations in activity at a local level over time.

Other publications

A full list of Health and Social Care Information Centre (HSCIC) reports produced on eye care can be found at: www.hscic.gov.uk/primary-care

Our Beginners Guide to NHS Eye Care Publications contains a further list of related publications and data sources: www.hscic.gov.uk/pubs/gosactivity1213

Scotland

http://www.isdscotland.org/Health-Topics/Eye-Care/

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

http://wales.gov.uk/topics/statistics/theme/health/primary-care/ophthalmic/?lang=en

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

http://www.dhsspsni.gov.uk/index/stats_research.htm

Ophthalmic data is not currently published, but there is some health and social care data available.

8 http://www.hscic.gov.uk/catalogue/PUB10038

http://www.hscic.gov.uk/primary-care


http://www.isdscotland.org/Health-Topics/Eye-Care/

http://wales.gov.uk/topics/statistics/theme/health/primary-care/ophthalmic/?lang=en

http://www.dhsspsni.gov.uk/index/stats_research.htm

http://www.hscic.gov.uk/catalogue/PUB10038



Published by the Health and Social Care Information Centre

Part of the Government Statistical Service

Responsible Statistician

Gemma Ramsay, Section Head

ISBN 978-1-78386-148-4

This publication may be requested in large print or other formats.

For further information

www.hscic.gov.uk

0845 300 6016

[email protected]

Copyright © 2014 Health and Social Care Information Centre. All rights reserved.

This work remains the sole and exclusive property of the Health and Social Care Information Centre and may only be reproduced where there is explicit reference to the ownership of the Health and Social Care Information Centre.

This work may be re-used by NHS and government organisations without permission.

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