Coming into Force Date minus 1 Day

1
Coming into Force Date(minus 1 Day)

• Steve Taylor
• Chair, Optometric Advisers Group
• Optometric Adviser Dorset PCTs

2
Objectives

• Set Scene
• Examine assumptions underpinning the new regs
• Suggest opportunities created by the introduction
  of the new regs

3
Outline

• In an ideal world
• In a less than ideal world
• Where do you fit
• How can you judge
• Does it matter

4
In an Ideal World

• All regs unambiguous and accessible
• Ophth lists correctly constructed and current
• Optoms and OMPs always notify PCTs of changes
• PCTs and profession
• fully conversant with existing regs
• shared understanding
• fully informed on proposed regs changes
• prepared for any change in responsibilities
• Adequate lead in time for reg changes
• Easily accessible statistics for
  tracking/monitoring

5
In a Less than Ideal World

• All regs NOT unambiguous and accessible
• Variations in construction and currency of lists
• Optoms and OMPs rarely notify change of
  circumstances
• PCTs and profession
• Variable familiarity with existing regs
• Variable familiarity with proposed new regs
• Variable levels of preparedness for new
  responsibilities
• Variable levels of understanding
• Lead times often unpredictable
• Access to statistics for tracking/monitoring
  variable

6
Where do you fit

• Ideal
• 10 9 8 7 6 5

• Less than Ideal
• 4 3 2 1

7
How can you judge?

• Is everyone on your ophthalmic list eligible to
  be a GOS contractor?
• Are there eligible contractors in place at all
  premises?
• Do you list practitioners who are in your area
  for short periods only?
• What mechanism do you have for taking off
  practitioners who have not practiced in the area
  for gt6mnths?
• Do you have application forms and declarations
  for all your contractors?
• How do you determine the contractor status of a
  corporate body?
• Are you always notified of changes in
  circumstances?
• How many databases do you use when communicating
  with practitioners?
• How many letters begin Dear Optometrist/OMP

8
Does where you fit matter?

• YES
• It will affect what you need to do next
• It will affect the efficiency and effectiveness
  of the new regs

9
Preparation

• Will determine
• how well/easily you can intro the new regs
• method (not same for everyone)
• timescales
• resources needed
• effectiveness

10
Long term

• Opportunity for
• admin tidying
• clearer accountability
• easier dissemination of info
• Provides building block for service quality

11
Summary

• Drafting of new regs based on ideal scenario
• Interpretation and Implementation of current regs
  is variable
• Will need to vary implementation strategy to suit
  existing situations
• Use opportunity to establish robust systems
• Should have an eligible contractor in place for
  all premises ie can meet current Terms of Service

12
(No Transcript)
13
John Hearnshaw

• Eye Care Lead

14
Rationale for Changes

• Puts GOS on same footing as GMS/PMS, GDS/PDS and
  PhS
• Overall acceptability and service quality more
  clearly a PCT/CSA responsibility
• Health and Social Care Act 2001 provides legal
  basis
• Alternative view post Shipman hysteria
• Effective date 1 April 2005

15
The different lists

• Ophthalmic List
• A list of OOs and OMPs who have an agreement with
  a PCT to provide GOS within the PCTs locality,
  ie. contractors

• Supplementary List
• A list of OOs and OMPs who may assist contractors
  in the delivery of GOS, ie assistants

16
A GOS Contractor

• Must be one of the following
• an optometrist registered with the GOC as an
  ophthalmic optician
• an OMP registered with the GMC and approved by
  the OQC
• a corporate body listed with the GOC as carrying
  on business as an ophthalmic optician (corporate
  optician)

17
A GOS Contractor

• Must be able to meet the GOS terms of service
  including those for premises, equipment, records
  and responsibility for acts and omissions of
  employees/assistants (including locums both
  employed and self employed)

18
A GOS Contractor

• Must have an agreement with that PCT in which
  he/she/it undertakes to provide GOS
• May assist another contractor in the provision of
  GOS anywhere in England (not Scotland, Wales or
  NI)
• Contractors may not be included on a
  Supplementary list

19
Corporate Optician

• Means body corporate registered with the GOC to
  carry on business as an ophthalmic optician
• Only appears once in any one PCTs Ophthalmic
  List
• Its entry lists all premises where it provides
  GOS in that PCTs area
• Must appear in the Ophthalmic List of every PCT
  where it provides GOS

20
Partnerships

• Cannot be listed as a partnership
• If both/all members are OOs or OMPs, list them
  all separately in Ophthalmic List
• If one is qualified (OO or OMP) and the other(s)
  not, then list only the qualified one
• If none are qualified, do not list they will
  need to rely on the transitional arrangements

