SOP 2.2 NHS Entitlement and Eligibility (Scotland)
SOP 2.2 (Scotland)
NHS Eligibility & Entitlement
In Scotland, all patients who are ordinarily resident in the UK, or exempt from NHS charges under NHS regulations are eligible for an eye examination free of charge under GOS services.
Under GOS contracts you are required to take reasonable steps to verify a patient’s eligibility for an eye examination or optical voucher. You are required to carry this out at the point of service by requesting evidence of eligibility. If a patient has any questions or queries about their eligibility, they can be directed to the NHS choices website(https://www.nhsinform.scot/care-support-and-rights/nhs-services/ophthalmics/your-entitlements-to-nhs-ophthalmic-services).
If a patient fails to produce evidence that proves their eligibility, this should not prevent them from accessing healthcare if you deem this clinically necessary. There is GOC duty to make care of patient a priority. Patient and public health interest supersedes administrative requirements; however, evidence must be crossed as not seen on the patient’s record
Patients on job seekers allowance may not be able to show proof, but those on pension credit guarantee will have been issued with a letter from the DWP.
For patients who hold a HC2 OR HC3 certificate, the validity of this must be checked. The certificate must be valid on the date the spectacles are ordered.
You should also confirm the date of the last sight test to ensure the correct examination is claimed. If you need to carry out a further eye examination at less than the maximum primary examination frequency for each patient category, then you should only claim for a supplementary eye examination
NHS Scotland Counter Fraud are empowered (but not required) to impose a financial penalty on patients who fraudulently claim a GOS sight test or optical voucher.
Eligibility for an NHS optical voucher
Patients under 16
Patients under 19 and in full time education
Patients who have been prescribed complex lenses (supplement towards cost)
Please note that HES in Scotland might request a cycloplegic refraction to be done by a community optometrist. If HES wants to the patient to have new spectacles, then they will issue an HES3, which the community optometrist should complete as the prescriber. Then it can be used to provide the child with new spectacles
Patients or named as partners of the following benefits:
Income based employment and support allowance
Income based job seekers allowance
NHS tax credit exemption certificate
HC3 may be entitled to help towards cost of spectacles
Pension credit guarantee
The value of the voucher is determined by the spectacle’s prescription. See below for voucher values for 2022. You can transpose a prescription to claim a higher voucher value, except in the case of HES vouchers
If a patient who is not ordinarily resident in the UK attends for an appointment, you may be able to perform a GOS examination if they are citizens of a member state of the European Economic Area or a country with which the UK has reciprocal arrangements regarding healthcare – but only if the need for treatment arose during their visit. For example, they may present with an eye injury or infection.