Diabetic eye screening programme supporting information
Updated 12 March 2021
Applies to England
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Introduction
These revised screening standards for the NHS diabetic eye screening (DES) programme replace previous versions. They apply for data collected from 1 April 2019 unless stated otherwise in the document.
The UK National Screening Committee (UK NSC) recommends diabetic eye screening for persons on the programme register who:
- are aged 12 years and over
- have a diagnosis of diabetes mellitus (excluding gestational diabetes)
- have perception of light in at least one eye
NHS DES programme has responsibility for implementing this policy. The programme service specification for NHS providers is available as part of the public health functions exercised by NHS England.
We aim to make sure there is equal access to uniform and quality assured screening across England and that people with diabetes are provided with high quality information so they can make an informed choice about whether to attend screening.
Screening guidance documents on GOV.UK may link to a central glossary of terms, ‘NHS population screening explained’ and NHS UK for definition of terms. To see the meaning of an acronym, hover over it with your cursor for the full definition.
Summary of changes from previous version of standards
DES: standard 1.1: single collated list of all people with diabetes and systematic call from a single management system
Withdrawn as included in the service specification.
DES: standard 1.2: comparison of DESP database programme size with CQRS diabetic population
Withdrawn as it is not a standard and cannot be reliably populated.
DES: standard 1.3: proportion of GP practices participating
Withdrawn as included in the service specification.
DES: standard 1.4: regular database cleansing using national standard operating procedures
Withdrawn as included in the standard operating procedures.
DES: standard 2.1: percentage of eligible population invited to screening
This has changed from the previously published version of the performance standards (April 2017), to clarify the definition of ‘eligible’, and to separate out invitation standard from cohort classification measure.
Percentage suspended and excluded are separate from percentage invited to routine digital screening (RDS).
Performance thresholds revised to greater than or equal to 95.0% acceptable and greater than or equal to 98.0% achievable.
Name changed to DES-S01: uptake: completeness of offer for routine digital screening.
DES: standard 2.2: all newly diagnosed people with diabetes must be offered first screening appointment within 3 months of the programme being notified of their diagnosis
Revised wording so that it is clear the appointment date offered should be within 3 months.
Performance thresholds revised to greater than or equal to 90.0% acceptable and greater than or equal to 95.0% achievable.
Name changed to DES-S02: uptake: invitation for first routine digital screening appointment.
DES: standard 3.1: proportion of those offered screening who attend a digital screening event
Performance thresholds revised to greater than or equal to 75.0% acceptable and greater than or equal to 85.0% achievable.
Name changed to DES-S07: uptake: routine digital screening.
DES: standard 4: percentage of people with diabetes where a digital image has been obtained but final grading outcome is ungradable
Performance thresholds set at 2% to 4% based upon interquartile range of Q4 2014 to 2015 data.
Name changed to DES-S09: test: ungradable images.
DES standard 5.1: every grader registered on the software as a grader to participate in test and training
Withdrawn as included in the service specification.
DES standard 5.2: evidence of clinical lead or nominated senior grader feeding back outcomes to grading staff
Withdrawn as included in the service specification.
DES: standard 6: time between screening event and issuing of results letters to person with diabetes and GP
Now also includes relevant health professional and result letters from Digital Surveillance and Slit Lamp Biomicroscopy (SLB).
Name changed to DES-S10: test: timeliness of results letters.
DES: standard 7: time between screening event and issue of referral request
Stable treated proliferative retinopathy with maculopathy (R3SM1) outcomes are to be included in routine.
Performance thresholds for urgent set at acceptable greater than or equal to 95.0% and achievable greater than or equal to 98.0%; routine acceptable greater than or equal to 90.0% and achievable greater than or equal to 95.0%.
Name changed to DES-S11: referral: timely referral of people with diabetes with positive screening results.
DES: standard 8.1: time between notification of positive test and consultation (urgent)
Change notification of positive test to screening event and add 2 weeks to time frame.
Performance thresholds set at acceptable greater than or equal to 80.0% before or at 6 weeks.
Name changed to DES-S12: diagnosis or intervention: timely consultation for people with diabetes who are screen positive.
DES: standard 8.2: time between notification of positive test and consultation (routine)
Change notification of positive test to screening event.
Performance thresholds set at acceptable greater than or equal to 70.0% before or at 13 weeks and achievable greater than or equal to 95.0% before or at 13 weeks.
Name changed to DES-S12: diagnosis or intervention: timely consultation for people with diabetes who are screen positive.
