Making accurate

claims in England 2022

Supported by
Produced by
Making accurate
claims in England 2022

Produced for the optical profession in England

by the AOP, supported by ABDO and FODO
Introduction

This guidance is for General Ophthalmic Services (GOS)

contractors, optometrists, dispensing opticians and
ophthalmic medical practitioners (OMPs) providing or
performing GOS in England. All references to optometrists
should be read as applying also to OMPs (or medical
practitioners in general) as appropriate.

Separate guidance is applicable in Scotland, Wales and

Northern Ireland.

This document is informal guidance and is not an

authoritative interpretation of the law. In cases of uncertainty,
please contact your NHS England Directors of Commissioning
Operations (DCO) or representative body (See 44.
Representative bodieson page 58) for further advice.

This guidance is based on the most recent regulations NHS

General Ophthalmic Services and optical vouchers and
payments regulations in England.

All references to patient records include both paper and

electronic records. All references to GOS forms includes paper
forms as well as eGOS and PCSE Online.

The AOP, FODO and ABDO wish to thank the Department of

Health, NHS England, the College of Optometrists and the
National Optometric Advisers Association for their advice.

Association of Optometrists | www.aop.org.uk 3

 Contents

1. Introduction: providing and performing GOS in England.................................................6

2. Assistants, deputies, employees and staff working under supervision......................... 10

3. Post-payment verification (PPV)............................................................................................... 11

4. Supplying and claiming (general)...........................................................................................12

5. Filling and signing GOS forms (general)...............................................................................15

6. Verifying patients’ eligibility for GOS and vouchers: point of service checks.............. 18

7. Glaucoma.......................................................................................................................................21

8. Diabetes..........................................................................................................................................21

9. Frequency of sight tests.............................................................................................................22

10. Domiciliary visits...........................................................................................................................25

11. Visits to day centres.....................................................................................................................28

12. Changes to notifications of domiciliary visits and substitutes.........................................28

13. Filling GOS 1 forms (Application for an NHS-funded sight test)....................................29

14. Filling GOS 6 Forms (Application for a mobile NHS-funded sight test)........................31

15. Patients aged under 16 or incapable of signing..................................................................32

16. Patients aged 16, 17 or 18 and in full-time education.........................................................32

17. Prescribing and supplying tints or prisms.............................................................................33

18. AR coatings and UV blocks........................................................................................................34

19. Plano lenses with tints or prisms..............................................................................................35

20. Small prescriptions and small prescription changes..........................................................35

21. No change prescriptions............................................................................................................36

22. Non-tolerance..............................................................................................................................36

4 Making accurate claims in England 2022

23. Choosing correct voucher values............................................................................................ 37

24. Filling GOS 2 forms (Patient’s optical prescription or statement)..................................39

25. Filling GOS 3 forms (NHS optical voucher and patient’s statement)............................39

26. Modifying a prescription (back vertex distance)...................................................................41

27. Transposition.................................................................................................................................42

28. Single or reglazed lenses...........................................................................................................42

29. Validity of vouchers and prescriptions...................................................................................43

30. Small glasses supplement (SGS) and special facial characteristics (SFC)....................44

31. Complex lenses............................................................................................................................45

32. Contact lenses.............................................................................................................................. 47

33. HES vouchers...............................................................................................................................48

34. Fair wear and tear........................................................................................................................49

35. Filling GOS 4 forms (NHS optical repair/replacement voucher application form).....50

36. Repairs and replacements for adults.......................................................................................51

37. Repairs and replacements for children..................................................................................52

38. Spare or second pairs of spectacles for children and adults............................................53

39. Filling GOS 5 forms (Help with the cost of a private sight test).......................................54

40. Non-collection of spectacles and contact lenses................................................................54

41. HC5(O) forms and refunds.......................................................................................................55

42. Suppliers who redeem vouchers.............................................................................................56

43. Claiming a CET grant.................................................................................................................. 57

44. Representative bodies................................................................................................................58

Association of Optometrists | www.aop.org.uk 5

 1 Introduction: providing and
performing GOS in England

A practice must have a contract with the appropriate DCO to provide

GOS in that area

To perform GOS you must be on the England-wide Ophthalmic

Performers List

You must remember to keep your registered information up to date

A newly qualified optometrist who is not on the Performers List cannot

provide GOS even under supervision. You can apply up to three months
before you are expected to qualify to prevent this situation

In England NHS sight testing is provided under General

Ophthalmic Services (GOS).

In order to provide GOS a practice must hold a contract and each

optometrist or OMP must be included on the national Ophthalmic
Performers List.

Note that having a GOS contract and performing GOS are not the same thing.
Even if you own your practice and hold a GOS contract, you must also be on the
Ophthalmic Performers List in order to perform GOS sight tests.

Contracts to provide GOS

Any practice wishing to provide GOS in England must apply to the
appropriate Directors of Commissioning Operations (DCO) of NHS
England for a contract.

There are two types of NHS sight testing (GOS) contract:

1 Mandatory (for fixed premises services)
1 Additional (for domiciliary services, also referred to as mobile
services, operating outside fixed premises, normally in the
patient’s place of residence).

6 Making accurate claims in England 2022

All contracts are made in the name of the NHS Commissioning
Board, the legal name for NHS England.

Contractors wishing to provide both mandatory and additional

services must hold a contract for both. One contract is not
sufficient, as the contractual requirements are slightly different.

All contractors must have a GOS contract for every area in which
they wish to provide services, whether fixed or mobile. Therefore if
a contractor wishes to provide GOS in another area, whether from
fixed premises or as a domiciliary service, they must enter into a
contract with the relevant DCO. This is particularly important for
domiciliary services as a patient may live nearby but in a different
NHS area.

When a new GOS contract is issued by NHS England the

commissioner will confirm the ODS code for the practice. This
needs to be included on all GOS claims submitted in order
for payment to be made. You can find your ODS code at
https://odsportal.digital.nhs.uk

Note that a domiciliary provider will have a single ODS code even if they have
contracts in multiple areas. The commissioner will forward the ODS code to
PCSE along with the details required to register User Administrators for the PCSE
Online system. PCSE will contact the contractor to confirm User Administrators
have been set up and advise on next steps for creating and submitting GOS
claims. See 4. Supplying and claiming (general)on page 12.

The Ophthalmic Performers List

In order to provide GOS for any contractor, an optometrist or OMP
must be on the national Ophthalmic Performers List. To join this list
you should apply to Primary Care Support England (PCSE).

Being on an ophthalmic list in any Wales, Scotland or Northern

Ireland does not allow a practitioner to perform GOS in England,
and vice versa.

Association of Optometrists | www.aop.org.uk 7

 A practitioner may be removed from the Ophthalmic Performers
List if they have not performed GOS during a 12-month period
anywhere in England. PCSE will notify the performer accordingly.
Any performer removed from the Ophthalmic Performers List in
this way is not allowed to do GOS work in England before their re-
listing has been completed.

Note that re-listing may take several weeks. Performers must let PCSE know if
their details change, e.g. if they move house. This will ensure that their contact
details are kept up to date, and that they are able to receive communications.

Once admitted to the national list a practitioner can provide GOS

for a contractor in any area of England.

Pre-registration optometrists can apply to be admitted to the

list via PCSE up to three months before their planned date of
registration by the GOC.

Note that a pre-registration optometrist who becomes registered as a

qualified optometrist but has not yet been entered onto the Ophthalmic
Performers List may not perform GOS sight tests even under supervision.
Such an optometrist may only carry out private sight tests, other private
work such as contact lens fittings and checks, and carry out the duties of a
registered dispensing optician until they have been admitted to the List.

An optometrist or OMP who is suspended for any reason from

the Ophthalmic Performers List and so cannot perform GOS
sight tests is nevertheless eligible to receive GOS payments if so
determined by NHS England, in order to maintain GOS income
until the matter initiating the suspension is resolved. Suspension
is a neutral act. These powers are distinct from the normal GOS
and voucher regulations. In such cases, optometrists should seek
immediate advice from their optical representative body.

You should not assume that, just because you have applied
for a contract or to join the Ophthalmic Performers List, your
application has been approved.

8 Making accurate claims in England 2022

Performers should check with PCSE before performing GOS.
Contractors must also check that the performers whom they
employ are properly listed. You can check the performers list here
– https://secure.pcse.england.nhs.uk/PerformersLists

Keeping NHS England (PCSE) informed

It is important that you inform PCSE if you change your address
for correspondence. You are also required to notify PCSE
of any relevant changes in your circumstances, in particular
any changes in the information that you supplied in your
original application or information published about you. This
might include, for example, a finding against a practitioner
or contractor following an investigation by a regulator such as
the GOC. Different periods of notification apply in different
circumstances. In the case of contractors, and depending on the
type of contractor and on the nature of the information to be
notified, the periods vary between advance notice, immediate
notice, “as soon as reasonably practicable” and 28 days. In cases
of doubt, please check with your representative body.

