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Professional Resources

The Derbyshire Diabetic Eye Screening Programme forms part of the National Diabetic Eye Screening Programme https://www.gov.uk/government/collections/diabetic-eye-screening-commission-and-provide and cares for around 60,000 Diabetic patients in the Derbyshire area.

With the tight collaboration from General  Practices we provide a robust care pathway for our patients right through to treatment in the Hospital Eye Service.

As part of the service the Derbyshire Diabetic Eye Screening Programme provides feedback on Primary care patients to allow for secure failsafe and management of DNAs for the good of the patient’s health.

This section of the website hopes to provide you the professional  health specialist with information, links and resources  to help care for the patients  with Diabetes under your care with regards to Diabetic Eye Screening.

In order for patients to be triaged and categorised into the severity of their Retinopathy and Maculaopathy they must be given an outcome grade by the screening team, which consists of 3 basic aspects, Retinopathy, Maculaopathy and Photocoagulation. A typical outcome grade may look like this R1/M1/P0 or R0/M0/P0


The Retinopathy grade describes the severity of the pathology effecting the Retinal blood vessels due to Diabetes. Grades are broken down into 4 levels of severity, R0, R1, R2, R3.

R0 – The is no evidence of damage to the Retina due to Diabetic. 

Outcome – If no Maculopathy is found then the patient will be invited for another screening appointment in a years time.

Pathology – No Diabetic related pathology present

R1 – There is very mild damage to the Retina due to Diabetes however at this level it does not warrant referral to the Hospital Eye Service as no treatment would be given. 

Outcome - If no Maculopathy is found then the patient will be invited for another screening appointment in a years time.

Pathology – Background retinal pathology, low level disease that does not require intervention at that stage, which consists of cappiliary micro-aneurysm’s and small amounts of retinal haemorrhages.

R2 – There is moderate damage to the patient’s Retina due to Diabetes and does warrant referral to the Hospital Eye Service for treatment or monitoring at a higher frequency than routine screening. Although there is damage to the vasculature of the Retina this is held within the Retina itself and its called Pre-Proliferative disease, indicating that the rogue vessels in the Retina have not proliferated out of the Retina towards the vitreos.

Outcome – The patient will be made an appointment by the programme/ HES to attend the Hosptial Eye service within 14 weeks from the date of the original screening appointment.

Pathology – Pre-prolifereative disease which consists of Intra-retinal microvascular abnormalities, extensive deep blot haemorrhages spread evenly across the retina, venous beading and venous reduplication.

R3 – This indicates severe damage to the Retinal vessels which if left will cause sight threatening disorders in a short space of time. R3 level is called Proliferative eye disease as the rogue vessels caused by Diabetes have proliferated out of the Retinal layer towards the vitreous making them unstable.

Outcome - This is the most severe type of Diabetic Retinopathy and requires urgent referral to the Hospital Eye Service to be seen by an Ophthalmologist within 28 days from the date of screening.

Objective 1 

To ensure that there is a single collated list of Diabetic patients and that this is accurate. This list is compared with CQRS to ensure parity. This section also identifies the percentage of GP practices that are taking part in Diabetic patient referral (minimum standard 100%). Objective 1 also states that the database must be cleansed on a regular basis for patients that have deceased, moved out of area, move within area and moved GP within area.

Objective 2 

This objective is concerned with ensuring that all patients that are eligible for  screening are invited for a screening appointment. Patients that are eligible for a screening appointment are all diabetic patients 12 years and over that do not have bilateral ‘No perception to light’. 

Objective 3

Objective 3 is concerned with the uptake of the programme,  eg the number of patients that attend their appointments that have been invited. This is the first of three Key Performance Indicators (KPI DE1) that is used nationally to assess a programmes performance.

Objective 4

Diabetic screening is based primarily on fundus photography using a retinal camera. Due to pathology, access, camera use adequate photographs are not achievable with sufficient detail to allow photographic grading to take place, when this happens this is called a ‘Technical fail’.

Technical fail numbers should be within acceptable limits even though some are as a result of factors that cannot be altered eg patient cataracts. Objective 4 plots the percentage of technical fails within a programme to ensure that they are not above acceptable limits which could be down to poor photography.

Objective 5

All grading staff are mandated to complete a national online grading test set each month to test their competence at grading. Objective 5 sets out to ensure that the programme ensures all the staff that grade undertake this monthly test, and the results are fed back to them by the clinical lead of the programme for educational purposes.

