Guidance

Diabetic eye screening standards valid for data collected from 1 April 2019

Updated 10 December 2024

Applies to England

1. DES-S01: uptake: completeness of offer for routine digital screening

1.1 Description

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.

1.2 Rationale

To maximise the impact of the screening programme all eligible people should be offered an appointment for routine digital screening, unless they are suspended or excluded.

Monitoring the proportion of suspended and excluded people in the eligible population should help ensure that people are not being suspended or excluded unnecessarily.

1.3 Definition

1.1 Numerator: number of eligible people, categorised under routine digital screening on the final day of the reporting period, offered an appointment for routine digital screening during the reporting period (programme performance report (PPR) field 3.2c).

Denominator: number of eligible people, categorised under routine digital screening on the final day of the reporting period (PPR field 3.1.7a).

1.2 Numerator: number of eligible people that are suspended on the final day of the reporting period (PPR field 3.1.5a).

Denominator: number of eligible people on the final day of the reporting period (PPR field 3.1.1).

1.3 Numerator: number of eligible people that are excluded on the final day of the reporting period (PPR field 3.1.3a).

Denominator: number of eligible people on the final day of the reporting period (PPR field 3.1.1).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

If an eligible person attends a walk-in clinic or is screened for diabetic retinopathy while in care of ophthalmology for non-diabetic retinopathy it will be counted as an offer for that date.

1.4 Performance thresholds

Acceptable level: greater than or equal to 95.0%

Achievable level: greater than or equal to 98.0%

1.5 Caveats

Eligible people with diabetes, categorised under RDS towards the end of the screening year may not be sent an invitation within the reporting time period (their invitation would be sent in the subsequent year and reported on then).

This is a snapshot at the final day of the reporting period, meaning that 1.1 will not include individuals sent an invitation for RDS during the reporting period, but no longer categorised under RDS on the final day of the reporting period. This also means that anyone screened under surveillance during the reporting year and subsequently moved back to RDS before the final day will not be counted as having received screening.

For these reasons the provider is not expected to achieve 100%.

1.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider and clinical commissioning group (CCG)

1.7 Reporting period

Rolling 12-month data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

1.8 Review dates

Date standard introduced: 1 April 2013

Date standard last updated: 1 April 2017

2. DES-S02: uptake: invitation for first routine digital screening appointment

2.1 Description

Proportion of people with diabetes newly added to the register offered a first RDS appointment that is due to occur on or before 89 calendar days of the provider being notified of their diagnosis or registration.

2.2 Rationale

People can be diagnosed with diabetes several years after having developed the condition. It is therefore important that a screen of the retina is taken as soon as possible after diagnosis to assess whether retinopathy is present.

Reference: National Institute for Health and Care Excellence (NICE) guidance for the management of diabetes type 1 and type 2

2.3 Definition

Numerator: number of people with diabetes newly added to the register offered a first appointment for their first RDS event which is due to occur on or before 89 calendar days of the date of the provider being notified of their diagnosis or registration (PPR field 3.2.2a).

Denominator: number of people with diabetes newly added to the programme register during the reporting period (PPR field 3.5).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Note, the 89 calendar day period allows up to 7 calendar days for any provider using an open appointment model to generate their invitation (plus 82 calendar days for that appointment to be due to take place). The 89 calendar day period can be outside the reporting period.

Please refer to the PPR for an explanation regarding how 89 calendar days approximates 3 months.

2.4 Performance thresholds

Acceptable level: greater than or equal to 90.0%

Achievable level: greater than or equal to 95.0%

2.5 Caveats

Some individuals newly added will be immediately moved off register, for instance if they are under 12 years of age or if they are pregnant (they will move to digital surveillance), and so the provider is not expected to achieve 100%. If notification of exclusion occurs before invitation is issued, they will be counted in the denominator.

Providers may not be able to distinguish between individuals newly diagnosed with diabetes and those who are transferring into the service from another service.