To terminate your GOS contract, you must give three months’

notice, although this period can be made shorter by mutual
agreement. Any significant interruption in the provision of GOS,
for example through illness, must be notified to PCSE, except
for statutory or accepted seasonal or religious holidays.

In the case of performers, the periods of notification are usually

either seven or 28 days, depending on the nature of the information.
However, a performer intending to withdraw from the Ophthalmic
Performers List is required to notify PCSE three months in advance,
although this can be made shorter by mutual agreement.

Further information about the regulations governing GOS

contracts and the Ophthalmic Performers List is available
from your representative body (See 44. Representative
bodieson page 58).

Association of Optometrists | www.aop.org.uk 9

 2 Assistants, deputies, employees and
staff working under supervision
Contractors and performers are reminded that they are liable for
all acts and omissions of their assistants, deputies, employees and
staff working under their supervision including pre-registration
optometrists. Under the regulations, contractors have the
responsibility to check the registration and listing in relation to
performers they employ. They are also required to obtain and/or
check two clinical references from performers.

Performers should provide details of their registration, performers

listing and insurance arrangements to the contractor. Contractors
are also required by the GOS contracts in England to notify PCSE
at the start and end of their employment of optometrists or
engagement of locums.

Locums should only be engaged or accept engagements to cover

short-term vacancies, for example sick leave. Where regular cover
is required, alternatives such as part-time contracts should be
considered. In cases of doubt, advice should be sought from your
representative body.

Note that an employee who was a pre-registration optometrist, and

becomes registered by the GOC as a qualified optometrist, may not perform
GOS sight tests, even under supervision, until they have also been entered
onto the Ophthalmic Performers List. It is also not possible for GOS forms to
be signed by another performer on the newly qualified optometrist’s behalf
before they are listed.

10 Making accurate claims in England 2022

3 Post-payment verification (PPV)

Your claims will be audited by your local NHS team and they are legally
entitled to inspect all records relating to GOS patients

Keeping good records will enable you to support your GOS claims

From time to time you can expect your claims in relation to

GOS sight tests and domiciliary visits, as well as the issuing and
redemption of optical vouchers, to be audited by your local
NHS team or NHS BSA on their behalf. NHS England, or its
representative, is legally entitled to inspect records relating to your
GOS patients including mixed GOS and private records relating
to that patient. You are obliged under the regulations to make the
records available within a period specified by them.

If you, your practice or the practice where you work is subject to a

PPV visit, you can check with your local NHS team or Local Optical
Committee the scope of the local or national protocol, according
to which the PPV visit is to be conducted.

Good records are vital

Clause 52 of the GOS contract requires you to keep full, accurate
and contemporaneous records. It is essential that these records
include the clinical reasons for any prescriptions and early retest
recommendations. This latter point is particularly important in the
case of patients aged 70 and over who may need to be recalled
annually rather than at longer intervals.

Keeping good records is not only best practice to ensure

continuity of care and effective hand-over between practitioners
but will also enable you to support your GOS claims in the event
of any queries by the NHS. Failure to do so may lead to payments
being reclaimed.

Association of Optometrists | www.aop.org.uk 11

 Your local NHS team can make a written request to any
supplier (whether a GOS contractor or not) who has redeemed
optical vouchers to produce relevant records. The records have
to be produced within 14 days (or longer at the local NHS
team’s discretion).
ӹ See 42. Suppliers who redeem voucherson page 56

4 Supplying and claiming (general)

You must keep accurate records of all services and appliances supplied
under GOS and voucher regulations

The patient can redeem an NHS voucher as a grant towards spectacles

or contact lenses at the practice of their choice

You can claim the lower of either the appropriate voucher value or retail
price and the patient can choose how they use the voucher

You cannot claim GOS fees for contact lens fitting or aftercare
appointments

You should submit vouchers regularly for payment within the maximum
time limits specified

You should claim only for what you have supplied and keep
accurate and dated records of these services including details of
any voucher issued. You should therefore not:

1 Redeem a voucher for distance and reading spectacles and

supply the patient with a pair of bifocals
1 Submit a GOS 3 form (voucher) and a GOS 4 form (repair and
replacement voucher) at the same time in respect of the same
patient in order to provide a spare appliance.

12 Making accurate claims in England 2022

A voucher is a grant to the patient towards the cost of spectacles
or contact lenses, which they may redeem at the practice of
their choice. There is no stipulation of type of appliance which a
voucher can be used for, whether a frame, lenses or professional
dispensing fees. For example, a voucher may be used towards:

a) A re-glaze using relatively expensive high index lenses to the

patient’s own frame; or
b) Less expensive lenses in a new frame; or
c) Plastic lenses with an anti-reflection coating to the patient’s
own frame.

The choice is the patient’s. They are entitled to ‘spend’ a voucher

of a specified amount on or towards an appliance containing the
correct prescription and the practice can claim the lower of the
voucher value or the retail price of the appliance.

If the practice operates an ‘all inclusive’ charging policy for a

complete pair of spectacles then care must be taken to ensure
that the patient receives their correct entitlement. As long as the
retail price for the completed appliance – however it is made up
– exceeds the total value of the voucher plus any supplements,
then the practice is entitled to claim the full value of the voucher.
Conversely, if the ‘all inclusive’ retail price is less than the value of
the voucher, then only this lower amount can be claimed.

If a patient requires an additional procedure as part of the

sight test (for example dilation, cycloplegia, repeat fields or
pressures) and returns on a second occasion for this procedure,
the GOS sight test has not been completed until the additional
procedure has been carried out. You should not submit a
claim until the sight test has been completed, the prescription
or statement has been issued to the patient, or a referral has
been made. You cannot claim a second fee for the additional,
clinically necessary, procedure.

Association of Optometrists | www.aop.org.uk 13

 A contact lens fitting or aftercare appointment is not a sight test
and is not funded by GOS.

You must submit GOS 1, 3, 4, 5 and 6 forms within the time limits
in the regulations, namely:
1 Six months for GOS 1 and 6 forms
1 Three months for GOS 3, 4 and 5 forms
after the date of supply of the service or appliance.
ӹ See 41. HC5(O) forms and refundson page 55

You are advised to submit your claims at regular intervals for

payment in order to assist the payments agency to expedite
payment on the due date. You can check the submission and
payment dates with the payments agency.
ӹ See 42. Suppliers who redeem voucherson page 56

You should only submit GOS 3 forms for payment after you
have supplied the spectacles or contact lenses, except when
the spectacles or contact lenses remain uncollected. In the case
of non-collection, you should record what steps were taken to
remind the patient to collect their spectacles or contact lenses and
submit the GOS 3 claim in the normal way. Submission should
normally be made within the standard three-month timescale
except in unusual circumstances.
ӹ See 32. Contact lenseson page 47 and 40. Non-collection of
spectacles and contact lenseson page 54

14 Making accurate claims in England 2022

5 Filling and signing GOS forms (general)

You should only sign forms for services which you provided

Forms should be completed fully

A voucher can only be provided following a GOS sight test

Lay suppliers may sign the supplier’s declaration on the GOS 3 and 4
forms and redeem vouchers, provided they comply with the provisions
of the Opticians Act relating to restricted groups

All statements which apply to the patient on the front of all GOS
forms must be ticked, and other details entered as required for
that category of patient, for example GP name and address.

GOS claims can be submitted electronically via the PCSE Online

portal or a Patient Management system (PMS) eGOS solution.
Claims entered on PCSE Online undergo real time validation which
ensures any errors or omissions are corrected before submission.
For claims submitted by eGOS an electronic rejection message is
returned automatically if a claim has been rejected due to missing
or incorrect mandatory data. Electronic claims received before
midnight seven working days before your payment due date will be
paid in the current payment cycle.

Paper GOS forms can be used if you are unable to submit claims
electronically. NHS England and NHS Improvement launched new
style paper GOS forms on 1 February 2021 which are processed
via an automated scanning solution that requires all mandatory
information to be completed accurately. Forms with any missing
or incorrect data are automatically rejected and returned. You are
advised to submit paper claims at regular intervals for processing in
order to assist PCSE to expedite payment on the due date. You must
attach the appropriate batch headers when you submit paper forms.
You can check the submission and payment dates with PCSE.
ӹ See 42. Suppliers who redeem voucherson page 56

Association of Optometrists | www.aop.org.uk 15

 You will receive a detailed monthly statement for GOS payments which
can be viewed and downloaded via PCSE Online.

You should only sign those GOS forms relating to the services
which you have personally provided and you are advised to sign
the forms at the time of seeing the patient. Never sign blank GOS
forms. If those forms were subsequently submitted fraudulently
then you may be held responsible and could be accused of fraud.
Similarly vouchers should never be post-dated.

This advice is of particular importance to those practitioners who

do locum work. Apart from signing the contractor’s section, you
should only sign a GOS 1, 5 or 6 form for a test done by someone
else if that test was performed by a pre-registration optometrist
under your supervision.