DES: standard 9: timeline tracking undertaken to agreed national template
Withdrawn as included in the standard operating procedures.
DES: standard 10: maximum time between RDS and attendance for SLBS to be no more than 13 weeks
Reworded to match DES-S12 - time between screening event and first attendance at SLBS.
Performance thresholds set at acceptable 70% before or at 13 weeks and achievable 95% before or at 13 weeks.
Name changed to DES-S13: diagnosis or intervention: timely consultation for people with diabetes whose images are recorded as ungradable.
DES: standard 11: time between listing and first treatment following screening if listed at first visit
Withdrawn as outside scope of screening programme.
DES: standard 12: time between screening event and first treatment if listed at first visit
Withdrawn as outside scope of screening programme.
DES: standard 13.1: audit of Severely Sight Impaired and or Sight Impaired certifications
Withdrawn as included in the service specifications and standard operating procedures.
DES: standard 13.2: audit of visual acuity
Withdrawn as data is not collectable at a local level.
DES: standard 14: screening and grading staff to be appropriately qualified in accordance with national standards
Withdrawn as included in the service specification.
DES: standard 15: graders must meet minimum grading requirement
Withdrawn as included in the service specification.
DES: standard 16: minimum programme size
Withdrawn as included in the service specification.
DES: standard 17: programme operates on annual screening interval for RDS
Now looks at whether eligible people are offered an RDS appointment that occurs within plus or minus 6 weeks of their due date.
Name changed to DES-S03: uptake: timely recall for routine digital screening.
DES: standard 18.1: production of nationally specified reports
Withdrawn as included in the service specification.
DES: standard 18.2: production of KPI data
Withdrawn as included in the service specification.
DES: Standard 19: external quality assurance
Withdrawn as included in the service specification.
DES-S04: uptake: timely recall for slit lamp biomicroscopy
New standard to make sure those on slit lamp biomicroscopy are seen within an appropriate time frame.
DES-S05: uptake: timely recall for digital surveillance
New standard to ensure those on digital surveillance are seen within an appropriate time frame, aligning with DES-S03. The standard counts appointments rather than individuals as there may be more than one appointment per year.
DES-S06: coverage: pregnant women seen in digital surveillance
New standard to make sure those on the pregnancy pathway are seen according to National Institute for Health and Care Excellence (NICE) guidelines; aligns with DES-S03 and DES-S05.
DES-S08: uptake: repeat non-attenders
New standard to reduce repeat non-attenders.
Pathway themes
NHS DES screening standards look at 6 themes to assess the pathway and 3 KPIs are derived from standards DES-07, DES-S10 and DES-12.
Theme: coverage
The related standard is DES-S06: coverage: pregnant women seen in digital surveillance
Theme: uptake
The related standards are:
- DES-S01: uptake: completeness of offer for routine digital screening
- DES-S02: uptake: invitation for first routine digital screening appointment
- DES-S03: uptake: timely recall for routine digital screening
- DES-S04: uptake: timely recall for slit lamp biomicroscopy
- DES-S05: uptake: timely recall for digital surveillance
- DES-S07: uptake: routine digital screening
- DES-S08: uptake: repeat non-attenders
Theme: test
The related standards are:
Theme: referral
The related standard is DES-S11: referral: timely referral of people with diabetes with positive screening results
Theme: diagnosis or intervention
The related standard is DES-S13: diagnosis or intervention: timely consultation for people with diabetes whose images are recorded as ungradable
Theme: intervention or treatment
The related standard is DES-S12: intervention or treatment: timely consultation for people with diabetes who are screen positive
Resources to support providers and commissioners
Additional DES operational guidance is included in the:
Reporting and publishing standards
We publish annual standards and quarterly KPI data. We share the data with NHS England before publication.
The data to support the DES standards is collected through submission of quarterly and rolling 12-month programme performance reports. These reports provide aggregate figures for important fields required to calculate the standards. The report is specified through the diabetic eye screening dataset, the programme performance report template and the dataset calculations for the programme performance report documents. The 3 reports are submitted to the national programme team, which calculate the standards. The standards are then approved by the provider manager and clinical lead. The screening providers obtain information on attended consultation dates from the hospital eye services they refer into. The hospital eye service is responsible for offering appointments to referred people with diabetes within the nationally specified time frames.
The standards are described in terms of the criteria used for the calculations in the database but they have been written in plain English where possible. Where specific field options are given, these are the ones used in the dataset calculation document.