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OPTOMETRY FAQs
1.     Disqualification of Contractors
2.     Internet Dispensing
3.     Authorised Signatories
4.     Special Transitional Arrangements
5.     Supplementary Lists
6.     Fitness to Practice Information and national Bodies Corporate
7.     Cross Border Domiciliary Visits
8.     Day Centres
9.     Checks on Bodies Corporate
10.    “Trading As” Difficulties and Offshore Bank Accounts
11.    Notifications by Mobile Operators
12.    GOS on Hospital Premises
13.    Alternative to Form GOS18
14.    Retirement of OMP for Superannuation Purposes Only
15.    Standards for Better Health
16.    New Optometry Contract
17.    CET Payments
18.    LOC Liaison


1.     Disqualification of Contractors

In relation to Disqualification of Contractors one of the automatic refusals is if the
contractor has had 6 months imprisonment or more in the UK after 13 December 2001.
Where does this date come from?

The disqualification for six months' imprisonment is not new from 1 April 2005. It has in
fact been around since 14 December 2001. A new Regulation 7A was inserted into the
NHS (GOS) Regulations 1986 by Regulation 4 of the NHS (GOS) Amendment (No 2)
Regs 2001, SI 2001 No 3739. These can be found at
http://www.legislation.hmso.gov.uk/si/si2001/20013739.htm

The new Reg 7A(2)(b) states:

       "(2)The grounds on which a Health Authority must refuse to include an
       ophthalmic medical practitioner or optician are –

       (b) where, after 13th December 2001, he has been convicted in the United
       Kingdom of a criminal offence and sentenced to a term of imprisonment of over
       six months"

There is a corresponding provision in a new Reg 9C(1)(b) for removing an existing
optician or OMP who receives a six months' (or longer) prison sentence.

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2.       Internet Dispensing

We have been approached by a company which wishes to dispense spectacles via the
internet (with an NHS logo on its website!), to patients on our patch, by redeeming NHS
General Ophthalmic Services spectacle vouchers. Even though the current GOS
regulations might not actually prevent this venture eg. how can the glasses be fitted or
adjusted at a later date if the dispenser does not see the patient?!

It is not the GOS Regs where people should be looking, it is the Sale and Supply of
Optical Appliances Order 1984, which is different. This sets out requirements for sale
which apply whether the glasses are paid for with the person’s earnings or with a
voucher. That said, there is nothing in this latter Order which would entitle your PCTs to
refuse to honour vouchers for which the glasses had been ordered via the internet or via
mail order, although PCTs scan ask suppliers who are seeking to redeem vouchers how
they have complied with the 1984 Order. Even though the initial contact may have been
made via the internet, the patient would have to send the hard copy voucher to the
supplier and he would have to post (or deliver) the glasses to the patient.

The usual exceptions under which supply to registered blind and partially sighted
patients and to children could not be made by an unqualified supplier of glasses would
apply. These come from the 1984 Order.

There are still, however, significant potential shortcomings in an internet based supply
chain and PCTs are vulnerable in this respect.

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3.       Authorised Signatories

I have a question regarding authorised signatories; who has the power to authorise
countersignatories for a ophthalmic corporate body?

        local manager (either lay person or optometrist?)
        or a person in the Head Office

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The new Regulation 39(11) amends paragraph 9(2)(b) of the Terms of Service for
opticians to say that:

         "where the practitioner is not on the ophthalmic list of that PCT" sight test claims
         must be "counter-signed on behalf of the contractor by a person (who may be the
         practitioner), duly authorised by the contractor to counter-sign, whom the
         contractor has previously notified the PCT as being so authorised".
In other words, the decision at what level within the contractor company to make the
authorisation is not prescribed. We would suggest, however, that a listed director of the
company should make the authorisation. This will ensure that the accountability chain is
not broken.

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4.     Special Transitional Arrangements

We have on our Ophthalmic List a partnership consisting of a registered DO, and his
wife who is a lay partner. Neither of the employee optometrists working for the
partnership wish to have anything to do with a grandfathering arrangement and the
partnership’s accountant is dead set against them becoming a limited company. The
accountant proposes that they set up a limited company and thus an enrolled body
corporate, purely for the purpose of receiving the fees which can then be passed directly
to the practice. The partnership have cleared this proposal with the GOC and want to
know whether this is acceptable to the PCT?