The optometrist or OMP who performed the sight test should sign
the practitioner’s declaration on the GOS 1, 2, 3, 5 and 6 forms,
indicating the date on which the sight test took place and giving
their Ophthalmic Performers List number.

The contractor, or their authorised signatory, should sign and date

the claim section of the GOS 1, 3, 4, 5, and 6 forms. If the authorised
signatory (if they are not the contractor) conducted the sight test,
they sign twice: once as the sight tester and once as the agent for
the contractor, using the contractor’s number (if issued). If the
contractor conducted the sight test personally, they need to sign
only once in the claim section on a paper form and cross the box in
the Performer’s Declaration to confirm they are the contractor. The
Performer’s Declaration must be signed on each electronic claim
and the Contractor’s Declaration can be signed in bulk.
ӹ See 13. Filling GOS 1 forms (Application for an NHS-funded sight test)
on page 29

The use of a rubber stamp instead of a written signature on paper

forms is not acceptable.

16 Making accurate claims in England 2022

Only an Ophthalmic Performer can issue a voucher to an eligible
person. Normally you may issue a voucher only on the basis of a
GOS sight test. If, however, a patient has had a private sight test,
chosen not to buy spectacles at the time and subsequently
becomes eligible for a voucher, a voucher may also be issued. You
should copy the details of the private prescription into the part of
the GOS 3 entitled ‘NHS Optical Voucher’, enter your name and
Ophthalmic Performers List number and sign and date the form.
You must also record the date of the prescription on which the
GOS 3 is based. You should make a note in the patient’s record that
the private prescription has been used.If, unusually, a sight test is
provided privately (including a sight test free of charge) to a person
who would otherwise be eligible for a GOS sight test, a voucher
cannot be issued and the date of that sight test must be included as
the “Date of last sight test” on the GOS 1 when they next have an
NHS sight test. This may mean that the patient will have to continue
as a private patient without the benefit of vouchers unless a suitably
extended period between sight tests occurs.
ӹ See 25. Filling GOS 3 forms (NHS optical voucher and patient’s
statement)on page 39

Lay suppliers may sign the supplier’s declaration on the GOS 3

and 4 forms and redeem vouchers, provided they comply with
the provision of the Optician’s Act, notably that dispensing to
patients who are under 16 years of age or who are registered sight
impaired or severely sight impaired (previously partially sighted
or blind) must be carried out by, or under the supervision of, a
registered optometrist, OMP or dispensing optician. The registered
practitioner should be identified on the dispensing record.

Connection problems
If either your internet connection or the Online Portal is not
available, you should record the date and time of the incident in
the standard template (https://pcse.england.nhs.uk/media/2537/
system-outage.xlsx). You can then either submit a paper claim or

Association of Optometrists | www.aop.org.uk 17

 when the problem has been resolved submit the form in the usual
way – inserting ‘PCSE Online outage [time]’ or ‘Internet down [time]’
in the Patient Signature box as appropriate.

Note that the use of this exception to the requirement for a signature will be
monitored and you may be asked to provide your incident log as evidence.

6 Verifying patients’ eligibility for GOS and

vouchers: point of service checks

You are required to verify a patient’s eligibility for a sight test or

voucher and are required to carry out a Point of Service check

If a patient cannot provide evidence of eligibility you should mark the

form as “Evidence Not Seen”

A patient is required to be eligible on the date of the sight test and the
date on which they order their spectacles or contact lenses

You are required by regulations and the GOS contracts to take

reasonable steps to verify patients’ eligibility for a sight test or a
voucher. You should not carry out a sight test, if it is clear to you
(using your common sense) that the patient is not eligible, e.g.
if the patient is not in the correct age category or could not be
eligible for a particular benefit.

In addition, you are required to carry out a Point of Service

check by requesting written evidence of eligibility. It can be
helpful to make a note on the patient’s evidence of eligibility
that you have seen. If patients have any questions about these
criteria, further information about eligibility for NHS sight tests
and optical vouchers is available on the NHS Choices website
at: https://www.nhs.uk/using-the-nhs/help-with-health-costs/
free-nhs-eye-tests-and-optical-vouchers or in leaflet HC11.

18 Making accurate claims in England 2022

However, failure by a patient to produce documentary evidence
should not prevent you performing a sight test if you deem this
to be clinically necessary. The patient’s and public health interest
and your GOC duty to make the care of the patient your first and
continuing concern rightly override administrative requirements.

You must cross “Seen” or “Not seen” in the Evidence of

Eligibility section of all GOS 1, GOS 3, GOS 4 or GOS 6 forms.
If a patient fails to produce satisfactory evidence of eligibility,
you should, nevertheless, carry out the sight test (and issue the
voucher if applicable).

For patients who are eligible due to having diabetes or glaucoma

you should enter their GPs details on the form. Patients who are
eligible due to being a close relative of someone with glaucoma
are unlikely to be able to furnish documentary proof of eligibility.
You should mark their forms “Evidence Not Seen”.

If patients are eligible for a sight test because they have a HC2 or
HC3 certificate, you must check that the certificate is valid on the
date of the sight test and enter the number on the GOS form.
Similarly, in respect of a GOS 3 form, you must see the HC2 or HC3
certificate and check that it is valid on the date on which the patient
orders their spectacles or contact lenses. It is not a requirement that
the certificate is still in date when they collect them.

If a patient undergoing a private sight test is found to need a

complex lens, then the test is deemed to have been a GOS
sight test; and a GOS 1 or GOS 6 form should be completed
and submitted for payment. Conversely, a GOS patient currently
wearing complex lenses, who undergoes a sight test and is found
no longer to require a complex lens, is still eligible for the GOS
sight test on this occasion but not again in the future unless they
again require complex lenses.
ӹ See 31. Complex lenseson page 45

Association of Optometrists | www.aop.org.uk 19

 NHS England is empowered (but not required) to impose a
financial penalty on patients who fraudulently claim eligibility for
GOS sight tests or optical vouchers. Consequently, it is also not in
the patient’s interest to claim erroneously.

Prisoners and other detained persons

Prisoners on day release who visit a practice are eligible for a
GOS sight test (and voucher if an appliance is required) in the
same way as other members of the public. If the patient claims
NHS eligibility but has not brought proof, you should cross the
“Evidence Not Seen” roundel or box.

Separate non-GOS sight testing and supply services are

commissioned by NHS England for persons who are detained in
prison, secure institutions or special (high-security) hospitals.

Overseas visitors and asylum seekers

If you decide to provide a GOS sight test to an overseas visitor
you should apply the same eligibility criteria as you would to a UK
resident. If in doubt, you should consult NHS England.

Bona fide asylum seekers will normally be in possession of an

HC2 certificate and are therefore entitled to a GOS sight test (and
voucher if an appliance is required).

20 Making accurate claims in England 2022

7 Glaucoma
Patients with glaucoma are entitled to a GOS sight test.

After receiving treatment in hospital for glaucoma (either by

medication or surgery), patients are not cured of the disease. They
will, therefore, continue to be eligible for GOS. Parents, children
and siblings of glaucoma sufferers are also eligible for a GOS
sight test, if they are aged 40 or over.

A patient considered by an ophthalmologist to be predisposed to

the development of glaucoma is also eligible for a GOS sight test.
However, this eligibility does not extend to their family members.
ӹ See 13. Filling GOS 1 forms (Application for an NHS-funded sight test)
on page 29

8 Diabetes
Patients with diabetes are entitled to a GOS sight test. Even if a
patient with type 2 diabetes has the condition fully controlled by
diet they are still eligible.

Patients who have gestational diabetes, or diabetes associated

with a medical condition that is later resolved, are only eligible for
a GOS sight test while they are suffering from the condition.

A GOS sight test does not constitute diabetic retinopathy

screening, although you should take action to manage any
condition(s) encountered as part of that sight test. All patients
with diabetes, unless they have opted out, should be receiving
regular retinal screening from an NHS Diabetic Eye Screening
Programme accredited scheme. It is advisable to establish
whether a patient with diabetes is receiving retinopathy screening,
and if they are not you should bring this to the attention of their
GP, so that the patient may be included.

Association of Optometrists | www.aop.org.uk 21

 You are only required to dilate the pupils of a diabetic patient
during their GOS sight test if you judge dilation to be clinically
necessary. You cannot be instructed by a GP, practice nurse, local
NHS team or any other person or body routinely to dilate all
patients having a GOS sight test. See also the guidance of The
College of Optometrists.

9 Frequency of sight tests

Sight tests should only be carried out when clinically necessary

You should exercise clinical judgement when recalling patients or

issuing a changed prescription

If you decide to see a patient at an interval shorter than recommended,

then the appropriate code should be used on the form and the reason
noted on the record

As required by the regulations, you should only carry out a GOS

sight test if you think it is clinically necessary. You should ensure
that the reason for the test is clearly shown on the patient’s record.

