John O’Donnell LOC Chairman
The Contractor shall carry out its obligations under the Contract in a timely manner and with reasonable care and skill. • The Contractor shall ensure that premises and equipment used for the provision of services under the Contract are: • suitable for the delivery of those services; and • sufficient to meet the reasonable needs of the Contractor’s patients; • includes the provision of proper and sufficient waiting-room accommodation for patients;
Mixing mandatory services with private services • A Contractor shall not, with a view to obtaining the agreement of a patient to undergo services privately- • advise a patient that mandatory services are not available from the Contractor under the Contract; or • seek to mislead a patient about the availability, quality or extent of services available under the Contract.
Health & Safety • Safety of the Public • The Contractor shall ensure–that it • has appropriate arrangements for infection control and decontamination; • has regard to any relevant requirements of the MHRA or of the Health and Safety Executive;
Mandatory Services • Testing of Sight • The Contractor shall, having accepted an application from or on behalf of an eligible person for the testing of sight— • secure the testing of the patient’s sight to determine whether he needs to wear or use an optical appliance; and • in so doing, secure the fulfilment of any duty imposed on a tester of sight by, or in regulations made under, section 26 of the Opticians Act (duties to be performed on sight testing).
Mandatory Services • Where the Contractor or an ophthalmic practitioner employed or engaged by it to perform the Contract is of the opinion that a patient whose sight has been tested pursuant to clause 30— • shows on examination signs of injury, disease or abnormality in the eye or elsewhere which may required medical treatment; or • is not likely to attain a satisfactory standard of vision notwithstanding the application of corrective lenses, • it shall, if appropriate, and with the consent of the patient— • refer the patient to an ophthalmic hospital, which includes an ophthalmic department of a hospital, • inform the patient’s doctor or GP practice that it has done so, and • give the patient a written statement that it has done so, with details of the referral.
The Usual • Where a Contractor or an ophthalmic practitioner employed or engaged by it to perform the Contract tests the sight of a patient diagnosed as suffering from diabetes or glaucoma, it shall inform the patient’s doctor or GP practice of the results of the test. • Where a Contractor or an ophthalmic practitioner employed or engaged by it to perform the Contract issues to a patient a prescription for an optical appliance, it shall, immediately thereafter, require the patient to acknowledge its receipt on a sight test form.
Eligibility • Contractor shall— • satisfy himself that the person is an eligible person by asking for satisfactory evidence of entitlement, unless the Contractor, in cases other than where the patientis a person specified in regulation 3(1)(d) of the POS Regulations (person of limited resources), already has satisfactory evidence of that available to it; or • where the patienthas been asked for, but not produced, satisfactory evidence that the patient is an eligible person, record that fact on the patient’s sight test form; • ensure that particulars of the patient and the approximate date of the last testing, if any, of the patient’s sight are inserted in a sight test form by or on behalf of the patient; and • satisfy itself that the testing of sight is necessary.
Refusing Mandatory Services • The Contractor shall only refuse to provide services under the Contract to an eligible person if it has reasonable grounds for doing so, and those grounds cannot relate to a person’s— • race, gender, social class, age, religion, sexual orientation, appearance, disability or medical or ophthalmic condition; or • decision or intended decision to accept or refuse private services in respect of himself or a family member. • shall keep a record of that refusal, specifying in that record its grounds for doing so and shall make this record available to the PCT on request.
Qualifications of Performers • No ophthalmic practitioner shall perform ophthalmic services under the Contract unless - • included in an ophthalmic performers list of a Primary Care Trust in England; • not suspended from that list or from the register; and not subject to interim suspension under section 41A of the Medical Act 1983 or section 13L of the Opticians Act.