Providers using open appointment models generate appointments that are due to take place exactly 82 days later, until the individual with diabetes contacts the provider and books their appointment (this then becomes their due date). Any invitations generated later than 7 days after each individual has been added to the register will not be counted towards achieving the standard if the individual does not respond to the invitation.

2.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider and CCG

2.7 Reporting period

Quarterly data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

2.8 Review dates

Date standard introduced: 1 April 2013

Date standard last updated: 1 April 2019

3. DES-S03: uptake: timely recall for routine digital screening

3.1 Description

Proportion of eligible people offered an appointment for RDS occurring before or at 6 weeks after their RDS recall due date.

3.2 Rationale

Providers should operate a 12-month screening interval. To ensure that the 12-month screening interval is maintained, the invitation should be offered to enable the appointment to occur before or at 6 weeks after the due date. If the screening interval is not maintained, people with diabetes may not be seen often enough and detection of disease may be delayed.

3.3 Definition

Numerator: number of individuals, categorised under RDS on the final day of the reporting period, who are offered an appointment that is due to occur before or at 6 weeks after their due date (PPR field 3.4.2b plus 3.4.2c).

The offered appointment can occur outside of the reporting period provided it is before or at 6 weeks after the due date.

Denominator: number of individuals, categorised under RDS on the final day of the reporting period, with a due date for RDS within the reporting period (PPR field 3.4.2a).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The definition for counting open and closed invitations is available in the PPR template.

This standard will not include those individuals screened for the first time or those referred into the service and not screened during the screening year.

Excluded are people with diabetes who were due to have an RDS within the reporting period, but are no longer categorised under RDS on the final day of the reporting period.

3.4 Performance thresholds

Acceptable level: greater than or equal to 95.0%

Achievable level: greater than or equal to 98.0%

3.5 Caveats

This standard does not include all individuals who were due to have an RDS within the reporting period.

3.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider and CCG

3.7 Reporting period

Rolling 12-month data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

3.8 Review dates

Date standard introduced: 1 April 2013

Date standard last updated: 1 April 2019

4. DES-S04: uptake: timely recall for slit lamp biomicroscopy

4.1 Description

Proportion of eligible people with diabetes offered an appointment for slit lamp biomicroscopy (SLB) occurring before or at 6 weeks after their SLB surveillance recall due date.

4.2 Rationale

People with diabetes moved on to SLB surveillance need to be seen on a regular basis and may have complex needs due to other eye pathology. It is important that individuals attend their surveillance appointments in a timely manner.

If the surveillance interval is not maintained, people with diabetes may not be seen often enough and detection of disease may be delayed.

4.3 Definition

Numerator: number of individuals, categorised under SLB surveillance on the final day of the reporting period, who are offered an appointment that is due to occur before or at 6 weeks after their due date (PPR field 9.1.5b plus 9.1.5c).

Denominator: number of individuals, categorised under SLB surveillance on the final day of the reporting period, with a due date to have an SLB appointment within the reporting period (PPR field 9.1.5a).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The offered appointment can occur outside the reporting period if it is before or at 6 weeks after the due date.

The definition for counting open and closed invitations is available in the PPR template.

Excluded from this standard are:

• people with diabetes screened for the first time in SLB surveillance during the screening year
• people with diabetes due to have a SLB screen within the reporting period, but no longer under SLB pathway on the final day of the reporting period

4.4 Performance thresholds

Acceptable level: greater than or equal to 60.0%

Achievable level: greater than or equal to 85.0%

This threshold will be reviewed again in 12 months

4.5 Caveats

None

4.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider

4.7 Reporting period

Rolling 12-month data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

4.8 Review dates

Date standard introduced: 1 April 2017

Date standard last updated: 1 April 2019

5. DES-S05: uptake: timely recall for digital surveillance

5.1 Description

Proportion of due appointments for digital surveillance that have an offer of an appointment due to occur within a reasonable time of the follow-up period.

5.2 Rationale

People with diabetes moved on to digital surveillance need to be seen on a regular basis and it is important that they attend their follow-up appointments in a timely manner. If the follow-up period is not maintained, people with diabetes may be seen too frequently or not often enough and detection of disease may be delayed.