I am afraid that your PCT/agency needs to say a clear "no" to this partnership. The main
purpose of the Regulatory changes is to ensure that a clear trail of accountability for
premises, equipment, records and staff is available to each PCT/agency for each
optometric practice. If your existing contractor cannot interest any of his ophthalmic
opticians in undertaking the special transitional arrangement on his behalf, his only
alternative is to set up a registered body corporate which will provide the PCT/agency
with full accountability under the Terms of Service for premises, equipment, records and
staff. If he puts it to his accountant that the options are a fully functioning limited
company or the loss of all future NHS sight testing income, I think his accountant might
well revise his advice.

We have a practice that was included on the list at 31 March 2005 that entered into a
grandfathering arrangement with the optician already working at the premises on 31
March 2005. The company subsequently changed hands and it was agreed that as long
as the grandfathering optician was still working at the practice and she was happy to
continue under the arrangements, this would be fine. However for some reason the
optician has now resigned and the company have now found another optician who will
be happy to undertake the grandfathering arrangements. I understand that she was on
a list at 31 March Is this acceptable would you think?

Yes, provided that the new front man (or front woman in this case) can prove to your
satisfaction that she was on a list somewhere in England on 31 March 2005, the
grandparenting arrangement can continue for now. There may soon be new Performers'
List arrangements in place and then the Special Transitional Arrangements will come to
an end.

Can the Special Transitional Arrangements apply to a new practice that wants to open in
our patch now or do they only apply to those practices that were in place in March?
No, the special transitional arrangements can apply to a new practice that wants to
open. The front man for such an arrangement, however, has to be an optometrist (or an
OMP) who was on a PCT Ophthalmic List in England on 31 March 2005 although s/he
doesn't necessarily have to have been on your PCT's Ophthalmic List on that date.

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5.     Supplementary Lists

With a corporate body, does the optometrist have to be on the supplementary list of the
PCT where his practice is or does it matter if he is already on a supplementary list of
another PCT?

Optometrists who work as assistants to a corporate optician do not necessarily have to
be on the Supplementary Ophthalmic List of the PCT where the practice is located and
in whose Ophthalmic List the corporate optician is included. They can be on the
Supplementary List of any other PCT in England. If the arrangement under which the
assistant works for the corporate optician is exclusive (ie. they don't work anywhere else)
and permanent, it would be good practice to encourage the assistant to resign from the
distant PCT's Supplementary Ophthalmic List and join your own PCT's Supplementary
Ophthalmic List.

I understand that a practitioner who is listed as a contractor in another PCT area can
work as a supplementary/assistant in our PCT area. Do we need to issue him with our
supplementary number or does he use his other PCT’s contractor list number on the
forms?

No, there should not be any need for you to issue your own supplementary list number.
He should use the contractor number allocated by his home PCT.

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6.     Fitness to Practice Information and national Bodies Corporate

As you may know, under the new NHS (Pharmaceutical Services) Regulations 2005
(Schedule 1, paragraph 31), pharmacy bodies corporate can, if they wish, provide fitness
to practise information to one Primary Care Trust rather than, in the case of Boots, to
over 300 PCTs! The one PCT is the PCT where their pharmacy company's registered
office is based i.e. for Boots plc, this would be Nottingham City PCT. Can you tell me if
anything similar is being done for the Ophthalmic List?

At present, there are no DH proposals to adopt a similar process for corporate opticians.

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7.     Cross Border Domiciliary Visits

I am getting conflicting information regarding payments for domiciliary visits if they are
cross border from their premises. Is it the PCT where the premises are based or the
PCT where the service is carried out, ie the patient’s address, that pays for these? If it is
the PCT of the patient’s address would you confirm that the contractor then needs to
register on that PCT list and anything else that is relevant to this please?

It is the address where the service is carried out, ie. the patient's home address for a
domiciliary, which dictates which PCT pays for the sight test. This is new as from 1 April
2005 and is a change to the previous situation. Mobile-only contractors will have to
register with every PCT on whose patch they intend to operate. Fixed premises
contractors who do a few domiciliaries on the side may need to register with more than
one PCT for the first time and they may struggle to get their heads around this.