Checking you out • The Contractor shall not employ or engage an ophthalmic practitioner to perform ophthalmic services under the Contract unless- • that practitioner has provided it with his professional registration number and the name and address of the Primary Care Trust on whose ophthalmic performers list the practitioner appears; and • the Contractor has checked that the ophthalmic practitioner meets the requirements • The Contractor shall not employ or engage an ophthalmic practitioner to perform ophthalmic services under the Contract, other than an ophthalmic practitioner falling within clause 48, unless the Contractor has obtained and is satisfied with the practitioner’s clinical references.
Holiday Cover • Where the employment or engagement of an ophthalmic practitioner is urgently needed and it is not possible to be satisfied of the matters referred to in clause 47 before employing or engaging him, he may be employed or engaged on a temporary basis for a single period of up to 14 days whilst such references are obtained and considered and for an additional period of a further 14 days if the Contractor has good reason to believe that the referee is ill, on holiday or otherwise temporarily unavailable. • Where the Contractor employs orengages the same ophthalmic practitioner on more than one occasion within a period of 6 months, it may rely on the references provided on the first occasion, provided that those references are not more than 12 months old.
Suitability for employment • Before employing or engaging any person to assist it in the provision of services under the Contract, the Contractor shall take reasonable care to satisfy itself that such persons are both suitably qualified and competent to discharge the duties for which they are to be employed or engaged and shall have regard, in particular, to their - • academic and vocational qualifications; • education and training; and • previous employment or work experience.
Patient Records • Patient records • The Contractor shall ensure that a full, accurate and contemporaneous record, which may be in electronic form, is kept in respect of each patient to whom it supplies services under the Contract, giving appropriate details of sight testing. • The record required by clause 52 may kept in electronic form . • The Contractor shall keep that record for a period of at least 7 years.
Confidence Tsar • Confidentiality of personal data • The Contractor shall nominate a person with responsibility for practices and procedures relating to the confidentiality of personal data held by it.
Patient Information • The Contractor shall ensure that there is displayed in a prominent position in its practice premises (in a part to which patients have access) – • a notice supplied or approved by the PCT, indicating the services available under the Contract; • in respect of the Contractor’s arrangements under clause 28, a written statement relating to its commitment to those arrangements; • a notice supplied or approved by the PCT, indicating to which descriptions of patients a payment may be made under the Charges Regulations; and • information about the complaints procedure which it operates in accordance with Part 5 of Schedule 1 to the Regulations, giving the name and title of the person nominated by the contractor in accordance with clause 108.1.
PCTs can ask for records • Provision of information • Contractor shall, at the request of the PCT, produce to the PCT or to a person authorised in writing by the PCT or allow it, or a person authorised in writing by it, to access, on request the information specified in clause 59 at such intervals or within such period as the PCT may specify. • The information referred to is - • any information which is reasonably required by the PCT for the purposes of or in connection with the Contract; and • any other information which is reasonably required in connection with the PCT’s functions, • including the Contractor’s patient records.
Let the PCT know… • Notifications to the PCT • Contractor shall notify the PCT - • as soon as reasonably practicable, of any serious incident that, in the reasonable opinion of the Contractor, affects or is likely to affect the Contractor’s performance of its obligations under the Contract; • as soon as reasonably practicable, of any circumstances which give rise to the PCT’s right to terminate the contract • within 28 days (unless it is impracticable to do so) of any occurrence requiring a change in the information about it published by the PCT in accordance with regulations made under section 115(5) of the Act; and • when an ophthalmic practitioner who is performing or will perform, as the case may be, services under the Contract- • leaves the Contractor and the date on which the practitioner left or is to leave, or • is or is to be employed or engaged by the Contractor, • and the notification shall include the name of the ophthalmic practitioner who has left, or who has been or is to be employed or engaged, together with the professional registrationnumber and the name and address of the Primary Care Trust in whose ophthalmic performers list he is included.