You are free to exercise your clinical judgement to determine

how frequently a patient needs a sight test and to determine
when to issue a changed prescription. However, the Department
of Health has specified (in a Memorandum of Understanding
with the profession) the minimum intervals between sight tests
for different categories of patients, in respect of which GOS
claims will normally be accepted.

In the event of testing a patient’s sight at a shorter interval than

that specified by the Department of Health, you must record
the appropriate numerical “early retest code” on the GOS 1 or 6
form, in order to indicate the reason for the earlier sight test and

22 Making accurate claims in England 2022

 Top tips for early reason codes

I t is important to remember that it is the symptoms

which validate an early test – not the outcome of that
test. So, if a patient presents to you, for example,
complaining that their vision is worse then a GOS test is
appropriate. The outcome of the test will dictate which
code you use to validate the claim – i.e. a changed
prescription is 3.2 and no change is 3.3.

It is never the case that the outcome of the test

determines if it can be claimed and it is also not
appropriate to charge a patient if no change is found.

validate the claim. This reason should also be clearly noted on

the patient record. You may be challenged by a local NHS team
to justify your clinical decision. Nevertheless all bona fide claims
will be paid. Such claims (like other claims) may be subject to
post-payment verification.

However, a patient who has a sight test when they are 15 or 69

years old would not normally be expected to have a further
sight test a year later, unless there was a clinical reason for
having one.

The Department of Health’s guidance of January 2002 also allows

claims for sight tests within one month of the minimum interval to
accommodate patients’ commitments and to give some flexibility.

Note that the forms require you to enter the date of last sight test – and it
does not matter whether this was under GOS or private.

While you have complete freedom to exercise your clinical

judgement in individual cases, it is not appropriate to apply a
blanket recall interval to all patients within a category. Your local
NHS team have discretion to ask you to justify each decision.

Association of Optometrists | www.aop.org.uk 23

 Over-frequent GOS sight testing could cause them to question
whether you should remain on the Ophthalmic Performers List
or retain a GOS contract. When you intend to recall a patient at
less than a two-year interval, the reason should be noted on the
patient’s record.

Table of intervals from the Memorandum of

Understanding (January 2002)

Patient’s age or clinical condition Minimum interval

between sight tests

Under 16 years, in the absence of any binocular 1 year

vision anomaly

Under 7 years with binocular vision anomaly or 6 months

corrected refractive error

7 years and over and under 16 with binocular vision 6 months

anomaly or rapidly progressing myopia

16 years and over and under 70 years 2 years

70 years and over 1 year

40 years and over with family history of glaucoma, 1 year

or with ocular hypertension and not in a monitoring
scheme

Diabetic patients 1 year

24 Making accurate claims in England 2022

10 Domiciliary visits

Patients are entitled to a domiciliary visit if they are unable to leave

home unaccompanied

You must record the reason for this on the GOS form

Hospital in-patients are not entitled to a GOS domiciliary sight test

You must have an Additional Services contract for each area in which
you wish to provide domiciliary visits

You must notify PCSE at least 48 hours before you make a visit to one or
two patients and three weeks before you see three or more patients at
the same address

You can only claim a domiciliary fee in respect of an eligible

patient if they are unable to leave home unaccompanied for
reasons of physical or mental illness or disability. You must ask the
patient to indicate the specific illness or disability which prevents
them from attending a practice and note this on the GOS 5 or 6
form and it is good practice to note it in your records.

Terms like “housebound”, “immobile”, “wheelchair-bound” or

“resident of a home” are insufficient. The duty of providing a
reason why the patient cannot leave home unaccompanied is the
patient’s or their carer’s responsibility, not yours; and, as such, it
raises no issues of medical confidentiality.

Patients in hospital are not eligible for a domiciliary sight test

under GOS. The fees for any visits and optical appliances
supplied to patients in hospital must be met by the NHS Trust
requesting the service, or privately by the patient themselves. If
you are providing such services for the first time, you should verify
before you attend that the hospital understands the position and
is prepared to pay your fees for providing the service. Alternatively
you can provide the service privately with the patient’s agreement.

Association of Optometrists | www.aop.org.uk 25

 The regulations stipulate that GOS sight tests may only be
provided either at a listed practice, at a patient’s normal place of
residence (including a residential home), or at some day centres.
This means that a person in respite care in a care home is not
entitled to a GOS domiciliary sight test.
ӹ See 11. Visits to day centreson page 28

You should assume that most residential homes will be considered

as a single address and as a single unit of accommodation for
the purpose of calculating the domiciliary fees payable to you.
Accordingly, a lower domiciliary visiting fee is payable in respect
of NHS sight tests provided to a third and subsequent resident
during a single visit. However, where residents in sheltered
housing have individual postal addresses, these should be
considered as individual visits and a separate domiciliary fee
should be payable for each.

If you intend to make domiciliary visits in an area which is not

included in your or your employer’s contract for additional
services, the provider (i.e. contractor) will have to apply to the DCO
for a contract before any visits can be made.

You must notify PCSE at least 48 hours (excluding weekends and

public holidays) before you intend to make a domiciliary visit to
one or two patients at a single dwelling and at least three weeks’
notice if you intend to see three or more patients at the same
address. No notification may be made more than eight weeks in
advance. All notifications must identify the individual patients,
the address where the sight test will take place, the date and
approximate time.

Pre-visit notifications (PVNs) can be submitted electronically via

the PCSE Online portal or a (PMS) eGOS solution. A unique
reference number is generated for a PVN once it has been
accepted and must be included on the GOS 6 claim for it to
be processed for payment. If you are unable to submit PVNs

26 Making accurate claims in England 2022

electronically, you will need to complete the standard PVN
template (https://pcse.england.nhs.uk/media/1424/pre-visit-
notification_template.xls) and email it to PCSE.

Note you must use a secure nhs.net email address. PCSE will send you a PVN
reference number once the notification has been processed.

For details of changes to a notification see 12. Changes to

notifications of domiciliary visits and substituteson page 28.

The notification form should only contain the names of the

patients whom you intend to see on that day. Reminders to
patients do not count as notifications to PCSE.

It is the responsibility of PCSE to verify notifications on receipt. On

the rare occasions when NHS England decide that a visit may not
take place, it should notify the service-provider immediately.

If the internet or the Online Portal is not available so you are not
able to make the submission within the required time frame then
you must record the time of the outage, complete the PVN setting
the date for the earliest allowed by the regulations and then contact
the PCSE Customer Support Centre and ask them to update the
date of the visit to the correct one. You will need to quote your ODS
code, the PVN reference and the details of the outage.

Association of Optometrists | www.aop.org.uk 27

 11 Visits to day centres

Every day centre must be approved by your local NHS team

A domiciliary fee is never payable for sight tests in a day centre

You may carry out GOS sight tests at some day centres. “Day
centre” means an establishment in the locality of the local NHS
team attended by eligible persons, who would have difficulty in
obtaining sight-testing services from practice premises because of
physical or mental illness or disability or because of difficulties in
communicating their health needs unaided.

The local NHS team must confirm that the premises where you
have been asked to visit patients complies with the definition of a
day centre for the purpose of mobile sight-testing under GOS.

Irrespective of this, the domiciliary visiting fee is never payable

for GOS sight tests carried out at day centres but a GOS 6 form
must be completed indicating the reason the patient is unable to
attend a practice unaccompanied.

You must notify PCSE, giving patients’ details, before you visit
a day centre in the same way as a domiciliary location.

Schools, secure units and prisons are not considered to be

day centres.

12 Changes to notifications of
domiciliary visits and substitutes
Changes to notifications may be made at least 48 hours in
advance of any visit by notifying PCSE.

28 Making accurate claims in England 2022

 Up to three further changes (additions or substitutions) may be
made at the time of the notified visit, but only if it would not have
been possible to give 48 hours’ notice, for example in respect
of a new resident or a person who has only just developed an
eye or vision problem. In this scenario you must include the PVN
reference for the visit on the GOS 6 form(s) and cross the “Patient
was added/substituted on the day of the visit” box on the claim.

If, on the day of the visit, a contractor is unable to visit the

residence previously notified for reasons beyond their control, for
example an outbreak of illness affecting a care home, another
venue may be substituted on the day of the visit, provided: a) a
planned visit to the alternative venue has already been notified
and this visit has not yet taken place; and b) the contractor informs
NHS England and they agree.

13 Filling GOS 1 forms (Application for

an NHS-funded sight test)

The date of last sight test should be entered on the GOS 1, whether
NHS or private

If you have not seen evidence of eligibility for GOS, then you should
mark the form “Evidence Not Seen”

The Performer and the Contractor (or their agent) must sign the GOS 1

If the contractor personally conducted the sight test they only

need sign once

You are required to fully complete the patient’s details on a GOS

1 form. You should always enter the patient’s full name on the
claim form, for example “Elizabeth” and not “Liz”, “Lizzie” or
“Betty” etc., to avoid confusion, enable continuity of care and to

Association of Optometrists | www.aop.org.uk 29

 facilitate PPV checks of the patient’s entitlement. (This is different
of course from noting in the record the name and title the
patient likes to be addressed by.) You are only required to ask the
patient to give a previous surname if you have reason to believe
that their surname might have changed in the last 12 months.
Marriage, civil partnership, divorce or adoption are cases when a
name might change.

