EOE GOS Implementation Network Wed 3 Sept, Radisson Stansted

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EOE GOS Implementation Network Wed 3 Sept,
Radisson Stansted
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Plenary

• GOS Contract Implementation
• Feedback, Surprises, Hints and Tips
• John Hearnshaw
• Specialist PCCA, Eye Care
• NHS Primary Care Contracting

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Unfinished Business

• Finalisation of contracts as at 1 August
  2008
• OMPs contracts and pensions
• GOS in hospital premises
• Use of protected business titles

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Finalisation of contracts as at 1 August 2008

• Transitional provisions conferred an absolute
  duty on PCTs to enter into a GOS contract with
  former contractors
• Subject to well defined exceptions
• Failure of the PCT to complete the proper
  paperwork on time cannot affect that right
• PCT and contractor can affirm the existence of a
  contract by their actions

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Unintended Contracts

• Those ineligible for a new contract may continue
  to behave as if they had one
• Submitting GOS sight testing claims and issuing
  NHS optical vouchers
• Danger that the PCT might affirm the existence of
  a contract if claims are paid
• Those ineligible to be shown as ceased as at 31
  July 2008 in Open Exeter OPS

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Contract numbers vs. Account numbers

• Contractor must have a separate contract with
  each PCT
• Separate contracts not required/allowed for more
  than one set of premises in a PCTs patch
• No legally required list of contractors
• Hence no legally required contract number
• PCTs will need to allocate their own account
  numbers on a one per premises basis for Exeter or
  local payment purposes

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OMPs contracts and pensions

• Entitlement to pension earnings from NHS activity
  is governed by the NHS Pension Scheme Regulations
  
• GOS Contracts Regulations 2008 do not refer to
  and have no effect on pensions
• Is the OMP providing the premises, equipment and
  record keeping?
• Or are they just part of someone elses
  commercial operation?
• Lease vs. licence is not really the issue here
• How much security of tenure is there?
• How credible is the document?
• Do not just take it in isolation think in
  context you know how OMPs usually work

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GOS in hospital premises

• 30 November 2006 DH guidance still relevant
  reference on PCC website
• Patients referred from hospital to high street
  should be treated under HES
• Instances still emerging of inappropriate GOS
  funding of hospital based practices
• Ophthalmic services needed by hospital patients
  are the prima facie responsibility of the
  provider NHS trust

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GOS in hospital premises

• Any new applicants for a GOS contract in hospital
  premises should be advised that their application
  must fully meet the requirements of the GOS and
  not be for a service which should be provided by
  the hospital
• Practices in designated retail units within the
  curtilage of hospital premises to be referred to
  NHS PCC for guidance
• Contracts between a PCT and a hospital trust
  would fall under Section 9 (hospital services)
  not Section 117 (GOS) of the NHS Act 2006

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Use of protected business titles

• Section 28 of the Opticians Act is aimed at
  persons (individual or corporate) seeking to
  imply that they are registered with the General
  Optical Council when they are not
• A practice called XXX XXXXX Optometrist or
  Opticians would be in breach of the Opticians
  Act if the person were not an optometrist

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Use of protected business titles

• PCT should notify any concerns to the General
  Optical Council who are responsible for enforcing
  the Opticians Act
• PCTs should not refuse applicants a contract
  unless they are clear that there is a breach
• In cases of uncertainty, notify the General
  Optical Council and draw the attention of the
  contractor to the relevant clause in the
  Opticians Act
• If the General Optical Council subsequently
  confirm that there is a breach and they commence
  proceedings, then the PCT should act at that time

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More legal bumph

• Optical Charges and Payments Amendment
  Regulations 2008
• Redemption of Optical Vouchers Determination 2008
• Primary Ophthalmic Services Amendment,
  Transitional and Consequential Provisions
  Regulations 2008

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Electronic Claiming

• Electronic sight test claims now well established
• Electronic optical voucher claims being trialled
• Currently restricted to Specsavers and Vision
  Express but likely to spread
• Paper backup claims still needed for now
• How welcome is this? Your views please
• Where next? Universal electronic claims?

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NICE Guidance on Lucentis

• Ranibizumab (Lucentis) is recommended as a
  possible treatment for people with wet AMD if all
  the following apply to their eye
• The best possible visual acuity after correction
  with glasses or contact lenses is between 6/12
  and 6/96
• There is no permanent damage to the fovea (the
  part of the eye that helps people to see things
  in sharp detail)
• The area affected by AMD is no larger than 12
  times the size of the area inside the eye where
  the optic nerve connects to the retina
• There are signs that the condition has been
  getting worse

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NICE Guidance on Lucentis

• Treatment should be stopped if a person's vision
  gets worse and there are changes inside the eye
  which show that treatment isn't working
• The NHS should cover the drug cost of ranibizumab
  for the first 14 injections in each eye being
  treated
• If people need more than 14 injections per eye,
  the manufacturer of ranibizumab has agreed to
  take over the drug cost from the NHS

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NICE Guidance on Macugen

• Pegaptanib (Macugen) is not recommended for
  people with wet AMD
• Healthcare professionals should not immediately
  stop prescribing pegaptanib for people who were
  already taking it when the guidance was issued
• These people should be able to carry on taking
  pegaptanib until they and their healthcare
  professionals decide that it is the right time to
  stop treatment

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NICE Guidance on Lucentis

• Final NICE guidance issued on 27 August 2008
• All PCTs to have appropriate services in place in
  3 months, ie. by 27 November 2008
• Many hospitals with ophthalmology departments are
  already gearing up for this
• There will be a cost pressure in 2008-09 with
  full year effect in 2009-10

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