5.3 Definition

Numerator: number of due appointments for digital surveillance where there has been an offer of a follow-up appointment that occurs within a reasonable time of their follow-up period (PPR fields 10.1.6a, d, g, j). See table 1 below.

Table 1: follow-up appointment recall timeframes

Recall period	Timeframe
3 months	plus or minus 1 week
6 months	plus or minus 3 weeks
9 months	plus or minus 4 weeks
12 months	plus or minus 6 weeks

Denominator: number of due appointments for digital surveillance in the reporting time period (PPR fields 10.1.5a, d, g, j).

The definition for counting open and closed invitations is available in the PPR template.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

5.4 Performance thresholds

Acceptable level: to be set

Achievable level: to be set

5.5 Caveats

Please note that providers should not be held accountable for this standard until they have fully implemented digital surveillance within their service. The digital surveillance pathway is under review.

5.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider

5.7 Reporting period

Rolling 12-month data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

5.8 Review dates

Date standard introduced: 1 April 2017

Date standard last updated: 18 September 2020

6. DES-S06: coverage: pregnant women seen in digital surveillance

6.1 Description

Proportion of pregnant women with diabetes seen before or at 6 weeks of notification of their pregnancy to the screening provider.

6.2 Rationale

Pregnant women with diabetes have clear guidelines for the management of their diabetes as set out by NICE. Screening providers should comply with this guidance. It is anticipated that any provider that sees women within 6 weeks of notification of their pregnancy to the provider will be re-screened according to the NICE guidance.

6.3 Definition

Numerator: number of pregnant women with diabetes attending digital surveillance before or at 6 weeks after notification to the screening provider of their pregnancy (PPR field 10.1.4).

Denominator: number of notifications of women with diabetes who are pregnant received by the screening provider within the reporting period (PPR field 3.8.1a minus 3.8.1b).

Excluded are:

• women diagnosed with gestational diabetes
• women already under the care of hospital eye services (HES) for diabetic retinopathy as they will remain under the care of HES for the duration of their pregnancy
• women who were screened before or at 89 days before the date of notification (this includes women who notify the provider of their pregnancy on the day of their annual screen)

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Please refer to the PPR for an explanation of how 89 calendar days approximates to 3 months.

The provider may be notified of the pregnancy by the woman’s GP or other health professional or they may be notified by the woman. In all instances the date of notification should be recorded.

6.4 Performance thresholds

Acceptable level: To be set

Achievable level: To be set

6.5 Caveats

Women with diabetes who are on the pregnancy pathway but who are no longer pregnant before attending their first digital surveillance appointment can be exception reported to local programme boards via quarterly reporting.

6.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider

6.7 Reporting period

Quarterly and rolling 12-month data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

6.8 Review dates

Date standard introduced: 1 April 2017

Date standard last updated: 1 April 2017

7. DES-S07: uptake: routine digital screening

7.1 Description

Proportion of those offered RDS who attend a routine digital screening event where images are captured.

7.2 Rationale

This standard gives an indication of the acceptance of the screening test in those offered the screen. A low uptake may be due to people with diabetes not wishing to be screened, not understanding the importance of being screened, forgetting the appointment or not being able to easily access the screening service.

Uptake should be looked at in conjunction with the DES-S01.

7.3 Definition

Numerator: number of people with diabetes who have attended a successful RDS event within the reporting period, where images are captured such that a screening outcome can be determined (PPR field 3.4).

Denominator: number of people with diabetes offered an RDS event which was due to take place within the reporting period (PPR field 3.2b).

If an eligible person attends a walk-in clinic or is screened for diabetic retinopathy while in care of ophthalmology for non-diabetic retinopathy it will be counted as an offer and an attendance on the same day.

The numerator includes instances where one or both eyes are not assessable through digital photography and a screening outcome of ungradable is assigned. In these cases a subsequent invitation to SLB clinic is issued, the screening event is considered ‘complete’ and is counted in the numerator of this performance measure.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The definition for counting open and closed invitations is available in the PPR template.