You should enter the date of the last sight test, either GOS or
private, regardless of whether it took place at your practice or
another practice. If the exact date is not known, the month and
year should be indicated if possible. Otherwise, you should write
“not known” or, if this is the patient’s first sight test, you should
enter the word “first”. On the electronic forms there are check
boxes for both of those options.

If the patient is able to provide their NHS or National Insurance

number you should enter it on the form. The patient may still
receive GOS, even if they do not provide these numbers.

You must ask the patient for evidence of their eligibility for GOS
and cross “Seen” or “Not seen” in the Evidence of Eligibility
section of the form. Some patients may qualify for GOS in more
than one category, e.g. being 60 and over and also having a
family history of glaucoma. In such cases, you should tick all the
categories that apply.

You should ensure that the patient or their carer or authorised

representative always signs and dates the patient’s declaration.
If the patient cannot sign, their carer or representative must sign
in the appropriate place and print their name and provide their
address. If the signatory’s address is the same as the patient’s this
can be confirmed by crossing the box in the Patient Declaration
section. Under no circumstances should you or a member of your
staff sign on behalf of a patient, unless you or the member of staff
is the patient’s carer or normal authorised representative.

30 Making accurate claims in England 2022

 The person who performed the sight test must sign and date the
form, recording the date on which the sight test took place and
giving their Ophthalmic Performers List number.

The contractor or their authorised signatory must sign and

date the claim section. If the contractor conducted the sight
test personally, they need only sign once after the contractor’s
declaration on a paper form and cross the box in the Performer’s
Declaration to confirm they are the contractor. The Performer’s
Declaration must be signed on each electronic claim and the
Contractor’s Declaration can be signed in bulk.
ӹ See 6. Verifying patients’ eligibility for GOS and vouchers: point of
service checkson page 18

14 Filling GOS 6 Forms (Application for a

mobile NHS-funded sight test)
In addition to the requirements for completing a GOS 1 form, you
must indicate the venue of the domiciliary visit, whether it was the
first, second or third or subsequent patient seen at that address
on that visit and the reason for the domiciliary visit.

The reason for the visit must indicate the specific illness or
disability which prevents the patient from attending a practice.
Terms like “housebound”, “immobile”, “wheelchair-bound” or
“resident of a home” are insufficient.
ӹ See 10. Domiciliary visitson page 25

You can only claim a domiciliary fee if the sight test is

carried out at the patient’s place of residence.

Association of Optometrists | www.aop.org.uk 31

 15 Patients aged under 16 or incapable
of signing
If the patient is under the age of 16, or over 16 and is incapable of
signing, the patient’s parent, carer or other person responsible for
the patient should sign the GOS 1, 3, 4, 5 or 6 form and print their
name and provide their address. If the signatory’s address is the
same as the patient’s this can be confirmed by crossing the box
in the Patient Declaration section (if different from the patient’s
address). Neither the contractor, nor the optometrist nor their staff
can sign on behalf of the patient (unless the patient is their child
or dependant).

16 Patients aged 16, 17 or 18 and in

full-time education
Patients aged 16, 17 or 18 in full-time education are eligible for
GOS, once they have joined an academic course. They also remain
eligible for the duration of their course including during holidays
and the long vacation.

Students between academic years, changing schools or between

school and university also remain eligible. To prove eligibility they
should be able to show:

1 A letter from their school, saying either that they are a current
pupil or that they were a pupil and are changing to another
school, or
1 An offer of a place at a college or university to be taken up
immediately after the long vacation.

32 Making accurate claims in England 2022

 1 Full-time education means that the student must be
receiving full-time instruction at an educational establishment
recognised by NHS England or in another setting similar to a
school, college or university (for example, home education).
1 Students on a “gap year” or those on a work study programme
are not eligible for GOS as a student.

17 Prescribing and supplying tints or prisms

A tint or prism is a supplement to a necessary prescription

They should only be provided if it is clinically necessary

The tint supplement must be prescribed by the sight tester – not added
to the voucher at the time of dispensing

Tints and prisms are supplements to a voucher for a powered lens.

This means that a tint or prism can only be added to a claim for a
clinically significant prescription. A voucher cannot be issued for
plano, or not clinically significant, lenses to provide a tint or prism.

You should only prescribe a tint under GOS if you judge it clinically
necessary as a result of the sight test you carried out. The clinical
reason for the tint should be noted in your records.

If a patient requests a tint for cosmetic reasons it cannot be

prescribed under GOS.

A tint must be prescribed by the optometrist or OMP who

performed the sight test – it cannot be added to the voucher at
the time of dispensing.

Association of Optometrists | www.aop.org.uk 33

 If a tint has been prescribed as clinically necessary and
photochromic lenses would be suitable, then the spectacles
may be dispensed with photochromic lenses and the tint
supplement claimed.

You should only prescribe prisms in accordance with your clinical

judgement and based on the outcome of the GOS sight test you
carried out. You should record the reason, for example symptoms
and test results, on the patient’s record.

Tints and prisms determined as a result of a private examination,

including additional investigations such as colorimetry for specific
learning difficulties, are outside the scope of GOS; and a voucher
supplement cannot be claimed.

If a practice operates an ‘all inclusive’ charging policy, you are

entitled to claim the full voucher value as long as the patient
has been supplied with the correct appliance (including the
prism or tint as appropriate) and the retail price of the complete
appliance equals or exceeds the value of the voucher including
any supplements.

18 AR coatings and UV blocks

Neither anti-reflection coatings nor ultra-violet blocks are
considered to be tints under GOS. Regardless of whether you
have supplied an anti-reflection coating or ultra-violet block you
cannot claim a tint supplement.

34 Making accurate claims in England 2022

19 Plano lenses with tints or prisms
You may not claim a GOS voucher for plano lenses (either
spectacles or contact lenses) with a tint or prism. If a patient
needs a small, but clinically significant correction, and a tint or
prism is clinically necessary, you may claim a supplement, in the
same way as with a stronger prescription. You should ensure
that your records note the reason for this small prescription. The
voucher issued should, as always, correspond to the power of the
prescription issued, plus the appropriate supplement.

20 Small prescriptions and small

prescription changes
You should keep a complete record of the reasons for issuing a
small prescription, including any supplements. If there are small
changes to a prescription, the patient should only be advised
of the need for a new optical appliance, when you consider the
change to be clinically significant. In such cases, you can issue
a GOS voucher and you should record the reason for this. If,
however, you decide the change is not clinically significant, you
should not issue a voucher. If the sight test results in a small
refractive change, which you do not consider clinically significant,
you are advised to indicate this on the GOS 2 form by ticking
the box “No Change” and by noting the small change in the
comments section.

The College of Optometrists issues guidance on prescribing

small prescriptions.

Association of Optometrists | www.aop.org.uk 35

 21 No change prescriptions
You should not issue a voucher following a sight test if there is no
change in the patient’s prescription and they have a serviceable
pair of spectacles.

Although not stipulated in regulations, spectacles for an adult are

normally expected to last for two years.
ӹ See 34. Fair wear and tearon page 49

As indicated by the Department of Health’s guidance in FPN

713, if a patient’s spectacles break after their sight test and the
spectacles are now more than two years old (for example, two
years and six months have elapsed since the patient last used a
voucher towards an appliance), it is reasonable to assume that the
spectacles have become unserviceable through fair wear and tear.

In these circumstances, you should issue a new voucher without

performing another sight test, unless you think there has been a
change in prescription since the last sight test. You should ensure
that the date of the sight test and date of issue of the voucher
are correct.
ӹ See 36. Repairs and replacements for adultson page 51 and
37. Repairs and replacements for childrenon page 52

22 Non-tolerance
The GOS scheme provides support for patients who,
exceptionally, cannot tolerate new spectacles made with a
“clinically correct” prescription.

In such cases, you should make a note on the patient’s record

explaining the reason for the second sight test and enter the
appropriate early retest code on the GOS 1 form. You may only

36 Making accurate claims in England 2022

 issue a second voucher after receiving the prior approval of NHS
England (from your local NHS team) and should annotate the
patient’s record accordingly (including the date and the name of
the official who gave you the approval).

You should not claim if patients are unable to tolerate new

spectacles as a result of a mistake, a misjudgement by the
prescriber, a mistake by the dispenser, intolerance to the chosen
lens form or design, or manufacturing errors.

23 Choosing correct voucher values

A voucher may be used towards the cost of spectacles or contact
lenses. The value of the voucher is determined by the spectacle
prescription not the strength of the contact lenses.