Corporate Bodies • Notice provision specific to a Contractor that is a corporate body • The Contractor, if a corporate body, shall give notice to the PCT forthwith when- • it passes a resolution or a court of competent jurisdiction makes an order that the Contractor be wound up; • circumstances arise which might entitle a creditor or a court to appoint a receiver, administrator or administrative receiver for the Contractor; • circumstances arise which would enable the court to make a winding up order in respect of the Contractor; • the Contractor is unable to pay its debts within the meaning of section 123 of the Insolvency Act 1986; or • a new director, chief executive or secretary of the corporate body is appointed. • A notice under clause 67.5 shall confirm that the new director, chief executive or, as the case may be, secretary of that corporate body meets the conditions imposed on such persons by virtue of regulation 4 of the Regulations and shall contain an application form in accordance with Schedule 3 to the Regulations in relation to each such person.
Partners • Notice provision specific to a Contractor that is a partnership • The Contractor shall give notice to the PCT forthwith when- • a partner leaves or informs the partners that of an intention to leave the partnership, and the date upon which that partner left or will leave the partnership; and • a new partner joins or proposes to join the partnership. • A notice under clause 69 shall- • state the date that the new partner joined or it is proposed will join the partnership; • state whether the new partner is an ophthalmic practitioner; • confirm that the new partner meets the conditions imposed by regulation 4 of and shall contain an application form in accordance with Schedule 3 to the Regulations, in relation to the new partner; and • state whether the new partner is or is to be a general or limited partner.
Visiting Your Practice • Entry and inspection by the PCT • Contractor shall allow persons authorised in writing by the PCT to enter and inspect the practice premises at any reasonable time, provided that- • reasonable warning of the intended entry has been given; • written evidence of the authority of the person seeking entry is produced to the Contractor on request; and • entry is not made to any premises or part of the premises used as residential accommodation without the consent of the resident. • Entry and viewing under the LiNKs Regulations • The Contractor must comply with regulation 3 of the Local Involvement Networks (Duty of Services-Providers to allow entry) Regulations 2008 (SI 2008/915) in so far as it applies to the Contractor. • Entry and inspection by other bodies • The Contractor shall allow any person who has a legal right to enter and inspect the practice premises to do so.
Signing things • Signing of documents • In addition to any other requirement relating to any forms that are required to be completed as a consequence of the Contract or any clinical documents (if either require a signature), the Contractor shall ensure that any such document or form includes- • the name of anyone who signed it; • if the signatory is a member of a clinical profession that fact and of which profession he is a member; and • the name of the Contractor.
We Hope So ! • PAYMENT UNDER THE CONTRACT • The PCT shall make any payments under the Contract promptly and in accordance with both the terms of the Contract and any other conditions relating to the payment contained in the Financial Directions
No Bungs • FEES AND CHARGES • Contractor shall not, either itself or through any other person, demand or accept, from any patient of its or any person who has requested services under the contract for that patient or a family member, a fee or other remuneration for its own or another’s benefit— • for the provision of any treatment under the Contract, or • as a prerequisite to providing services under the Contract. • The Contractor in making a decision— • as to what services to recommend or provide to a patient who has sought services under the Contract; or • to refer a patient for other services within the National Health Service, must do so without regard to its own financial interests.
Form filling • Any claim by the Contractor for fees in respect of the provision of mandatory services shall be made by completing or securing the completion of a sight test form and sending it to the PCT within 6 months after the date of completion of the provision of the services. • Any such claim shall be— • signed by the ophthalmic practitioner who performed the sight test in respect of which the claim is made, who shall also supply, with that signed claim, his professional registration number; and • in a case where the ophthalmic practitioner is not the Contractor, counter-signed on behalf of the Contractor by a person (who may be the ophthalmic practitioner), duly authorised by the Contractor to counter-sign, whom the Contractor has previously notified the PCT is so authorised. • A signatory or counter-signatory shall sign any such claim in ink with their initials or forename and with their surname in their own handwriting and not by means of a stamp. • The Contractor shall be entitled to demand and recover from a patient or person having charge of a patient a sum in respect of loss of remunerative time resulting from that patient’s failure to keep an appointment.
