Guidance

Diabetic eye screening: role descriptions

Updated 2 October 2023

Applies to England

In accordance with programme standards the provider will make sure that all important roles are filled. These include:

• clinical lead
• programme manager
• senior screener or grader
• screener or grader
• failsafe officer
• administrator

Clinical lead

The provider is responsible for providing clinical leadership.

The clinical lead has overall clinical responsibility and professional accountability for the service across the pathway.

The clinical lead (CLDESP) will either be a consultant (or senior specialty doctor) ophthalmologist with medical retina experience or a consultant diabetologist.

In many services, the CLDESP is also the ophthalmology lead for diabetic retinopathy (DR) at one of the hospital eye service (HES) or treatment centres but this is not a requirement.

If the CLDESP is a consultant diabetologist then a consultant or senior specialty doctor grade ophthalmologist with medical retina experience will be appointed to provide dedicated ophthalmic support to the service.

Programme manager

The provider is responsible for providing a dedicated programme manager. The programme manager has overall responsibility for the operational running of all aspects of the service including its quality assurance (QA) processes, evaluation of ongoing audits, and for implementing continuous improvement strategies. The programme manager is responsible for:

• safe running of call or recall, management of exclusions and suspensions, administration, failsafe
• smooth running of screening sessions
• ensuring screening and grading capacity
• compliance of workforce with education and training requirements
• compliance with internal QA requirements
• monitoring the service’s performance against standards

Senior screener or grader

The provider is responsible for providing a senior screener or grader. The senior screener or grader will be clinically responsible to the clinical lead.

The senior screener or grader will be an experienced grader who supervises and provides training and feedback to the service’s team of screeners and graders and make sure all members of the screening and grading team meet national standards.

This role may be undertaken by the clinical lead or be delegated to the programme manager or an accredited screener/grader.

Screeners or graders

The provider is responsible for providing an appropriate number of screeners and graders to make sure that all eligible people with diabetes in its cohort are screened and graded according to national standards. Grading will be provided at primary, secondary, arbitration and referral outcome grade levels.

The responsibilities of the screener include:

• explaining the test procedure to the people with diabetes and obtaining consent
• undertaking visual acuity checks
• instilling eye drops
• taking digital images

The responsibilities of the grader include grading each digital image according to national standards.

Failsafe officer

The provider is responsible for providing failsafe of all stages of the screening pathway.

The failsafe officer role may be undertaken by one designated person or may be a clearly defined shared responsibility among 2 or more members of the team, each undertaking failsafe for a particular aspect of the care pathway from cohort identification through to referral and follow up. Failsafe will be undertaken at each stage of the care pathway according to national guidelines.

Administrator

The provider is responsible for providing an appropriate number of administrators for the service in order to make sure the timely provision of:

• identification of cohort
• invitation, reminder, appointment booking
• dispatch of results
• responding to telephone enquiries

Quality assurance

The provider will undertake internal QA activities in accordance with programme guidance.

The clinical lead is responsible for implementing internal QA and taking action for continual service improvement. This will include as a minimum:

• regular review of data of grading quality
• provision of a multidisciplinary team meeting at regular intervals
• regular audits of people with diabetes presenting with disease to symptomatic services in line with programme standards and guidelines
• ensuring optimum workload for all graders to maintain expertise:
  • graders must grade a minimum of 1,000 patient image sets per year
  • graders who are qualified optometrists must grade a minimum of 500 patient image sets per year
  • clinical leads who are medical retinal specialists are not required to grade a minimum number of patient image sets
  • clinical leads who are not medical retinal specialists and are grading on the system are required to grade a minimum of 500 patient image sets per year

The provider will participate fully in national QA processes, cooperate in undertaking ad-hoc audits and reviews as requested by screening quality assurance service (SQAS) teams and respond in a timely manner to their recommendations. This will include the submission to the commissioner and SQAS of:

• agreed data and reports from external QA schemes
• minimum datasets as required
• adherence to and submission of the programme or SQAS audit schedule

The provider will operate failsafe systems that can identify, as early as possible, people with diabetes that may have been missed or where screening results are incomplete.

The provider will respond to SQAS recommendations within agreed timescales. The provider will produce with agreement of the commissioner an action plan to address areas for improvement that have been identified in recommendations.

Where SQAS believe there is a significant risk of harm to the population, they can recommend to the commissioner to suspend a service.