Objective 6

Objective 6 is the second of three Key Performance Indicators (KPI DE2) that checks the performance of the programme to send out results to patients and GPs in a timely manner.

Objective 7

Objective 7 is concerned only with the timely referral of R3a patients (those with active new vessels / Proliferative retinopathy). 

Objective 8

This objective concerns timely consultation from screening event of patients with referable pathology. R3 (proliferative disease) must be seen with 28 days and R2(pre-proliferative disease) & M1(maculopathy) must be seen within 14 weeks. This objective is the third KPI (KPI DE3) and probably the most important.

Objective 9

All patients are tracked through the patient pathways with a ‘Timeline tracker’ which records when patient enter different states of their pathway to ensure that their care is timely. Objective 9 ensures that this timeline tracker is in place.

Objective 10

Technical fail patients need to have an appointment with an Optometrist to be assessed on a slit lamp biomicroscope (SLB). Objective 10 in place to ensure that the programme sees these patients within 14 weeks.

Objective 11

Once the patient has been referred to the hospital eye service with referable pathology and attended a consultation then objective comes in play if they then go onto receive treatment. This objective tracks timely treatment following consultation.

Objective 12

This is the same as objective 11 however it tracks the time between the screening event and treatment in the hospital eye service to ensure that it is timely and appropriate.

Objective 13

The patients that are known to the programme can easily be tracked however it is possible for patients to not attend their GPs or medical establishments regarding their eyesight and ultimately this can result in them being registered sight impaired or seriously sight impaired. This provides the programme with an external source for judging how successful they are at highlighting diabetic patients and even if the patient is known to the programme whether timely and appropriate care has been given. Objective 13 ensures that the programme has robust audit processes in place for assessing certificates of visual impairments.

Objective 14

It is mandated that all staff who are part of the screening programme complete their City & Guilds qualification in Diabetic Screening. This objective ensures that the programme is compliant with this.

Objective 15

In order for graders to recognise pathology found in diabetes they must grade at least 1000 patients (image sets) a year. Objective 15 ensures that all the staff in the programme are compliant with this national guidance.

Objective 16

National guidance states that the minimum programme size to be clinically viable is 12,000. Objective 16 ensures that the total programme is larger that this minimum figure. Currently the Derbyshire programme cares for around 60,000 diabetic patients.

Objective 17

All patients must be offered a screening appointment annually. This objective tracks whether this is being offered.

Objective 18

The programme is responsible for reporting its performance via annual reports and Key Performance Indicator reports. This objective ensures that this occurs when they are requested.

Objective 19

Periodically the programme is assessed by its peers and the national team for performance and care. This peer review team consists of a regional quality assurance manager from the national screening team, a clinical lead, programme manager and screener grader from other programmes. Derbyshire was last assessed by its peers in 2012.

National guidelines state that the General Practitioners and Screening programme administration should work together to ensure that the patient receives a screening appointment within 3 months of diagnosis of Diabetes.

Registration should be done by completing the registration proforma found in the downloads section  (registration proforma) and sending this from an NHS.Net email account to dhft.diabetic@NHS.net . This will then be picked up by our administration team and the patient will be sent a letter inviting them to contact the programme to make a suitable appointment. Alternatively they can do this by logging onto our online booking we page and entering their uniquely generated ID and their date of birth.

The programme relies on initial registration of patients to build up its database of Diabetic patients however as a failsafe measure the programmes failsafe team also validate the database every quarter. This is done in two ways:

GP database validation: The programme will request on a quarterly basis a list of NHS numbers for all the patients that are coded as Diabetic at GP practices. This information once submitted will be checked against the programmes database to see if any patients have not been registered.

The programmes database is also validated against the national spine database ‘Summary Care Record’ to check for disparity such as patients that are now deceased, moved out of the area, move within the area or moved GP within the area.

By completing these two validation processes the programme can ensure that their database is accurate therefore meeting the national objective 1.

In order to ensure that clinic appointments are not wasted for repetitive DNAs the programme has a specific DNA policy for each patient pathway. For routinely screened patients 2 appointments can be missed before they are returned to annual recall where the next time they will be called for screening will be 48 weeks from the date of their last missed appointment.

There is also a 2 strike discharge policy for Slit Lamp patients and Digital Surveillance patients however for certain digital surveillance patients the programme may choose to keep on inviting the them for screening for clinical reasons.

Pregnant patients are not subject to a DNA discharge policies due to national guidance and clinical requirements.

Diabetic Eye Screening - Screening Diagnosis Outcome