For example, Seymour Clearly Opticians Ltd of 1 High Street, Uptown have a long
standing contract with the Uptown PCT. They also have a few housebound older
patients living just across the border in the Downtown PCT area for whom they have
always done domiciliaries and claimed through Uptown PCT – not technically correct but
never queried until now. From 1 April 2005 they must apply to go on the Ophthalmic List
and the mobile operators’ list of the Downtown PCT.

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8.     Day Centres

One of our opticians has visited a village medical centre since 1997 and was
recommended at that time to register it (in mobile ophthalmic terms) as a Day Centre
since he did not claim domiciliary fees but his reading of the new Regulations is that he
needs to register this address as one of the official addresses that he now visits as a
mobile practitioner in order to continue providing a service there and to claim domiciliary
fees. This is a slightly tricky situation as it is not a true day centre. Would you consider
this a practical route?

Service at a medical centre does not qualify for the mobile operator scenario at all. A
day centre is defined as:

       "an establishment in the locality of a Primary Care Trust attended by patients
       who would have difficulty in obtaining such (general ophthalmic) services from
       practice premises because of physical or mental illness or disability or because
       of difficulties in communicating their health needs unaided".

The most common type of day centre is an adult training centre for adults with learning
disabilities which clearly is not the case here.

Why doesn't this operator simply register this address as ordinary practice premises? If
he did so, he would not need to pre-notify attendances at the village medical centre as
he would at a day centre but he must not claim domiciliary fees either. The downside is
that he will need to maintain full equipment and records here but it is the only legitimate
way that he can get paid for providing GOS here.

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9.     Checks on Bodies Corporate

As a large primary care support agency, we have seen a large number of our optical
contractors form Bodies Corporate because of the new regulations. It is unclear in the
regulations, on whom we should be completing the GOC, FHSAA, reference and
CFSMS checks etc? Should it be the Body Corporate itself? If so we cannot do the
CFSMS check, Professional Experience or references.

You cannot check the uncheckable and we accept that the guidance could perhaps have
been clearer on this point. Bodies Corporate are required to disclose any of the
prescribed adverse events details about their directors. If the Body Corporate makes the
declaration that none of its directors has had any of the prescribed adverse events then
you can take that declaration at face value.

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10.    “Trading As” Difficulties and Offshore Bank Accounts

We have an affiliate of a national optometric corporate which trades under the corporate
name but which is legally a company with an entirely different name and which is not
registered with the GOC. Would the special transitional arrangements be appropriate
here and can payments still be made to the offshore bank account of the national
corporate?

If the unregistered company can be persuaded to get itself quickly registered with the
GOC, that is the best way out of your problem. If they are unwilling or unable to register
with the GOC, then the special transitional arrangement (grandparenting) is your next
best option provided that one of their optometrists can be persuaded to act as the front
man.

Either way you should not be making payments under GOS into the bank account of a
party which is not on your Ophthalmic List. Regulation 12 of the GOS Regulations 1986
states:

       "Payment for services

       12.-(1) A Primary Care Trust shall make payments to contractors in accordance
       with the Statement.”

Payments must therefore be made to contractors on the list or into bank accounts in
their names and not into the bank accounts of third parties.
You should take legal advice before making payments into any offshore bank accounts
even for contractors on your Ophthalmic List. Some offshore bank accounts (the
Channel Islands, for example) clear through the British banking system and have branch
sort codes and account numbers which look like those of any British mainland account,
so care should be taken.

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11.    Notifications by Mobile Operators

The Caldicott Guardian at my PCT is concerned that we should not accept prior
notifications by email from domiciliary providers unless they are encrypted, as they
contain patient identifiable data. None of our local domiciliary providers is on NHSNet
and the PCT cannot afford to offer them encrypted DSL lines within the foreseeable
future. Is there a way out of this problem?

The problem is that mobile contractors have a statutory right to make notifications
electronically. The definitions of "notice" and "notify" at Reg 2(1) of the 2005 Regs make
this explicit. Whilst Caldicott considerations make it inappropriate to make insecure
email transmissions of unencrypted patient data, the mobile contractors' statutory rights
appear to trump this and in any event it is the sender, not the recipient, of unencrypted
data who would bear responsibility for any breaches of confidentiality.