21
An Assistant in the delivery of GOS

• Must be either
• an optometrist registered with the GOC as an
  ophthalmic optician
• an OMP registered with the GMC and approved by
  the OQC

22
An Assistant in the delivery of GOS

• Must be employed by a GOS contractor (includes
  self employed OOs, OMPs and locums)
• Must be included on a PCT Supplementary List
• May be included on only one Supplementary List
  (normally PCT of most frequent attendance)

23
Employed optometrist/OMP

• Means any employment, whether paid or unpaid and
  whether under a contract for services or a
  contract of service
• Covers those providing services (the
  self-employed)
• Covers those employed under a contract of service
  (employees)

24
Avoidance of Limbo

• OOs and OMPs can be readily transferred from the
  old Ophthalmic List to the new Supplementary
  List, ie without having to make a fresh
  application
• Transfer must be direct and instantaneous
• No-one should fall down a crack, ie be held
  between Lists
• Keep on old Ophthalmic List temporarily if in
  doubt
• No-one to be prevented from working

25
Transitional Arrangements

• Special arrangements on a temporary basis for
  optometrists and OMPs to be included in an
  Ophthalmic List, ie. a contractor list, where
  they are
• employed by a person or company who is not
  included in the ophthalmic list
• eg. a lay person, a dispensing optician, etc
• Involves a legally enforceable contract
• No end date set yet

26
Transitional Arrangements

• Intended for employers of OOs and OMPs who cannot
  be included in the Ophthalmic List
• Not recommended as a soft option for employers of
  OOs and OMPs who could be included in the
  Ophthalmic List but who choose not to be
• Only if pushed, allow them their legal rights to
  such an arrangement
• Sometimes called grandfathering or
  grandparenting not good titles

27
Three specific areas

• Requisite, proper and sufficient consulting and
  waiting room accommodation
• Suitable equipment for the provision of GOS
• A proper record in respect of each GOS patient
• "contractor" dependent on somebody else
• needs to have assurance that standards will be
  met
• CSA/PCT must be satisfied that a legally binding
  and suitable arrangement exists

28
CSA Role

• Survey and explanation to all OOs and OMPs on
  Ophthalmic Lists
• Follow OAG model
• Probably a lot of telephone queries
• Chase up the stragglers
• Employees / locums notified that they are to be
  transferred to a supplementary list
• Transfer them subject to their response or after
  28 days if they do not respond

29
CSA Role

• May need to make some assumptions
• Body Corporate ? Ophthalmic List
• Sole optometrist at a single address ? probably
  Ophthalmic List
• Declared partnership (both eligible) ? Ophthalmic
  List
• Most other OOs and OMPs ? Supplementary List
• BUT when you make the transfer, think about which
  contractor the assistant OO/OMP will work for
• May be no-one for locums

30
Expanded Application Process for New Applications

• More details about an optometrist/OMPs previous
  professional career
• Details of any criminal record
• Details of any involvement in NHS fraud
  investigations
• Details of past investigations by regulatory
  bodies
• Declarations concerning any involvement as a
  Director of a Body Corporate
• Consent to information sharing between PCTs and
  with professional bodies

31
Expanded Application Process for New Applications

• References must be taken up normally clinical
  references
• Check all new applicants with CFSMS
• Knowledge of English must be checked for EEA
  applicants
• No routine CRB checks at present
• BUT
• CRB checks may start soon
• There will be a catch up exercise

32
Expanded Application Process for New Applications

• Some vagueness in career history allowed, ie. not
  every individual locum job need be listed
• No need to account for career breaks for
  maternity and study leave
• Details to be checkable but not necessarily
  checked
• Significant career breaks to be considered by
  CSAs/PCTs not defined, so do you get a funny
  feeling about this one?
• eg. Says he went to Oz to woo the Sheilas so why
  the prison pallor instead of a Bondi Beach tan?

33
Disqualification of OOs, OMPs and Corporate
Opticians

• Tiny minority
• Grounds for disqualification
• Efficiency
• Fraud
• Unsuitability
• Decision reserved to PCT not CSA but in some
  cases CSA may administer joint vetting panels (by
  whatever name)

34
Disqualification of OOs, OMPs and Corporate
Opticians

• Must automatically refuse inclusion if
• Murder conviction in the UK
• More than 6 months' imprisonment in the UK after
  13 December 2001 (not suspended sentence)
• National disqualification by the FHSAA (in future
  the NHS Litigation Authority)
• Not on appropriate register GOC or GMC/OQC
• If already included must be removed if any of the
  above happens or emerges

35
Disqualification of OOs, OMPs and Corporate
Opticians

• PCTs may
• Refuse to include
• Conditionally include
• Remove
• Contingently remove or
• Suspend
• PCTs must
• Give reasons
• Tell the NHS Litigation Authority
• Tell the CFSMS