Insurance • Contractor shall at all times hold adequate insurance against liability arising from negligent performance of clinical services under the Contract. • Contractor shall at all times hold adequate public liability insurance in relation to liabilities to third parties arising under or in connection with the Contract which are not covered by the insurance referred to above. • For the purposes of this Part- • “insurance” means a contract of insurance or other arrangement made for the purpose of indemnifying the Contractor; but • if insurance is held by a person employed or engaged by it in connection with clinical services which that person provides under the contract, the Contractor shall be regarded as holding insurance in relation to that person.
Just Like MPs • The Contractor shall keep a register of gifts which- • are given to any of the persons specified in clause 93 by, or on behalf of, a patient, a relative of a patient or any person who provides or wishes to provide services to the Contractor or its patients in connection with the Contract; and • have, in its reasonable opinion, a value of more than £100.00. • The persons referred to in clause 92 are- • the Contractor; any partner; any director, chief executive or secretary ,any person employed by the Contractor for the purposes of the Contract; any ophthalmic practitioner engaged by the Contractor for the purposes of the Contract, any spouse or civil partner of the Contractor (if the Contractor is an individual) or of a person specified in this clause; or any person (whether or not of the opposite sex) whose relationship with the Contractor (where the Contractor is an individual) or with a person specified in this clause has the characteristics of the relationship between husband and wife or between civil partners. • A gift need not be entered in the register if - • there are reasonable grounds for believing that the gift is unconnected with services provided or to be provided by the Contractor; • the Contractor is not aware of the gift; or • the Contractor is not aware that the donor wishes to provide services to the Contractor. • The Contractor shall take reasonable steps to ensure that it is informed of gifts which fall within clause 92 and which are given to the persons specified in clauses 93. • The register referred to in clause 92 shall include the following information- • the name of the donor; • in a case where the donor is a patient, the patient’s National Health Service number or, if the number is not known, his address; • in any other case, the address of the donor; • the nature of the gift; • the estimated value of the gift; and • the name of the person or persons who received the gift. • The Contractor shall make the register available to the PCT on request.
Complaints procedure • Contractor shall establish and operate a complaints procedure to deal with any complaints in relation to any matter reasonably connected with the provision of services under the Contract. • Contractor shall take reasonable steps to ensure that patients are aware of- • the complaints procedure; • the role of the PCT and other bodies in relation to complaints about services under the Contract, and • the right to assistance with any complaint from independent advocacy services provided under section 248 of the Act. • The Contractor shall take reasonable steps to ensure that the complaints procedure is accessible to all patients.
Making of complaints • A complaint may be made by or, with his consent, on behalf of a patient, or former patient, who is receiving or has received services under the Contract, or • where the patient is a child, by- • either parent, • a person duly authorised by a local authority which is accommodating the child under the provisions of the Children Act 1989; or • a person duly authorised by a voluntary organisation which is accommodating the child under the provisions of that Act; or • by a relative or other adult who has an interest in the patient’s welfare, where the patient is incapable of making a complaint. • Where a patient has died a complaint may be made by a relative or other adult person who had an interest in the patient’s welfare or, where the patient fell within clause 104.1.2 or .3 by the local authority or voluntary organisation, as the case may be.
Period for making complaints • The period for making a complaint is- • 6 months from the date on which the matter which is the subject of the complaint occurred; or • 6 months from the date on which the matter which is the subject of the complaint comes to the complainant’s attention, provided that the complaint is made no later than 12 months after the date on which the matter which is the subject of the complaint occurred. • Where a complaint is not made during the period specified in clause 106, it shall be referred to the person specified in clause 108, who may, if of the opinion that- • having regard to all the circumstances of the case, it would have been unreasonable for the complainant to make the complaint within that period; and • notwithstanding the time that has elapsed since the date on which the matter which is the subject matter of the complaint occurred, it is still possible to investigate the complaint properly, • treat the complaint as if it had been received during the period specified in clause 106.