The notification form template on our website at:

http://www.primarycarecontracting.nhs.uk/uploads/Optometry/Non%20Event%20Materia
l/Optometry%20Notice%20Mobile%20Centre%20Nov%2005.doc

is a Microsoft Word document and is therefore capable of password protection. One
workaround solution would be for support agencies to notify mobile contractors by
snailmail of an appropriate strong password and to request them to use it to password
protect all notification forms sent electronically. The password could be changed as
often as the PCT’s/agency's Caldicott Guardian deemed fit.

We know that the password protection on Word documents can be hacked by those
knowledgeable and determined enough but the above process would certainly deter a
casual snooper.

I am afraid that that is the best we can offer for now.

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12.    GOS on Hospital Premises

We have a large eye hospital on our PCT’s patch. Several years ago they applied for
and were granted GOS registration status for sight testing children with special needs.
Our primary care support agency has raised a number of queries in respect of GOS
claims for services performed at the hospital, where monies are paid direct to the
hospital trust and requesting clarification on eligibility to claim under GOS. The
response received from the PCC Team was along the lines that no GOS should be
provided on hospital premises and entry to the Ophthalmic List should be refused.

I have looked at the regulations and cannot find reasons to refuse entry to the list within
the criteria outlined.

I think that you need to look further than the Regulations on this matter and delve into
the underlying primary legislation. If you decide that this is a hospital service, then it falls
under Part I of the NHS Act 1977 and the GOS Regulations cannot apply. If so and if
the PCT values the service then it will need to be mainstream funded via the hospital
trust and flagged as a cost pressure. If you decide that it operates essentially in a high
street environment, then it can be GOS funded under Part II of the NHS Act 1977,
although your decision may be subject to audit scrutiny.

Some of the questions you may find it helpful to ask are:

         on what basis do the optometrists occupy the premises at the hospital?
         is their accommodation demised under a specific lease from the hospital trust?
         if so, have you seen it?
         do they pay a market rent for the premises?
         who owns the slit lamps, field testing equipment, tonometers and other
          equipment which they use in sight testing?
         if they are leased from the hospital trust, is there a written leasing agreement,
          who pays for maintenance and are the sums involved on a commercial basis?
         if the optometrists left and went into a high street practice would there be any
          problem raised by the hospital trust about them taking the records with them
          away from the hospital premises?
         how general is the patient population treated?
         what proportion of patients are walk-ins?
         what proportion are referred from other healthcare professionals?
         what proportion are adults?
         what proportion are children without any underlying eye care problems other than
          the need for a routine sight test?

We feel that, unless you are satisfied that the optometrists are personally responsible for
the provision of their premises, equipment and records as required by paragraph 4 of the
Terms of Service and that they provide an essentially generalist service, then they
cannot appear as contractors in the Ophthalmic List.

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13.       Alternative to Form GOS18

Can you please confirm that optometrists are at liberty to use alternatives to form GOS
18 if they need to refer a patient? Our local cataract choice pilot wants to use different
paperwork.
Yes, paragraph 10(2) of the Terms of Service for opticians reads:

       "Where a contractor or an ophthalmic medical practitioner or optician assisting
       him in the provision of general ophthalmic services is of the opinion that a patient
       whose sight he has tested pursuant to sub-paragraph (1) –

                     (a) shows on examination signs of injury, disease or abnormality in the
                     eye or elsewhere which may require medical treatment; or
                     (b) is not likely to attain a satisfactory standard of vision notwithstanding
                     the application of corrective lenses,

       he shall, if appropriate, and with the consent of the patient,

             (i)        refer the patient to an ophthalmic hospital,
             (ii)       inform the patient's doctor or GP practice that he has done so,
                        and
             (iii)      give the patient a written statement that he has done so, with details
                        of the referral."

The paragraph does not restrict the means of informing the patient's doctor or the
ophthalmic hospital to the use of any particular form so any local arrangements that your
cataract choice pilot uses are likely to be compliant with the terms of service.

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14.    Retirement of OMP for Superannuation Purposes Only

One of our OMPs who is aged 60 wants to take his pension and then return to work after
a month’s gap. He has gone on a month’s holiday and has arranged for a locum to take
over his practice during his absence. Is that in order please?