If a person is invited more than once in the year the most recent invitation and subsequent attendance, if it occurs, will be counted.

Full definitions can be found in the PPR template and dataset calculation document.

7.4 Performance thresholds

Acceptable level: greater than or equal to 75.0%

Achievable level: greater than or equal to 85.0%

7.5 Caveats

Providers should note that people with diabetes who are invited and then excluded before attendance remain in the denominator.

If notification of exclusion occurs before invitation being issued, the individual will not be counted in the denominator.

Providers using open appointment model may find that individuals invited but excluded prior to the reporting period are counted in the denominator.

7.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider and CCG

This standard is also the key performance indicator DE1.

7.7 Reporting period

Rolling 12-month data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

7.8 Review dates

Date standard introduced: 1 April 2013

Date standard last updated: 1 April 2019

8. DES-S08: uptake: repeat non-attenders

8.1 Description

Proportion of eligible people with diabetes who have not attended for RDS in the previous 3 years.

8.2 Rationale

This standard identifies people with diabetes who do not regularly attend RDS appointments. This will enable providers to identify and implement interventions to increase participation in this cohort.

The proportion of non-attendance should be looked at in conjunction with standard DES-01 and DES-07.

8.3 Definition

Numerator: number of people with diabetes on the RDS pathway who have not attended an RDS event within the previous 3 years and have been on the register for at least 3 years (PPR field 3.4.3).

Denominator: number of people with diabetes on the RDS pathway who have been on the register for at least 3 years (PPR field 3.1.7b).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

8.4 Performance thresholds

Acceptable level: less than or equal to 8.0%

Achievable level: less than or equal to 5.0%

8.5 Caveats

None

8.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider

8.7 Reporting period

Rolling 12-month data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

8.8 Review dates

Date standard introduced: 1 April 2017

Date standard last updated: 1 April 2019

9. DES-S09: test: ungradable images

9.1 Description

Proportion of eligible people with diabetes where a digital image has been obtained but the final grading outcome is ungradable.

9.2 Rationale

The proportion of images with a final grading outcome of ungradable can indicate if there is a problem with the photography, grading process or equipment. It can also be a reflection of other eye pathology. If a high or low rate is due to equipment or the process it indicates a need for training within the service.

9.3 Definition

Numerator: number of individuals with a final grading outcome of ungradable in either eye following an RDS event during the reporting period (PPR field 4.1.10).

Denominator: number of individuals who have attended a successful RDS event, during the reporting period, where images are captured such that a screening outcome can be determined (PPR field 3.4).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

9.4 Performance thresholds

Acceptable level: 2.0% to 4.0%

9.5 Caveats

A small number of individuals will have eyes that are ungradable due to extensive media opacity, for example due to previous trauma. The clinical lead may make a decision to base the screening outcome and future screening method on the one gradable eye. This can lead to a higher rate of ungradable images.

It is recognised that local screening providers recall individuals back to screening to have repeat photographs. This is in cases where adequate images were not captured at the initial screening appointment, but it is believed that better images can be achieved and prevent referring the individual unnecessarily to SLB surveillance. For example, where individuals have refused drops but have agreed to have drops at a subsequent screening appointment. This can lead to a higher rate of ungradable images.

9.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider

9.7 Reporting period

Quarterly data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

9.8 Review dates

Date standard introduced: 1 April 2013

Date standard last updated: 1 April 2017

10. DES-S10: test: timeliness of results letters

10.1 Description

The proportion of eligible people with diabetes attending for diabetic eye screening, digital surveillance or SLB surveillance to whom results were issued before or at 3 weeks after the screening event.

10.2 Rationale

In order to reduce anxiety for people with diabetes it is important for them to receive their results in a timely manner. It is also important for the GP and relevant health professional(s) to be informed in a timely manner so that they can take appropriate steps in the ongoing care of the people with diabetes.