The amount that you can claim for a GOS 3 or GOS 4 is the lower
of the voucher value (including all relevant supplements) or the
retail price of the appliance.
ӹ See 27. Transpositionon page 42

If a patient with no significant distance prescription would like

bifocals or varifocals for convenience, then a voucher A can be
used towards the cost of these.

Vouchers E-H for bifocal lenses may also be used towards the
cost of varifocal/progressive lenses but this can only be claimed
when there is a clinically significant distance prescription. There
may be situations where this is not the case but the claim is valid,
e.g. a child who requires a reading addition for a binocular vision
problem, but these will be exceptions and should be clearly noted
on the patient’s record.
ӹ See 20. Small prescriptions and small prescription changes
on page 35

Association of Optometrists | www.aop.org.uk 37

 The voucher value for a bifocal lens is determined by the distance
prescription only; the reading addition is ignored, except when
the addition is more than four dioptres more powerful than the
distance portion. If a bifocal lens has a reading addition of more
than four dioptres and the reading lens power gives a higher
voucher value, the higher value can be claimed.

Prism-controlled bifocal lenses for patients entitled to a full

voucher are classed as voucher H in all cases, regardless of the
distance or reading power.
ӹ See 31. Complex lenseson page 45

Vouchers for multifocals and computer lenses

Eligibility for a voucher is determined by what the patient

requires rather than the appliance they choose – i.e. if a patient
requires a distance correction and a near addition they can
have either 2 pairs of glasses or bifocals/multifocals and you
can issue e.g. A+A or an E voucher. But if a patient only requires
a reading prescription and chooses multifocal lenses or an
occupational lens for convenience you can only issue the single
vision voucher – but the patient can put that voucher towards a
more expensive appliance.

Similarly anti-fatigue lenses would not be claimed using a

voucher E-H because in this case the patient would only be
prescribed a single vision lens. If the patient wishes to have these
lenses the single vision voucher can be used towards the cost.

If a patient wishes to have lenses with a longer working distance

for VDU use this is a reasonable claim – however, it is not possible
for them to also have regular reading lenses (the voucher can
only be used for a distance and a near prescription) and it should
be clearly explained to them that they will not be able to have
another pair of glasses for close reading.

38 Making accurate claims in England 2022 Association of Optometrists | www.aop.org.uk

24 Filling GOS 2 forms (Patient’s
optical prescription or statement)
You must sign and give the patient the GOS 2 prescription
statement (or equivalent) at the end of every sight test, unless you
have referred the patient to their doctor.

If there is no refractive change, you must tick the box “An

unchanged prescription was issued” on the GOS 2 form and issue
an unchanged prescription.
ӹ See 20. Small prescriptions and small prescription changes
on page 35

25 Filling GOS 3 forms (NHS optical

voucher and patient’s statement)

If the patient is eligible for an NHS voucher it should be given to them

following the sight test

A patient is not entitled to a GOS 3 after a private sight test unless they
subsequently became eligible

You can transpose a prescription to claim a higher voucher value

(except in the case of Hospital Eye Service vouchers)

The patient must be eligible for a voucher on the day on which

they order the appliance

If the patient is eligible for an NHS voucher and requires

spectacles for the first time, or the prescription has changed
significantly, or new spectacles are required as a result of fair wear
and tear, the regulations require you to issue a GOS 3 following a
GOS sight test. The patient should sign part 1 of the GOS 3 form
when the spectacles have been ordered.

Association of Optometrists | www.aop.org.uk 39

 Normally you may issue a voucher only on the basis of a GOS
sight test. If, however, a patient has had a private sight test,
chosen not to buy spectacles at the time and subsequently
becomes eligible for a voucher, a voucher may also be issued.
You should copy the details of the private prescription into the
part of the GOS 3 entitled ‘NHS Optical Voucher’, enter your
name and Ophthalmic Performers List number and sign and
date the form. You must also record the date of the prescription
on which the GOS 3 is based. You should make a note in the
patient’s record that the private prescription has been used.
Vouchers cannot be issued to any patient who would have been
eligible at the time of their sight test including children under
16 years of age, but who opted instead for a private sight test.
For example, children who receive a private prescription from an
ophthalmologist cannot be provided with a voucher when their
spectacles are dispensed.

Patients have the choice of deciding where to have their spectacles

dispensed or contact lenses fitted and supplied. Spectacles for
children under 16, those registered as sight impaired or severely
sight impaired (previously partially sighted or blind) may only be
dispensed by, or under the supervision of a registered optometrist,
dispensing optician or medical practitioner.

If, immediately following a sight test, the patient chooses to order

spectacles or to have contact lenses fitted at your practice, it is not
necessary to physically hand the GOS 3 form to the patient, only
to take it back again. However, if the patient wishes to order their
spectacles or to have their contact lenses fitted elsewhere, or
if they choose not to have the spectacles dispensed or contact
lenses fitted immediately, you must sign the GOS 3 and give it
to the patient at the end of the sight test. If the GOS 3 has been
created electronically, it can be printed from PCSE Online and
given to the patient.

If you receive a GOS 3 voucher for dispensing and the prescription

is not written in the form which gives the highest spherical power,

40 Making accurate claims in England 2022

 you should transpose the prescription and initial the amendment
with the annotation FPN 713, if this provides a higher-value
voucher. It is not necessary to transpose prescriptions on an
electronic form as the system automatically calculates the highest
voucher value. You may not transpose HES vouchers.
ӹ See 27. Transpositionon page 42

You must always check that the patient is still eligible for the
voucher on the date when the patient orders their spectacles or
contact lenses. There is no need to check eligibility when the patient
collects their spectacles or contact lenses as this is not relevant.

When the patient collects their spectacles or contact lenses, you

should indicate the dates when the spectacles or contact lenses
were supplied, insert the number of pairs, and ensure that the
patient signs and dates the GOS 3 form.

You must not ask the patient to sign the declaration of collection
before they actually receive their spectacles or contact lenses.

GOS 3 forms are not transferrable. They can only be used to

pay for or towards spectacles or contact lenses for the patient
named on the front of the voucher.

26 Modifying a prescription
(back vertex distance)
If you need to modify a prescription because of a change in the
vertex distance, and the change requires a higher voucher band,
you should annotate the GOS 3 or HES voucher form accordingly
and submit it for Exception Processing. This calculation should
also be noted on the patient’s record.

Association of Optometrists | www.aop.org.uk 41

27 Transposition
In order to establish the correct voucher values for the patient,
you should write all prescriptions on a GOS 3 or GOS 4 form in
the way which gives the highest spherical power. If you dispense
prescriptions not written in this way, you should transpose
them, so that they give a higher voucher value, and initial
the amendment with the annotation FPN 713. If you use the
electronic claim system the form in which the prescription is
written does not matter as the system automatically assigns the
highest possible voucher value.

Unlike GOS vouchers, prescriptions from the Hospital Eye

Service (HES) must not be transposed and should be claimed
based on their original format.
ӹ See 33. HES voucherson page 48

28 Single or reglazed lenses

There is no such thing as half a voucher – if a patient has a clinically

significant change in one eye, then they should be given a GOS 3 with
the prescription for both eyes

If they decide to change only one lens in their current spectacles, then
you should claim the voucher value or the retail cost – whichever is
the lower

If a patient has a change in prescription in one eye only and they

require a new pair of spectacles you should issue the appropriate
voucher inserting the prescription for both eyes.

They can then choose to use the voucher towards e.g. a whole
new frame and lenses, two new lenses, or a single lens.

42 Making accurate claims in England 2022

 When reglazing an eligible patient’s frame with a new
prescription, you should claim the appropriate voucher value
or your normal retail price for supplying and fitting the lens(es),
whichever is the lower. There is no such thing as half a voucher.
So, if only one lens is reglazed, you should claim the full voucher
value or your retail price for that lens, whichever is the lower.

29 Validity of vouchers and

prescriptions
A GOS 3 voucher is valid while the patient is eligible. If there is any
delay between the sight test and the dispensing, you must check
the patient’s eligibility for the voucher on the day when they order
the spectacles or contact lenses, as this may have changed.

Note that you should also satisfy yourself that the prescription is still
clinically valid.

The maximum validity of a prescription is two years if presented

to an unregistered supplier. However, a registered optometrist or
registered dispensing optician can dispense an optical appliance
against a prescription which is more than two years old if, in
their professional judgement, this is in the best interests of
the patient. Such an occurrence would be rare; and the reason
should be recorded in the patient record. (See also the College of
Optometrists’ guidance).

Association of Optometrists | www.aop.org.uk 43

30 Small glasses supplement (SGS) and
special facial characteristics (SFC)

A SGS is only valid if the requirements below are met

You should verify the measurements of the frame and record

this information

You should clearly note the alterations made to the frame or lenses

Both the SGS and SFC can be claimed for specially manufactured frames

You should claim a small glasses supplement only if you have supplied:

1 Glasses with a boxed centre distance of not more than 55mm, and
1 A custom-made frame or a stock frame requiring extensive
adaptation to ensure a satisfactory fit.