Further requirements for complaints procedure • Contractor shall nominate- • a person to be responsible for the operation of the complaints procedure and the investigation of complaints; and • a partner, or other senior person associated with the Contractor, to be responsible for the effective management of the complaints procedure and for ensuring that action is taken in the light of the outcome of any investigation. • All complaints shall be- • either made or recorded in writing; • acknowledged in writing within the period of 3 working days beginning with the day on which the complaint was made or, where that is not possible, as soon as reasonably practicable; and • properly investigated. • Within the period of 10 working days beginning with the day on which the complaint was received by the person specified under clause 108.1 or, where that is not possible, as soon as reasonably practicable, the complainant shall be given a written summary of the investigation and its conclusions. • Where the investigation of the complaint requires consideration of the patient’s ophthalmic records, the person specified under clause 108.1 must inform the patient or person acting on the patient’s behalf if the investigation will involve disclosure of information contained in those records to a person other than the Contractor or an employee of the Contractor. • The Contractor shall keep a record of all complaints and copies of all correspondence relating to complaints for a period of at least 2 years from the date on which the complaint was made, but such records must be kept separate from patients’ ophthalmic records.
Co-op in investigations • Contractor shall co-operate with- • any investigation of a complaint in relation to any matter reasonably connected with the provision of services under the Contract undertaken by the PCT or the Commission for Healthcare Audit and Inspection; • any investigation of a complaint, which relates to a patient or former patient of the Contractor, by an NHS body or local authority, and • “NHS body” means a Primary Care Trust, an NHS trust, an NHS foundation trust, a Strategic Health Authority, a Local Health Board, a Health Board, a Health and Social Services Board, or a Health and Social Services Trust. • Contractor shall, by way of example- • answer questions reasonably put to the Contractor by the PCT; • provide any information relating to the complaint reasonably required by the PCT • attend any meeting to consider the complaint (if held at a reasonably accessible place and at a reasonable hour, and due notice has been given) if the Contractor’s presence at the meeting is reasonably required by the PCT. • The Contractor shall inform the PCT, at such intervals as shall be agreed/[AS MAY BE SPECIFIED HERE] , of the number of complaints it has received under the procedure established in accordance with this Part of the Contract. •  This clause is required, but the Parties may either specify that interval here or agree it later. It is recommended that it be specified in the contract, but time may not permit that in relation to the transitional arrangements.
Termination by the PCT for breach of conditions in regulation 4 of the Regulations • are the subject of a national disqualification order or a contract disqualification order • are disqualified or suspended from practising by any licensing body anywhere in the world; • have been dismissed (otherwise than by reason of redundancy) from any employment by a health service body • are removed from, or refused admission to, a primary care list by reason of inefficiency, fraud or unsuitability • have been convicted in the United Kingdom of murder or a criminal offence other than murder, committed on or after 14th December 2001, and been sentenced to a term of imprisonment of over six months; • have been convicted outside the United Kingdom of an offence, which would if committed in England and Wales constitute— the same as above • have been convicted of an offence referred to in Schedule 1 to the Children and Young Persons Act 1933 (offences against children and young persons) • have been adjudged bankrupt or had sequestration of their estate awarded unless (in either case) they have been discharged or the bankruptcy order has been annulled; • been made the subject of a bankruptcy restrictions order or an interim bankruptcy restrictions order under Schedule 4A to the Insolvency Act 1986, unless that order has ceased to have effect or has been annulled; • made a composition of arrangement with, or granted a trust deed for, their creditors unless they have been discharged in respect of it; or • been wound up under Part IV of the Insolvency Act 1986; • have been removed from the office of charity trustee or trustee for a charity by an order made by the Charity Commissioners or the High Court on the grounds of any misconduct or mismanagement in the administration of the charity for which they were responsible or to which they were privy, or which they by their conduct contributed to or facilitated or disqualification order under the Company Directors Disqualification Act 1986
