The NCL Diabetic Eye Screening Programme (NCL DESP) is the only provider of NHS specialist diabetic eye screening in north central London. This service is provided by North Middlesex University Hospital NHS Trust (NMUH) and conducts a quality-assured screening at eight locations across the five boroughs of  Barnet, Camden, Enfield, Haringey and Islington.

Eye screening is a key part of diabetes care and all diabetic patients aged 12+ should have a specialist diabetic eye screening test every year due to the risk of developing diabetic retinopathy (a microvascular disease which affects the small blood vessels in the retina), which can severely affect their sight.

Screening can detect the condition early and before any changes to the vision are noted by the patient and, where needed, the patient can be referred into hospital eye services for treatment. Early treatment can prevent severe sight loss.

Diabetic eye screening involves taking two digital photographs of the back of each eye, once a year, to detect any early changes (diabetic retinopathy) that can occur as a result of diabetes.

Please note: For newly-diagnosed diabetic patient referrals to NCL DESP, electronic/paper referrals are not needed.

NCL DESP contacts all newly referred diabetic patients to book their first screening appointment. Please make sure that they are aware of the diabetes diagnosis. Some patients state that they did not know they were diabetic.

General Practice to Diabetic Retinopathy Screening

With the implementation of General Practice to Diabetic Retinopathy Screening (GP2DRS), every month the NCL DESP automatically extracts newly-diagnosed diabetic patients from all NCL practice IT systems. This has been happening since 2022, and has proven to be a safe and efficient system commissioned by NHS England. Therefore, it is no longer necessary for GPs to send electronic or paper referral forms to the NCL DESP, unless it is an urgent referral to the service. Please ensure that all diabetic patients are coded correctly on the system, using the SNOMED CT coding systems. The data will be collected according to the diabetic codes.

The GP2DRS works in the following ways:

• Each month, a GP2DRS software query is initiated by NHS Digital's General Practice Extraction Service (GPES). This query extracts data for patients registered at the practice who have a current diagnosis of diabetes, are not deceased, are aged 12+, and have not withheld consent to the transfer of their information for diabetic eye screening. The extracted data is then transferred onto the GP2DRS central database and made available to DESPs.
• Practices should check to ensure that IT systems are up to date with GP2DRS. NCL DESP is not aware of any issues, however, if there was one, NCL DESP will inform practices and request that quick action is taken to rectify the problem.
• Practices should make sure that, when updates and upgrades are happening on the IT systems, GP2DRS is not deleted or negatively affected.

Eligibility Criteria

Inclusions

• aged 12+ and have received a definitive diagnosis of diabetes
• diagnosis has been discussed with the patient
• patients aged <12 years may be referred to the programme, but they will not be invited for a screening appointment until after their twelfth birthday.

If there are specific concerns about any patients aged <12, in accordance with national guidelines these patients should be referred to be seen by paediatric ophthalmology consultants in a hospital eye clinic.

Exclusions

• patients who are terminally ill
• patients who are medically unfit, such as
  • those who are unable to sit still in front of a slit lamp
  • those who need transport on stretcher
  • those who need to be transferred from a wheelchair via a hoist
  • those who are bedbound and housebound
  • those with severe dementia
• patients with pre-existing conditions (e.g. people who will never be able to benefit from and/or receive treatment due to a pre-existing condition)
• patients with gestational diabetes, because:
  • patients with pure gestational diabetes do not seem to progress to any referable degree of diabetic retinopathy during their pregnancy and are therefore excluded
  • if a patient has gestational diabetes, but has possible pre-existing diabetes, then the patient needs to be registered by the GP as having diabetes; NCL DESP will then add the patient to the screening programme and screen the patient according to the national guidelines (see the NCL DESP gestational guidelines in Resources for further clarity)
• patients with Impaired Glucose Tolerance (IGT), including:
  • patients who have a result indicating IGT, borderline diabetes or pre-diabetes, and impaired fasting glycaemia are excluded.

Please note: 

• medically unfit patients must be excluded from screening by GPs completing a Certificate Of Unsuitability (COU), emailed to DESP (or complete a COU when asked by NCL DESP)
• if GPs would like a patient who is excluded from screening to be seen for a retinal examination, patients can be referred to hospitals ophthalmology department directly by the GP.

How to Refer

Locations

Torrington Park Health Centre

Edgware Community Hospital

Evergreen Primary Care Centre

James Wigg Practice

Morum House Medical Centre

Royal Free Hospital

Whittington Hospital

Chase Farm Hospital