Both conditions must be satisfied for a claim to be valid. There is no

longer a maximum age for this supplement.

As Health Service Circular 1999/051 says, extensive adaptation can

apply to the frame or lenses; and examples include:

1 Reductions or increases in the length of sides

1 Manipulations to reduce or increase the bridge width which cannot
be achieved solely by adjustment of the pads
1 Lenses with a high, positive spherical power worked to a minimum
substance (either by the practice or by the wholesale supplier).

Details of the adaptation necessary should be annotated on the

patient’s record. The orders for the frame, lenses and/or modification
should be retained as evidence.

44 Making accurate claims in England 2022

 As you are certifying that the appliance supplied meets both criteria
above, you should always measure the dimensions of the frame,
before you submit your GOS claim. You should not assume that the
manufacturer’s stated dimensions meet the criteria.

The small glasses supplement is payable in addition to the appropriate

voucher. If a frame needs to be repaired or replaced, the supplement is
also payable in addition to a repair or replacement voucher. You should
claim the retail price of the spectacles or repair, or the sum of the
voucher and the supplement, whichever is the lower.

As of 2019 the supplement can be used to provide specially

manufactured frames as well as for specially modified frames.

Similarly, the Special Facial Characteristics (SFC) supplement can be

claimed for patients where their facial characteristics require a frame
to be custom made. These frames can be any size and can also be
specially manufactured or modified.

31 Complex lenses

If a patient is found to require a complex lens, you can claim a GOS

sight test

If, subsequently, a patient is found to no longer require a complex lens,

then you can claim a GOS sight test this time only

A complex lens voucher is not a supplement – it can only be claimed in

isolation, but with a tint or prism supplement if clinically necessary

A complex lens is defined as either a lens with a power in any one

meridian of plus or minus 10 dioptres or more; or a prism-controlled
bifocal lens. If the distance prescription is below 10 dioptres but the
reading addition takes it to 10 dioptres or more, the complex lens
voucher applies to the reading spectacles only and not to the distance
spectacles or to bifocal spectacles.

Association of Optometrists | www.aop.org.uk 45

 Note that British Standard BS EN ISO 13666:2012 defines prism controlled
bifocals as including “slab-off” or bi-prism lenses.

Any patient who is prescribed a complex lens qualifies

automatically for a GOS sight test and a complex lens voucher.
As the Department of Health’s guidance FPN 713 makes clear,
if a patient undergoing a private sight test is found to need a
complex lens, the practitioner should arrange for the patient to
complete a GOS 1 form (thereby converting the private sight test
to a GOS sight test). If a patient, previously requiring a complex
lens is found during a GOS sight test to no longer require a
complex lens, they may still receive the GOS sight test, but on
this occasion only, and should be informed that they may not be
eligible next time.

A complex voucher is not a supplement but a standalone voucher.

A patient who is prescribed a complex lens but who would not
be eligible for help with costs on any other grounds is eligible for
a complex lens voucher. However, patients who are eligible for a
GOS 3 are not also entitled to a complex lens voucher. Only the
normal voucher can be issued.
ӹ See 23. Choosing correct voucher valueson page 37

Supplements for tints or prisms, where clinically necessary, or

for small glasses or special glasses, can be added to a complex
lens voucher.

46 Making accurate claims in England 2022

32 Contact lenses

Any voucher value is calculated on the spectacle prescription

Disposable or planned replacement contact lenses do not entitle a

patient to vouchers on fair wear and tear grounds

A voucher can be used in lieu of payments for regular replacement lenses

You should only issue a voucher for contact lenses on the basis of
the prescription for spectacles.

Vouchers can be issued for contact lenses for a first prescription,

for a change in prescription, or on grounds of fair wear and tear,
as for spectacles. As a prescriber, you should use your professional
judgement to determine whether a pair of contact lenses needs
to be replaced as a result of fair wear and tear. You can only issue
a new voucher for disposable or planned replacement contact
lenses if the patient’s prescription has changed. Disposable or
planned replacement contact lenses do not entitle a patient to
vouchers on fair wear and tear grounds.

If patients pay for disposable or planned replacement contact

lenses by instalments, a GOS 3 voucher may be accepted in lieu of
a number of payments up to the value of the voucher. If a patient
has committed to a contract for the supply of such lenses, it is
acceptable to submit the voucher for payment once the first set of
lenses has been collected.

The replacement of lost contact lenses is subject to the same rules

as for spectacles for children and adults.
ӹ See 36. Repairs and replacements for adultson page 51 and
37. Repairs and replacements for childrenon page 52

Vouchers cannot be used for the purchase of plano tinted contact

lenses, plano cosmetic contact lenses or contact lens care solutions.

Association of Optometrists | www.aop.org.uk 47

33 HES vouchers

HES patients may be entitled to GOS according to the normal criteria

If the hospital requires a sight test that cannot be performed in-house,

the patient should be issued with a HES1 form

A HES prescription cannot be transposed even if this would give a

higher voucher value

Sight tests and glasses for in-patients are the responsibility of the
NHS Trust

On occasion, it may be necessary for Hospital Eye Service (HES)

patients to have a sight test as a part of the management of
their eye condition. If hospital staff determine that a sight test is
necessary and it is not available in-house, an NHS Trust hospital
can arrange for a sight test to be carried out by a GOS provider.
Such a sight test will be a GOS sight test if the patient is eligible
for a GOS sight test outside hospital. If the patient is not eligible
they should be issued with a HES1 form by the hospital, which
the sight test provider should submit directly to the hospital for
payment of the optometrist’s fees.

HES voucher categories and eligibility are the same as for GOS
vouchers but with the addition of a “catch all” category I. This
provides scope for the HES to prescribe an optical correction that
does not fall within the standard categories.

Where a patient is not eligible for a voucher and must pay towards
the cost of their appliance, this payment is limited for HES
patients to the published maximum patient charge.

Where a HES voucher is issued, it cannot be transposed. If the

spectacle prescription on a HES (P) (or HES 2 or HES 3) form is not
written to the highest spherical power, you should not transpose it.

48 Making accurate claims in England 2022

 Consequently, the voucher type will be determined by the
prescription as written, even if this disadvantages the patient
financially.

Separate guidance on the HES was issued by the Department

of Health in November 2006, entitled ‘Guidance on Optical
Charges for Hospital Eye Service Patients’. It is available
at: webarchive.nationalarchives.gov.uk/20080910134953/
dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_063239

34 Fair wear and tear

There is no statutory definition of fair wear and tear but spectacles for
an adult are expected to last two years

If you find an unchanged prescription in a child and give them a new

voucher you should record the reason why in your records

In general, spectacles for an adult are expected to last for two

years; however that is not a statutory limit. Following a sight test
you should only issue a voucher for new spectacles to the same
prescription as the patient’s existing spectacles if you judge the
existing spectacles to be unserviceable through fair wear and tear.
ӹ See 32. Contact lenseson page 47

In the event of an unchanged prescription for a child, you will have

to consider whether:
1 The spectacles have become unserviceable due to fair wear
and tear
1 Or the child has outgrown them.

In either case, you should issue a GOS 3 voucher and the patient’s
record should contain the reason for the replacement.

Association of Optometrists | www.aop.org.uk 49

35 Filling GOS 4 forms (NHS optical repair/
replacement voucher application form)

You should only claim for the parts necessary to repair the spectacles

You should keep dated records of what was repaired

You can only repair the most recent pair of spectacles – not a spare pair

Spectacles for a child provided on a HES voucher can be repaired using

a GOS 4

A GOS 4 may be used to repair or replace an appliance for an

eligible patient.

You should not claim a GOS 4 if the spectacles or contact lenses

are covered by a manufacturer’s warranty, insurance policy or
other guarantee. You should check a patient continues to be
eligible for a voucher at the time of the repair or replacement.
ӹ See 36. Repairs and replacements for adultson page 51 and
37. Repairs and replacements for childrenon page 52

You should keep dated records of repairs for which vouchers are
claimed, indicating the reason for the repair or replacement (e.g.
spectacles lost, side broken), and what was supplied (e.g. new side
fitted). It is not a requirement to indicate in your records how the
loss or damage occurred.

You should only claim for the parts of the appliance which are
damaged rather than claiming for a whole frame or a whole pair.

When repairing a patient’s spectacles (for example, by soldering

or by replacing a pad), you should claim the appropriate repair
voucher or the retail price of the repairs, whichever is the lower
and endorse the GOS 4 form accordingly. You should not claim
for a minor repair, for which you would not normally charge.

50 Making accurate claims in England 2022

 Repair or replacements to spectacles prescribed or supplied by
the Hospital Eye Service to a child under 16 can be made using a
GOS 4 form. In the case of adults, the Trust will decide whether to
pay for a repair or replacement.
ӹ See 36. Repairs and replacements for adults

A repair or replacement voucher must not be claimed in order

to provide a second or spare pair of spectacles to a patient or
to repair an old pair – only the patient’s current glasses can be
repaired or replaced.