Operationally, this standard also monitors if there is a backlog in the grading of digital images.

As described in the service specification the health professionals may include diabetologist, paediatrician and obstetrician among others.

10.3 Definition

Numerator: number of results letters produced before or at 3 weeks after the screen date (PPR fields 5.4a, 5.5 and 5.6).

Denominator: number of eligible individuals who have attended a successful screening event, within the reporting period (PPR fields 3.4, 9.1.2b and 10.1.2b).

The screening event may be:

• RDS
• digital surveillance
• SLB

‘Produced’ may be printing a letter or creating an electronic result letter. This is a proxy measure for the receipt of result letters as it is not possible to measure if they are sent or received.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

10.4 Performance thresholds

Acceptable level: greater than or equal to 70.0%

Achievable level: greater than or equal to 95.0%

10.5 Caveats

Providers are not expected to achieve 100% as people with diabetes who are under the care of HES for other non-diabetic eye pathology may be screened for diabetic retinopathy and so will not receive a results letter from the provider. It also takes into account if a person’s death takes place before the result letter is generated.

10.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider and CCG

This standard is also the key performance indicator DE2.

10.7 Reporting period

Quarterly data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

10.8 Review dates

Date standard introduced: 1 April 2013

Date standard last updated: 1 April 2017

11. DES-S11: referral: timely referral of people with diabetes with positive screening results

11.1 Description

Proportion of eligible people with diabetes urgently and routinely referred to HES before or at 2 and 3 weeks respectively.

11.2 Rationale

It is important for people with diabetes with referable and potentially sight threatening disease to be graded and referred to HES for treatment in a timely manner. This is the first step in the pathway for treatment and the provider should work to reduce unnecessary delays. Urgent referrals should be added to the rapid grading queue to enable grading to take place sooner and results sent before or at 2 weeks after the screen date.

11.3 Definition

Urgent referrals

Numerator: number of HES urgent referrals made before or at 2 weeks after the screen date (PPR field 6.1b).

Denominator: number of people individuals referred to HES with a final grading outcome of R3A in the worst eye, from a screening or surveillance event which occurred within the reporting period (PPR fields 6.2.1a and 6.2.1b).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Routine referrals

Numerator: number of HES routine referrals made before or at 3 weeks after the screen date (PPR field 6.1c).

Denominator: number of individuals referred to HES with a final grading outcome of R2 or M1 in the worst eye, from a screening or surveillance event which occurred within the reporting period (PPR fields 6.2.1d to 6.2.1g).

R2 or M1 referred as urgent by the referral outcome grader (ROG) will be counted as a routine referral for the purposes of reporting.

The screening event may be:

• routine digital screening
• digital surveillance
• SLB

If an individual has been referred previously to HES, is screened again and a new referral is generated within the reporting period, both referrals will be counted.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

11.4 Performance thresholds

Urgent referrals

Acceptable level: greater than or equal to 95.0%

Achievable level: greater than or equal to 98.0%

Routine referrals

Acceptable level: greater than or equal to 90.0%

Achievable level: greater than or equal to 95.0%

11.5 Caveats

None

11.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider

11.7 Reporting period

Quarterly data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

11.8 Review dates

Date standard introduced: 1 April 2013

Date standard last updated: 1 April 2017

12. DES-S12: intervention or treatment: timely consultation for people with diabetes who are screen positive

12.1 Description

Time between screening event and first attended consultation at HES or digital surveillance.

12.2 Rationale

An important part of any screening programme is for there to be an appropriate treatment for the screened-for condition. It is therefore important that an individual with R3A retinopathy is seen in hospital and R2 or M1 retinopathy is seen in hospital or digital surveillance in a timely manner so that they can receive the appropriate management. For R2 or M1 referrals, individuals should be seen in the same timescale regardless of whether they are referred to HES or digital surveillance.

Although local screening providers are not directly responsible for providing the appointments for HES they can work with them to ensure that this happens and there is seamless transfer of care.

