Guidance

Changes to the NHS Diabetic Eye Screening Programme Pathway Standards from October 2024

Updated 1 October 2024

Applies to England

1. Introduction 

These revised screening standards for the NHS diabetic eye screening (DES) programme replace previous versions. They apply for data collected from 1 October 2024. 

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 England works closely with UK Health Security Agency and the Department of Health and Social Care to provide and commission a range of public health services including screening programmes (NHS commissioning » Public health commissioning (england.nhs.uk)). The DES programme has responsibility for implementing this policy in-line with the service specification (which can be found on NHS futures), also adhering to national guidance (Diabetic eye screening: professional guidance - GOV.UK (www.gov.uk))

The aim of the diabetic eye screening programme is to make sure there is equal access to uniform and quality assured screening across England and people with diabetes are provided with high quality information so they can make an informed choice about whether to attend screening.

Useful links:

• Central glossary of terms (UK National Screening Committee: screening in healthcare - Screening glossary of terms - Guidance - GOV.UK (www.gov.uk)),
• ‘NHS population screening explained’ (Population screening explained - GOV.UK (www.gov.uk) and NHS UK (https://www.nhs.uk/)) for definition of terms

2. Summary of changes from previous version of standards 

2.1 DES-PS01Coverage and completeness of offer

This standard previously consisted of 3 parts:

1.1 The proportion of eligible people with diabetes, categorised under routine digital screening, who are offered an appointment for routine digital screening.
1.2 The proportion of eligible people categorised as suspended
1.3 The proportion of eligible people categorised as excluded.

All 3 of the above have been changed as follows:

• numbering for completeness of offer which was previously 1.1 has been changed to 01.3.
• 01.1 is now 12 month routine digital screening (RDS) coverage
• 01.2 is now 24 month routine digital screening (RDS) coverage
• previous standards 1.2 The proportion of eligible people categorised as suspended and 1.3 The proportion of eligible people categorised as excluded are now provided as supplementary data lines 01.3a and 01.3b respectively
• The new pathway standards 01.1 and 01.2 (RDS coverage for 12 and 24 month recall) will replace Pathway Standard 7 (RDS Uptake) as KPI DE1

Further detail on these new standards are as follows:

2.2 DES-PS01.1

12 month routine digital screening (RDS) coverage (KPI DE1a)

and

2.3 DES-PS01.2

24 month routine digital screening (RDS) coverage​ (KPI DE1b)

01.1 & 01.2 are new standards to measure the number of individuals who have attended a successful screening event out of those who required an RDS appointment within the reporting period. Individuals on 12 and 24 month pathways will be monitored and presented separately. 

For the denominator to be reported consistently, people with diabetes who are newly added to the register will be given a due date of 6 weeks after first registration (PS02 will calculate the proportion offered a first appointment within 3 months).

2.4 DES-PS01.3

Routine digital screening (RDS) offered within the last 12 months for both 12 and 24 month pathways 

Changes to the completeness of offer calculations are as follows: 

• the denominator has been amended to include ‘individuals who were due within the reporting period’ but were no longer ‘eligible for RDS at the end of the report period’. For example, an individual that was due within the report period, but had moved to another pathway/state by the last reporting day would still be counted
• the denominator will also be amended to count all those due for RDS screening instead of all eligible, to account for those on a 24 month screening interval and not due within the reporting year​
• the amended standard will report over 12 months for 12 and 24 month pathways combined
• there are supplementary data lines to show performance of the 12 and 24 month pathways and supplementary data lines to show whether the offer of an invitation resulted in a booked appointment (to support open/mixed booking services)

2.5 DES-PS03.1

12 month routine digital screening (RDS) timely round length

and

2.6 DES-PS03.2

24 month routine digital screening (RDS) timely round length

Pathway standard 3 previously calculated the proportion of individuals who were offered an appointment that occurred before or at 6 weeks after their due date. This was calculated differently for fixed and open booking models, making it difficult to use the data to compare performance across services. The main difference was how non-responders were counted for open booking models; open invitations that appeared to have no response within 82 calendar days were included in the numerator. This could have included individuals unable to book an appointment within the timescale due to accessibility or capacity within venues.

Therefore, to be consistent across all booking models, the standard now only counts initial booked appointments and the terminology ‘round length’ means the time period between last screen and 1st opportunity to be screened again. The round length to be achieved can be 12 or 24 months within the RDS pathway dependant on the previous grade and outcome.

Changes to the previous pathway standard 3 calculations are as follows:

• the denominator has been amended to also include individuals who were due within the reporting period but were no longer eligible for RDS at the end of the report period
• the numerator will count ‘offered with initial booked appointment due to occur within the timeframe’ instead of individuals whose invitation has simply been generated
• the amended standard reports over 12 and 24 month pathways separately
• the proposed changes will bring this standard in line with other national screening programmes and to allow services to demonstrate that they are working to both a 12 and 24 month recall period
• supplementary data lines will be included for both the 12 and 24 month pathways to detail attendances occurring within set time periods over 6 weeks

2.7 DES-PS04.1

Slit lamp bio-microscopy (SLB) coverage

A new standard for coverage within SLB has been introduced which is similar to the new coverage standard for RDS.​ 

• Performance thresholds cannot be set until enough data is collected to analyse trends to set an acceptable and achievable range. This is expected from quarter 3 2025/26
• To ensure that newly referred individuals have 13 weeks to attend, 6 weeks are added to the end of the reporting period for the numerator, and the denominator will only include those with a previous appointment in RDS, DS or HES where the attendance was at least 7 weeks prior to the reporting end date.