You must not carry out a GOS sight test without a valid clinical
reason. You must not carry out a sight test solely for the purpose
of issuing a voucher to replace broken or lost spectacles. If a valid
prescription is available, a repair or replacement should be made
on the basis of that prescription.

36 Repairs and replacements for adults

Adults are only eligible for a GOS 4, if they need a repair due to illness

If a patient has not had a voucher for over two years and breaks their
spectacles, a GOS 3 can be used under fair wear and tear

Adults are only eligible for a GOS 4 if they have broken or lost
their spectacles as a direct result of illness. You should contact
BSA and explain how the loss or breakage occurred and how this
relates to the patient’s illness or disability. If the claim is approved
you will be provided with a code which should be entered on the
form so it can be submitted. You should not make any repair or
replacement before this approval is given.

Full-time students aged 16, 17 or 18 are regarded as adults for the

purposes of repairs or replacements.

Association of Optometrists | www.aop.org.uk 51

 In cases of major hardship – for example a patient who is unable
to function or work because their spectacles have been stolen –
you should consult your local NHS team who may have a system
for providing a voucher in these circumstances.

Otherwise the patient must make a private arrangement for a

repair or replacement. Alternatively, the patient can wait until a
further sight test is due on clinical grounds.
ӹ See 34. Fair wear and tearon page 49

37 Repairs and replacements for children

You should only repair/replace the most recently prescribed spectacles

with a GOS 4

You should keep good records showing what was repaired/replaced

and what was claimed

Children under 16, including “looked-after” children (a looked-

after child is aged 16 or 17, was in local authority care up to age 16,
and is now being supported by the local authority) are eligible for
repairs or replacements in consequence of loss or damage of their
spectacles, without prior approval.

It is important to keep good records for payment verification

purposes particularly the reason for repair or replacement and
what was repaired or replaced along with the relevant dates.

GOS 4 forms can only be used to repair or replace the current

NHS-approved spectacles and not older pairs or private spare
pairs. If your practice provides a free second pair, only the initial
pair should be repaired.

52 Making accurate claims in England 2022

 If a child repeatedly breaks or loses their spectacles, the local NHS
team may seek an explanation from the contractor and consider
what advice to give to the child and the child’s parents or guardian
to take better care of the spectacles. The local NHS team may
choose to write formally to the family, if the problem persists.
In these circumstances it is particularly important to have clear
records of the necessity of all of the repairs.

38 Spare or second pairs of spectacles

for children and adults

No patient is automatically entitled to a spare pair of spectacles

You can request a spare pair for a patient by contacting your local
NHS team

If a spare pair is approved a GOS 3 should be used to make the claim

A GOS 4 may be used for repairs of a main or a spare pair

As Paragraph 27 of the Department of Health’s guidance FPN 713

states, no patient has ever been automatically entitled to a spare
pair of spectacles to the same prescription, but that in exceptional
circumstances, the NHS may be approached for approval of a
second pair. You should apply to the BSA and if approved an
additional GOS 3 should be submitted and evidence of the
approval should be kept in your records. Neither a GOS 4, nor a
post-dated GOS 3, should be used in any circumstances in order
to claim a spare pair.

Exceptional circumstances could include the strength of the

patient’s lenses, the nature of any medical condition and, in the
case of children, their age and evidence from a parent.

Association of Optometrists | www.aop.org.uk 53

 A claim for the repair or replacement of an NHS-authorised spare
or second pair of spectacles should be dealt with in the same way
as the repair or replacement of a first pair.

A spare or second pair prescribed by a hospital is also eligible for

repairs using a GOS 4 form, in the same way as a first pair.
ӹ See 37. Repairs and replacements for childrenon page 52

39 Filling GOS 5 forms (Help with the

cost of a private sight test)
The GOS 5 form is only for use by patients who hold a valid HC3
certificate at the time of their private sight test.

You should deduct the patient’s contribution shown on the HC3

certificate from your private sight test fee when completing the
GOS 5 form. If your private sight test fee is less than the GOS sight
test fee, you should use the lesser amount to make the calculation.

40 Non-collection of spectacles and

contact lenses
It is reasonable for you to submit your GOS 3 claim in respect of
uncollected appliances within the standard three-month timescale
except in unusual circumstances. You should keep a record of
the steps you took to notify the patient before the three month
deadline, together with dates.

54 Making accurate claims in England 2022

 In such cases, you should claim for the spectacles or contact
lenses at the retail price or the appropriate voucher value,
whichever is the lower, annotate the form with the words
“spectacles/contact lenses uncollected” in the patient signature
box and cross the “Exception Processing” box in the Supplier’s
Declaration section.

A claim may be made in respect of a patient who dies before

collecting the spectacles or contact lenses. You should annotate
the relevant form with the words “patient deceased” in the patient
signature box, adding the date of death if known to you, and cross
the “Exception Processing” box in the Supplier’s Declaration section.

41 HC5(O) forms and refunds

If a patient discovers, after receiving and paying for a private sight
test, that at the time of that test, they were eligible for an NHS
sight test, the patient can obtain a refund using the HC5(O) form.

The forms are available from: https://assets.nhs.uk/prod/

documents/HC5_O_optical.pdf

As in the case of GOS 3 vouchers, HC5(0) forms should be

submitted for payment within three months of the completion of
the sight test – this is different to the six months for GOS 1 and 6
sight test claims.

If a patient, who is eligible for GOS, chooses to have a private

sight test instead, you should be sure that the patient understands
beforehand that:

1 They cannot change their mind after the private sight test and
claim a GOS sight test using the HC5(O) form

Association of Optometrists | www.aop.org.uk 55

 1 They will not be eligible for an NHS optical voucher towards the
costs of spectacles or contact lenses as a result of the private
sight test.

If in doubt, it is advisable to ask the patient in advance to sign a

document stating that they understand this.

42 Suppliers who redeem vouchers

A supplier does not have to be a GOS contractor or performer.
Local NHS teams must refuse to redeem vouchers submitted by
contractors and unregistered suppliers alike if:

1 The supplier fails to produce the appropriate records; or

1 The supplier has been removed from the Ophthalmic
Performers List or has had their GOS contract terminated; or
1 The local NHS team judges the supplier to be unsuitable to
receive public funds.
1 In the first two cases the decision has immediate effect. In
a case of “unsuitability”, the local NHS team must give one
month’s notice of cessation.

In all cases the supplier has the right of appeal to the First-Tier
Tribunal against the local NHS team’s notice within 28 days. In a
case of “unsuitability”, the NHS has the discretion to continue to
make payments to the supplier while the appeal proceeds.

If a local NHS team believes that a supplier should be subject to a

national ban from redeeming vouchers, they can apply to the First-
Tier Tribunal for a national disqualification (called a stop order). The
supplier has a right to an appeal within 28 days and can continue
redeeming vouchers until the appeal has been determined.

56 Making accurate claims in England 2022

 The Department of Health made clear in guidance in 2008 that
the power to request records from suppliers is a discretionary
power only and does not enable local NHS teams to:

1 Impose a general policy of pre-payment verification of all

suppliers before vouchers are redeemed; or
1 Request records from all suppliers all of the time.

43 Claiming a CET grant

CET grants are negotiated each year and are paid out of the GOS
budget. A grant is available to optometrists and OMPs who:

Provided GOS services in the relevant year

Were on the Ophthalmic List for at least six months of that year

Have undertaken CET in that year

A CET grant can be claimed by an optometrist or OMP who was

on the Performers List for at least six months of the relevant year,
provided GOS and undertook CET.

The grant is claimed in arrears for the CET cycle, which runs each
calendar year, so the relevant year is the calendar year before
the claim – i.e. a claim made in September 2022 is for January to
December 2021.

OMPs can only claim the grant if their sole medical work is
providing eye examinations – i.e. they cannot also work part-time
in, for example, the Hospital Eye Service.

Association of Optometrists | www.aop.org.uk 57

 You should complete the claim form and submit it within the
claim window.

In England all CET claim forms must be signed by a registered

GOS contractor. Practitioners who are a GOS contractor are able
to sign their own form. The CET allowance will be paid directly into
the bank account of the GOS contractor who signs the form.

44 Representative bodies
FODO
16 Upper Woburn Place
London WC1H 0BS

020 7298 5151

info@fodo.com

ABDO
Unit 2, Court Lodge Offices
Godmersham Park
Godmersham
Kent CT4 7DT
01227 733905
general@abdo.org.uk

AOP
2 Woodbridge Street
London EC1R 0DG
020 7549 2000
postbox@aop.org.uk

58 Making accurate claims in England 2022

Making accurate
claims in England
2022

Association of Optometrists | www.aop.org.uk

Promoting the profession,
protecting the professional

© Association of Optometrists 2022