From what you say, I believe that your OMP has done nothing which should have
triggered his pension application, ie. he hasn't let you have an unequivocal resignation
from your PCT's Ophthalmic List. He also presumably expects his practice to carry on
earning for him during his absence on holiday.

You should contact the NHS Pensions Agency at Fleetwood to see whether Paymaster
(1836) Ltd have yet paid his lump sum retiring allowance. If they haven't, you should ask
them to sit on his pension application until he lets you have a formal resignation letter
but it may by now be too late for that.

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15.    Standards for Better Health

I have been asked to gather information to provide assurance to the Healthcare
Commission that the optometrists are going meet the Standards for Better Health. I have
done a lot of work on the pharmacists and there is guidance on the dentists, but I am
hitting a brick wall when it comes to the optometrists. Would you have any information
either locally or nationally of work that may be ongoing in this area?

The view of the DH policy leads for Standards for Better Health is as follows:

       "a moot point (and mute unfortunately in that the standards and the legislation on
       which they are founded is silent on application to e.g. GPs). It is the intention
       that the standards apply to all provision by and for NHS bodies (but not purely to
       private provision which I guess a lot of GOS services are).

       It would therefore be up to PCTs to ensure that, through their
       commissioning/contractual arrangements, they are satisfied that contracted
       services comply with SfBH (as appropriate - since healthcare organisations have
       to take the standards into account rather than apply them absolutely).

       I say a moot point since for example GPs are subject to a separate contract
       which defines how they act but which make no specific reference to SfBH. Much
       the same is true of dentistry. This has not posed a problem up till now and we are
       content that the GP contract more or less embraces the requirements of the
       standards."

We are not aware of any existing specific work, either local or national, on providing
assurances that the optometrists are going meet the Standards for Better Health.

We think that a PCT which could demonstrate that it had invited optometrists to
participate alongside other primary care contractors in seminars on patient safety issues,
clinical effectiveness, clinical governance, disability discrimination, working with carers,
access issues, etc and which had offered optometrists paid, protected learning time to
attend would get some brownie points from the Healthcare Commission for this.

Also a PCT which could demonstrate that it had a robust practice inspection system
using the existing Optometrists' Terms of Service criteria on premises and equipment (T
of S para 4) would be in a much better position than one which could not.

We are planning to do some future work to map our optometry competencies and the
existing Terms of Service for opticians across to Standards for Better Health, so watch
this space!

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16.    New Optometry Contract

What about performance monitoring of the optometry contract? Are there any plans or
examples on this yet or is it too early?

Once the Health Bill receives Royal Assent and the GOS Review is complete, we can
expect new Regulations to be in place for optometry services, possibly from 1 April
2007. The PCC Team has outline plans to run a number of national events in early
2007, so watch this space!

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17.    CET Payments

The Regulations state that CET claims have to be sent to the PCT where the assistant is
registered, but that the contractor does not necessarily have to be registered with the
same PCT. How are we able to pay a contractor that is not registered with us. As an
example I have a claim from an assistant registered with the Uptown PCT in my area,
however the contractor is in the Downtown PCT. How do we overcome this problem?

This is a difficult one. It is understandable that PCTs would not want to make payments
via a contractor who is not registered with them. The Directions state that the claim
goes the PCT where the assistant is on the supplementary list. An assistant can work
anywhere in England provided that s/he assists a contractor. The claims should go to a
PCT on whose list both the assistant and the claiming contractor are registered.

What about locum optometrists? How do they go about claiming CET?

Basically a locum optometrist who never works regularly for the same practice is
somewhat stuck since claims can only come from a contractor. A locum can claim (by
arrangement with the contractor) through any contractor for whom s/he works long
enough to still be around when the payment comes through from the PCT or support
agency.

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18.    LOC Liaison

I have been Director of Primary Care at our PCT for the last three years. I have recently
read on the PCC website that we ought to be liaising with our Local Optical Committee.
Presumably this must be a parallel body to the LMC and LDC but I am unaware of how
to contact them. Do PCC keep a list of LOCs? If not, will the SHA know?

If you have been in post for three years, you really ought to have made contact with your
LOC long before now. PCC Team does not keep a national list of LOC contact details
but your PEC optometrist or optometric advisor (if you have one) will know who you
should contact.

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