Guidance

Diabetic eye screening: roles and responsibilities of clinical leads

Updated 17 October 2024

1. Introduction

This guidance describes the role and responsibilities of the clinical lead (CL) within diabetic eye screening (DES) services. The CL role is supported by the Royal College of Ophthalmologists and is included within the national service specification.

2. Definition

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

The organisation providing the DES service is responsible for providing clinical leadership. The CL provides clinical support for all DES service staff, particularly in matters involving referral and treatment of people with diabetes.

3. Remit of the role

The role of the CL is to ensure the successful running of the service and maintenance of a high quality service.

The CL must be a consultant ophthalmologist (or senior specialty doctor) with medical retina experience, or a consultant diabetologist. In many DES services, the CL is also the ophthalmology lead for diabetic retinopathy (DR) at one of the hospital eye service (HES) treatment centres. This is not mandatory. If the CL is a consultant diabetologist then a consultant ophthalmologist or ophthalmology lead with medical retina experience should be appointed. This is to provide dedicated ophthalmic support to the CL and the DES service.

The ophthalmology lead (OL) for DR services in HES is a medical retina specialist who has clinical responsibility for people being managed or treated for DR. The OL should support HES to return feedback and outcome data to the screening service.

The CL should:

• be professionally accountable for the local DES service
• be responsible for the overall running of the local service
• provide strategic leadership
• provide clinical support for the manager of the local DES service
• ensure all grading is undertaken according to national grading criteria
• provide clinical supervision for screening and grading staff
• provide clinical supervision for staff operating surveillance clinics
• be responsible for maintaining the quality of grading through regular monitoring of grading staff performance
• ensure the provision of ongoing education and training
• lead a regular multi-disciplinary team (MDT) meeting to review cases and provide continuing professional development (CPD)
• be responsible for making clinical decisions related to screening individuals up to the point where a referral has been made into HES

4. Role requirements

The CL should have a job description or job plan that sets out their overall clinical responsibility and accountability for the service and their place within the clinical governance framework of their employing organisation.

The CL should have links with other clinicians and health workers involved in providing care for people with diabetes. These will include, but are not limited to:

• diabetologists
• GPs or other primary care workers
• obstetricians or midwives
• public health professionals
• optometrists
• ophthalmologists from other linked treatment centres

Training should be included in the CL induction to provide information about:

• leadership and management
• screening terminology
• screening grades, levels and responsibilities
• the screening pathway
• public health and commissioning
• diabetes
• data relating to pathway standards and national key performance indicator (KPI) targets
• sensitivity or specificity
• information technology (IT) and the service software
• ophthalmology treatments

The CL should have protected sessions for the role. The number of sessions per week should be agreed between the screening provider, the service and commissioner. The CL should have specific CPD time allocated for personal training, and DES updates which should be documented in their personal development plan (PDP).

5. CL responsibilities

The CL should, as a minimum:

• provide clinical responsibility and accountability for all aspects of the screening pathway up to the point of referral to ensure pathways are followed (this includes routine digital screening (RDS), digital surveillance (DS), pregnancy and slit lamp biomicroscopy (SLB))

• oversee the clinical operations of the service so they are safe, secure and monitored, with delivery by a qualified workforce, supervised by the manager of the DES service

• oversee all clinical aspects of the screening pathway so they are covered by appropriate standard operating procedures (SOPs) that reflect national guidance

• advise on clinical matters concerning the service or people with diabetes who are eligible for screening

• work closely with the manager of the DES service to ensure efficiency and safety of the service (this includes adherence to national pathway standards, KPIs and the return of screening service data reports from HES to the service)

• influence strategy and local service development by working with the provider and local commissioners

• make sure screeners and graders receive appropriate education and training in line with national standards (this includes regular feedback on grading performance, the monthly online test and training set and arbitration grade reports)

• make sure that assessment of staff’s grading feedback is part of their annual PDP.

• complete the accreditation of slit lamp biomicroscopy examiners

• communicate learning from other specialty areas (such as diabetology) as part of regular MDT meetings (this is to support education for clinical staff and improve services for people with diabetes)

• take part in regular audits and evaluation of services for people with diabetes to improve service performance

• attend programme board meetings

• provide clinical oversight and governance by participating in meetings arranged by the service, provider and local commissioner

• undertake image review as the referral outcome grader or provide support and training in order to ensure delegation of this role to a grading manager or senior grader is appropriate

• manage the interaction and communication between the screening service and treatment centre(s) (this is to ensure timely appointments for urgent and routine referrals and feedback from ophthalmology to the screening service on patient outcomes including visual acuity, treatment and retinopathy levels)

• manage the assessment of suitability for screening of people with diabetes, including decisions on those individuals who may be excluded or suspended from screening

• participate in Screening Quality Assurance Service (SQAS) visits

• work with the local DES service manager to ensure there is a service specific risk register in place

• make sure all incidents are regularly reviewed and managed in line with national guidance Managing Safety Incidents in NHS Screening Services

The CL should also oversee optimum workload for all graders to maintain grading expertise. The requirements are that:

• graders must grade a minimum of 1,000 image sets per annum
• graders who are qualified optometrists must grade a minimum of 500 image sets per annum
• clinical leads who are medical retina specialists are not required to grade a minimum number of image sets
• clinical leads who are not medical retinal specialists and are grading on the system must grade a minimum of 500 image sets per year