36
Content of List Entries

• Name
• Practice address (for contractors only)
• GOC Registration Number (GMC for OMPs)
• format xxxxxxx-yyy where x is the GOC/GMC
  number and y is the PCT's organisational code
• Date of inclusion
• Date of birth (Date of first full registration if
  OO/OMP objects to date of birth)
• C for contractor list
• S for supplementary list

37
(No Transcript)
38
Declarations of Financial Interests

• To be added later once Regulations made

39
Direct Referral

• Introduces direct referral by optometrists to
  ophthalmic hospitals following a sight test
• Not a big issue for CSAs but legalises existing
  practice in shared optometric care
• Some CSAs involved in pricing and payment of
  shared optometric care schemes, eg
• Cataract care pre- and post-extraction
• Diabetic retinopathies
• Glaucoma management

40
Mobile Services

• Means general ophthalmic services provided at
• a day centre
• a residential home or
• the patient's home, where the patient is unable
  to leave it unaccompanied because of physical or
  mental illness or disability

41
Mobile Providers

• Has to notify PCT/CSA 3 weeks in advance if
  seeing 3 or more patients at a
• Day care centre
• Residential home
• Has to notify PCT/CSA 2 days in advance in any
  other case, ie. 1 or 2 patients only
• Has to give 2 days notice of any changes

42
Mobile Providers

• DH sees prior notification as an important way of
  preventing fraud and reducing coercion of
  patients
• Optometric Advisors will need the opportunity to
  carry out surprise inspections when mobile
  operators visit care homes
• The devil is in the detail

43
Mobile Providers

• CSAs may not have the staff time to enter into a
  detailed dialogue in advance of sight testing
• All notifications and changes will need to be
  made in writing but this might be by email (at
  Agencys discretion)
• No specific need for PCTs/CSAs to acknowledge
• CSAs/PCTs will need to nominate a relevant
  representative or approved deputy and let
  optometrists know who to contact

44
Mobile Providers

• CSAs will need explicit protocols from their PCTs
  on whether to query prior notifications and/or
  changes to these
• CSAs may need to draft these protocols but PCTs
  must have some ownership
• If allowing email notification, consider creating
  a non person-specific email address such as
  ophthalmic_at_downshirecsa.nhs.uk

45
Key Dates

• 31 March 2005
• qualifying date for OOs/OMPs who can enter into a
  legal agreement with a person or company who is
  not included in the ophthalmic list in respect of
  compliance with the Terms of Service

46
Key Dates

• 1 April 2005
• Regulations came into force
• Legally binding agreements can be made under
  transitional arrangements
• Agreements can initially be verbal and should be
  notified immediately
• Written copy of agreement to be provided to CSA
  by 31 July 2005

47
Key Dates

• By 16 May 2005
• OOs and OMPs who have not previously been on the
  Ophthalmic List but who have worked as assistants
  to a GOS contractor must have applied for
  inclusion in the Supplementary List or they must
  stop working
• Mobile operators must have applied for inclusion
  in the Ophthalmic List of every PCT where they
  intend to operate or they must stop working

48
Key Dates

• By 31 July 2005
• Transfers from the ophthalmic to the
  supplementary list should be completed
• Corporate opticians on an ophthalmic list at 1
  April 2005must provide PCTs with any additional
  information required
• GOS 1 signing arrangements change

49
New GOS 1 Signing Arrangements

• Contractor may authorise others to sign on their
  behalf, including non-practitioner employees and
  assistants
• Claim forms to be signed by the practitioner who
  carried out the sight test and by the contractor,
  or his authorised signatory where they are not
  the same person
• CSAs/PCTs must have compiled their list of
  authorised signatories by 31 July 2005
• Max 10 signatories per practice

50
Newly Qualified Optometrists

• Students may start the application process up to
  3 months before anticipated GOC registration
• Lets all checks except GOC be done routinely but
  new OO can still start work as an assistant as
  soon as GOC registered

51
List Tidying

• List tidying by CSAs of assistants who have not
  worked for 6 months or more is recommended but
  use some common sense
• Encourage assistant to switch PCT Supplementary
  Lists if move seems permanent
• Encourage assistants leaving the List to keep
  contact details up to date
• Remove immediately if joining
• contractor list

52
(No Transcript)
53
Coming into Force Date(plus 1 Day)

• Steve Taylor
• Chair, Optometric Advisers Group
• Optometric Adviser Dorset PCTs

54
Objectives

• Highlight aspects that are
• New
• Unresolved

55
New

• Relationships and Responsibilities
• Lists
• Processes

56
Relationships and Responsibilities

• PCTs will continue to have direct links with GOS
  contractors
• Contractors responsible for assistants
• Some assistants may not be listed locally
• Assistants may only work for a contractor