Why are these changes needed? • Current system restricts who PCTs may contract with to optometrists, OMPs and registered corporate bodies • These restrictions no longer reflect the reality of service provision • DH wants to give PCTs the ability to contract directly with businesses who are providing services BUT • Qualified clinicians must undertake the clinical work
Applications for a Contract • Similar to present application for inclusion in the Ophthalmic List BUT • Literally anybody may apply for a contract • All current mandatory and discretionary exclusions apply • Requirement of suitability (for award but not for termination of contract)
The Structure of the Changes • 3 sets of Regs laid 1 May 2008 and coming into force 1 August 2008 • The General Ophthalmic Services Contracts Regulations 2008 • The Primary Ophthalmic Services Regulations 2008 • The Performers List (Amendments) Regulations 2008 • 1 set of Regs laid 1 May 2008 and coming into force shortly • The Primary Ophthalmic Services Transitional Provisions Regulations 2008
Controls over Redemption of Optical Vouchers • Allows PCTs to issues notices that no further payments will be made to a supplier who may have been fraudulent
What does not change? • Who is entitled to an NHS sight test • Patients being able to choose their GOS contractor • Contractors being able to have a GOS contract • Must meet national criteria • Must satisfy local decision making on service quality, eg. inspection of equipment and premises • Centrally negotiated sight test fee • Sight tests remain a demand led not a locally commissioned service • Who may conduct a sight test
Contractual Obligations • Contracts contain obligations on both parties • Contracts can be ended for breach of these obligations • Removal for unsuitability, inefficiency and fraud will not be applicable any more • There are other procedures such as breach notices and financial sanctions • Late payment notices can be issued by the contractor to late paying PCTs/agencies
3 possible types of contractor • Individual • Partnership • Partners will no longer be listed separately • Single contract with partnership as a whole • PCTs must check all partners individually • Look out for LLPs – uncommon in GOS at present • Corporate body • May be registered or unregistered • PCTs must check all directors, chief executive and company secretary individually
Performers Lists • Performers list resembles current supplementary list • Performer may be included in only one performers list • May then perform anywhere in England (but not Wales, Scotland, Northern Ireland) • Possible for an individual to be both contractor and performer • If so, he must be on the performers list in one area and have a contract in each area • A contractor/performer with contracts in multiple PCTs may choose which performers list to be on
Transitional Arrangements • Automatic process for existing persons on the ophthalmic list • The PCT must offer them a model contract • The PCT must fill in the blank spaces in accordance with the current ophthalmic list entry • They need to notify the PCT in writing by 1 July 2008 • If they don’t, this doesn’t mean they won’t get a contract, just that it won’t be automatic or definitely by 1 August 2008
Further Information Required • PCTs may not have full details required by the Contracts Regulations • Private addresses • Details and suitability of • Directors • Chief Executive • Company Secretary of registered corporate bodies • Where this information is not held it must be supplied before a contract can be finalised
Contractor/Performers • PCTs will need to write to ask individual and partnership contractors whether they are included in any other ophthalmic list • If so, on which performers list would they prefer to be listed? • Performer’s choice – but must be listed with a PCT with which they hold a contract
Complaints • Complaints procedure is laid down in Contracts Regulations and set out in the model contracts • Same procedure as in the current regulations • One small difference – Sch 1 para 27 of the Contracts Regs gives PCT power to require the contractor to advise the number of complaints received • No prescribed intervals for this • PCT will need to agree what intervals with each contractor • Unlike GMS and GDS where PCT can determine those intervals unilaterally
Information Leaflet • Mobile providers only • Required content set out in Schedule 4 to the Contracts Regulations • Model leaflet on the website
Duty to Patients • Contractors must put the interests of the patient before their own financial interests [Reg 16(4)] • Contractors must not mislead patients about the availability, quality and extent of the services available under the contract in order to get private work [Sch 1 para 2]