2.8 DES-PS04.2

Slit lamp bio-microscopy (SLB) timely round length

Pathway standard 4 previously calculated the proportion of individuals who were offered an appointment for SLB that occurred before or at 6 weeks after their due date. The standard now only counts the proportion of initial booked appointments that occurred before or that occurred before or at 6 weeks after their due date. The terminology ‘round length’ means the time period between last screen and 1st opportunity to be screened again.

The numbering for timely recall for SLB which was previously PS04 has been changed to PS04.2

Changes to the calculations are as follows:

• PS04 previously provided a snapshot of individuals eligible for 12 month recall to SLB on the last reporting day. The denominator will be amended to include individuals who were due within the reporting period, rather than just those who were in the SLB pathway on the last reporting day.
• The numerator will count individuals with ‘an initial booked appointment’ due to occur within the timeframe, rather than just counting individuals whose invitation has simply been generated. This will help open booking services understand if those who have received an invitation are booking an appointment in a timely way.
• To ensure that newly referred individuals have 13 weeks to attend, 6 weeks are added to the end of the reporting period for the numerator, and the denominator will only include those with a previous appointment in RDS, SLB or HES where the attendance was at least 7 weeks prior to the reporting end date. Any other outcome timescale chosen for referral into DS will be expected to meet the 13 weeks target and will therefore have the same calculation applied. If a service has a local policy for referral timescales, these will need to be exception reported.
• Due to this change, the thresholds previously set for PS04 will no longer be applicable. Performance thresholds cannot be set until enough data is collected to analyse trends to set an acceptable and achievable range. This is expected from quarter 3 2025/26.

2.9 DES-PS05.1 & PS05.2

Digital surveillance (DS) coverage

• New standards for coverage within DS have been introduced which will be measured for a rolling 12 months
• PS05.1 shows the proportion of individuals who attended out of the cohort over a rolling 12 month period. This standard counts people, not appointments. For example, an individual on 3 month recall could have 4 encounters within an annual reporting period but will only be counted once in the denominator. If one of those 4 encounters are attended, this will be counted in the numerator.
• Supplementary data lines will be included for this standard detailing different recall periods and pathways.
• PS05.2 shows the proportion of attended appointments out of due dates. This standard counts appointments. For example, an individual on a 3 month pathway may have 4 due dates within an annual reporting period so will be counted 4 times in the denominator and every attendance will be counted in the numerator.
• To ensure that newly referred individuals have 13 weeks to attend, 6 weeks are added to the end of the reporting period for the numerator, and the denominator will only include those with a previous appointment in RDS, SLB or HES where the attendance was at least 7 weeks prior to the reporting end date. Any other outcome timescale chosen for referral into DS will be expected to meet the 13 weeks target and will therefore have the same calculation applied. If a service has a local policy for referral timescales, these will need to be exception reported.

2.10 DES-PS05.3

Digital surveillance (DS) timely round length

• The numbering for timely recall for DS which was previously PS05 has been changed to PS05.3

Changes to the calculations are as follows:

• The numerator will count individuals with ‘an initial booked appointment’ due to occur within the timeframe, rather than just counting individuals whose invitation has simply been generated. This will help open booking services understand if those who have received an invitation are booking an appointment in a timely way.
• There is no change to the denominator from the previous PS05

2.11 DES-PS06

Timely first attendance for pregnant women within the digital surveillance (DS) pathway

The standard will now be reported over a rolling 12 months due to the thresholds being set and there being small numbers included in the calculations. A supplementary data line has been added to show the previous quarters achievement and for exception reporting.

The following threshold have been added. 

Performance thresholds: 

• Acceptable level: greater than or equal to 65%
• Achievable level: greater than or equal to 75%

2.12 DES-PS07

Routine digital screening (RDS) uptake

• This standard was previously KPI DE1, which will be replaced with the new coverage standard for RDS (1.1 and 1.2 - as detailed previously)
• The calculation for uptake remains the same and includes anyone due for routine digital screening within the reporting period (irrespective of whether they are on a 12 or 24 month pathway). This allows activity over most recent year to be reported. Supplementary data for uptake for the 12 and 24 month pathways individually will be provided.
• Over the 2 years following the implementation of the 24 month recall pathway (from October 2023), performance against the uptake standard is likely to reduce due to mathematical reasons. This is because those being chosen for the 24 month pathway must have attended 2 encounters to be eligible, so are likely to be frequent attenders. Therefore, there will be a higher proportion of frequent non-attenders remaining within the denominator, having the effect of reducing the uptake level.
• Due to these changes the current thresholds may not be appropriate, so they will be reviewed once an adequate amount of data has been collected to analyse trends to set an acceptable and achievable range. This is expected from quarter 3 2025/26.

2.13 DES-PS08

Persistent DNA to screening/surveillance

• Changes to the persistent DNA calculations are as follows:
• The definition previously only included individuals on the RDS pathway. This has now been updated to include individuals on the Surveillance pathways (Slit Lamp Bio-microscopy, Digital Surveillance and OCT).
• This change reflects the importance of programmes seeking to reduce non-attendance across all pathways.
• It is anticipated that attendance within the surveillance pathways will be the same or better than within RDS, as these individuals have previously attended for an RDS appointment. Due to there being small numbers within the surveillance pathways, it is not anticipated that the proposed change will materially impact programme’s ability to achieve of the current thresholds.  As such, no change is proposed to the current thresholds.
• Supplementary data will be reported for RDS and Surveillance pathways separately, as well as split by age group, IMD and ethnicity.

3. Resources to support providers and commissioners 

Additional DES operational guidance is included in the: 

• Screening guidance documents on gov.uk Diabetic eye screening: professional guidance - GOV.UK (www.gov.uk)
• service specifications are available on Futures NHS platform
• detailed programme performance report data lines and supporting dataset documents are available on Futures NHS platform