57
Lists

• Supplementary
• Authorised Signatory
• Approved Mobile Provider
• Lists are PCT based (not agency)
• Will not have complete record of everyone working
  in a locality

58
Processes

• To be set up for
• Approval/Evaluation of
• STAs
• providers of mobile services
• Management of notifications by mobile providers
• Maintenance of authorised signatories
• GOS payments to contractors only
• ? Individual cf batch processing of claims

59
Unresolved

• Gaps in contractor info
• No. of STAs per premises
• Multiple leasing of premises
• Body corporates that are not corporate opticians
• Prevention of illegal double entering of
  optoms/OMPs on lists
• Can an optometrist/OMP remain on current list if
  unable to fulfil Terms of Service
• Acceptability of forms submitted from day 1 where
  no contractor identified

60
Summary
61
General Ophthalmic Services

• John Flory
• Senior Manager (Governance)
• East Sussex, Brighton and Hove
• Primary Care Support Services

62
General Ophthalmic Services

• The National Health Service (General Ophthalmic
  Services Supplementary List) and (General
  Ophthalmic Services Amendment and Consequential
  Amendment) Regulations 2004 or 2005?
• The New Regs!

63
The New Way Forward

• Ophthalmic List for Contractors
• Supplementary Lists for everyone else

64
Ophthalmic List

• Definition of Contractors
• Sole Trader - (Must be an Optometrist)
• Partnership - (More than one partner is an
  Optometrist all contractors any partners who
  are not optometrists will not be contractors)
• Body Corporate - (Corporate Optician registered
  with the GOC)
• Note A contractor cannot be on a supplementary
  List and vice versa

65
Responsibilities of Contractor

• Premises
• Equipment
• Procedures
• Record Keeping

66
Further Responsibility

• It is the Contractor who must ensure that when he
  employs someone to carry out eye tests the person
  is competent to carry out such a test and is
  either
• included on a list of contractors of a PCT
  somewhere in England
• or
• included in the supplementary list of a PCT in
  England

67
Supplementary List

• An optometrist can only be included in one
  supplementary list in England (Similar to GPs and
  Dentists)
• Who would normally be included on a supplementary
  list
• Someone who is employed by a contractor to
  perform the clinical tasks involved in GOS

68
Supplementary List

• This means
• Employees
• Locums
• Ophthalmic Body Corporate Directors
• The Body Corporate itself is the contractor

69
Applications to join Lists

• Ophthalmic List (Contractors)
• Full Name
• Sex (not COs)
• Date of Birth (no Cos)
• Private Address (Cos give registered company
  address)
• Date of registration (section 7 or section 9)
  plus Reg No
• VT No (if applicable)
• Address of Premises (Mobile - correspondence
  address)
• Opening hours, appointments system,mobile
  regular places and times

70
Application to join Lists continued

• Intention to practice as sole trader, partner etc
• (Note if a partner names and addresses of all
  partners, identifying who is included in the
  PCTs Ophthalmic List
• Who he intends to employ
• Professional Experience
• Professional Indemnity
• Two referees
• Undertake to undergo an enhanced CRB check when
  requested by the PCT
• Other undertakings in line with Dental and
  Medical Regs

71
Application to join listsContinued

• Supplementary
• Full Name
• Sex
• Date of Birth
• Private address and Telephone Number
• Qualifications and where obtained
• Date included in the GOC Register and Reg No
• Details of professional experience
• Two referees
• Undertake to undergo an enhanced CRB check when
  requested by the PCT
• Usual Declarations

72
Practices not owned by Optometrists or Ophthalmic
Body Corporates

• Dispensing Opticians
• Lay people
• Non-enrolled companies
• Cannot carry out eye tests unless
• If possible they become corporate opticians
  (preferred option)
• Enter into a trust agreement with an optometrist

73
OMPs

• Normally contractors working at a practice and
  using the practices equipment
• Advise them to enter into an agreement with
  organisation which covers
• Premises
• Equipment
• Procedures
• Record Keeping

74
Newly Qualified Optometrists

• New Regs allow students to apply to a PCT for
  inclusion in its Supplementary List 3 months
  before they qualify
• Application can be processed as far as possible
  to avoid delays when they qualify
• When student qualifies and PCT is satisfied that
  he is registered with GOC he can practice

75
New GOS 1 Forms

• These forms are to have two signatories
• The signature of the optometrist who carried out
  the eye test
• The signature of the contractor or his
  representative
• This signature does not have to be by a
  registered optometrist but good practice would
  suggest a list of counter signatories be supplied
  to the PCT and regularly updated by the contractor

76
What Next

• PCTs should write to Optometrists
• copies of the letter used by East Sussex are
  available
• Prepare new application forms
• Drafts are available