Failure of screen positive subjects to attending for assessment within 6 weeks might be caused by:

• delays in the provider grading or administrative process
• delays in availability of consultation appointment within the hospital eye department
• failure by the individual to attend for assessment

12.3 Definition

Urgent referrals

Numerator: number of individuals referred to HES with a final grading outcome of R3A in the worst eye attending a first consultation in the hospital eye service before or at 6 weeks from their screening or surveillance event which occurred within the reporting period (PPR field 6.3a).

The HES appointment can occur outside the reporting period but must occur before or at 6 weeks of the screening or surveillance event.

Denominator: number of individuals referred to HES with a final grading outcome of R3A in the worst eye from a screening or surveillance event, which occurred within the reporting period (PPR fields 6.2.1a and 6.2.1b).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Routine referrals

Numerator: number of individuals referred to HES or digital surveillance clinic with a final grading outcome of R2 or M1 attending a first consultation in the HES or digital surveillance clinic within 13 weeks of their screening or surveillance event, which occurred within the reporting period (PPR fields 6.3b to 6.3d plus 10.1.3.2a plus 10.1.3.2b).

The HES or digital surveillance appointment can occur outside the reporting period but must occur before or at 13 weeks of the screening event.

Denominator: number of individuals referred to the HES digital surveillance clinic with a final grading outcome of R2 or M1 in the worst eye from a screening or surveillance event which occurred within the reporting period (PPR fields 6.2.1d to 6.2.1g plus 10.1.3.3a plus 10.1.3.3b).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

People with diabetes currently in HES for diabetic retinopathy (this must be verifiable) are not included in this indicator.

All other referred individuals should be included in the denominator, regardless of subsequent findings in HES. Exceptions can be reported through the quarterly reporting process.

The screening event generating the referral may be:

• RDS
• digital surveillance
• SLB

The attended appointment may occur within or outside the reporting period.

12.4 Performance thresholds

Urgent referrals

Acceptable level: greater than or equal to 80.0%

Routine referrals

Acceptable level: greater than or equal to 70.0%

Achievable level: greater than or equal to 95.0%

12.5 Caveats

It is not possible for the screening software to differentiate between low risk and high risk R3A. To minimise the risk of harm all R3A referrals are classed as high risk.

12.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider

This standard for urgent referrals is also the key performance indicator DE3.

12.7 Reporting period

Quarterly data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

12.8 Review dates

Date standard introduced: 1 April 2013

Date standard last updated: 1 April 2017

13. DES-S13: diagnosis or intervention: timely consultation for people with diabetes whose images are recorded as ungradable

13.1 Description

Proportion of individuals referred to SLB attending an appointment before or at 13 weeks from their last digital screen.

13.2 Rationale

People with diabetes whose images are ungradable at RDS or digital surveillance should be referred to SLB in a timely manner as they can still be screened and may have retinopathy.

13.3 Definition

Numerator: number of individuals with ungradable image(s) referred to SLB during the reporting period attending an appointment at an SLB clinic before or at 13 weeks from their last digital screen date (PPR field 9.1.4).

Denominator: number of people individuals referred to SLB surveillance during the reporting period (PPR field 9.1.3).

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

People with diabetes who are being seen in surveillance clinics with screen positive diabetic retinopathy (R2, M1, R3S) who develop ungradable images (for example, due to cataracts) should be referred to HES and are therefore not included in this standard.

13.4 Performance thresholds

Acceptable level: greater than or equal to 70.0%

Achievable level: greater than or equal to 95.0%

13.5 Caveats

It is recognised that a small number of individuals will have eyes that are ungradable due to extensive media opacity, for example due to previous trauma. The clinical lead may make a decision to base the screening outcome and future screening method on the one gradable eye.

13.6 Data collection and reporting

Data source: PPR

Responsible for data quality and completeness: screening provider

Responsible for submission: screening provider

Reported by: screening provider

Published by: screening provider

13.7 Reporting period

Quarterly data to be submitted between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

13.8 Review dates

Date standard introduced: 1 April 2013

Date standard last updated: 1 April 2017