John ODonnell

1
John ODonnell

• LOC Chairman

2

• 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
  Contractors patients
• includes the provision of proper and sufficient
  waiting-room accommodation for patients

3
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.

4
Health Safety

• Safety of the Public
• The Contractor shall ensurethat 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

5
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 patients 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).

6
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 patients 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.

7
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 patients 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.

8
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 patient is 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 patient has been asked for, but not
  produced, satisfactory evidence that the patient
  is an eligible person, record that fact on the
  patients sight test form
• ensure that particulars of the patient and the
  approximate date of the last testing, if any, of
  the patients 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.

9
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 persons
• 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.

10
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.

11
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 practitioners clinical
  references.

12
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 or engages 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.

13
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.

14
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.

15
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.

16
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 Contractors 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.

17
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 PCTs functions,
• including the Contractors patient records.

18
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
  Contractors performance of its obligations under
  the Contract
• as soon as reasonably practicable, of any
  circumstances which give rise to the PCTs 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 registration
  number and the name and address of the Primary
  Care Trust in whose ophthalmic performers list he
  is included.

19
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.

20
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.

21
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.

22
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.

23
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

24
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 anothers 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.

25
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 patients
  failure to keep an appointment.

26
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.

27
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
  patients 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

28
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.

29
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 patients 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 patients 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.

30
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
  complainants 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.

31
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 patients ophthalmic
  records, the person specified under clause 108.1
  must inform the patient or person acting on the
  patients 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.

32
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 Contractors 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 1, of the number of complaints it has
  received under the procedure established in
  accordance with this Part of the Contract.
• 1 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.

33

• 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

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37
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

38
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)

39
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

40
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

41
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

42
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

43
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

44
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

45
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 dont, this doesnt mean they wont get a
  contract, just that it wont be automatic or
  definitely by 1 August 2008

46
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

47
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?
• Performers choice but must be listed with a
  PCT with which they hold a contract

48
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

49
Information Leaflet

• Mobile providers only
• Required content set out in Schedule 4 to the
  Contracts Regulations
• Model leaflet on the website

50
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

51
Mobile services inducements and advice

• Mobile contractors must not offer improper
  inducements, particularly not to proprietors,
  managers and staff of residential homes or day
  centres Sch 2 para 7
• Mobile contractors must not seek to mislead
  anyone about the quality and extent of the
  services available under the mobile contract
• Includes any misleading advertising
• Discounts or special offers generally available
  to patients are exempt

52
Anti-discrimination

• Contractors may not refuse to provide GOS on
  grounds of race, gender, social class, age,
  religion, sexual orientation, appearance,
  disability or medical or ophthalmic condition or
  on patients decision to accept or refuse private
  services Sch 1 para 1(5)
• Contractors must keep written records if they
  refuse to provide GOS unless the patient is
  ineligible Sch 1 para 1(6)

53
Standards of Conduct

• Contractors to keep a register of gifts worth
  over 100 Sch 1 para 52
• Contractors to hold clinical negligence and
  public liability insurance Sch 1 para 51

54
General duty to comply with the law

• Para 53 of the Contracts regulations imposes a
  general duty to comply with relevant legislation
  and guidance
• Includes any legislation under the NHS Act
• Also includes the Opticians Act
• For OMPs also includes the Medical Act

55
Level of Skill

• Paragraph 10 provides
• The contractor shall carry out its obligations
  under the contract with reasonable care and
  skill
• Underlines the point that contractors are liable
  for any failure in service delivery
• A performer may be liable as well
• Given the fact that generally contractors are in
  a position to instruct performers and not vice
  versa this is a key principle

56
NHS (Redemption of Optical Vouchers)
Determination 2008

• PCTs given the right to require the production of
  records in relation to optical vouchers
• PCTs able to request records that are up to 2
  years old at the time the request is made
• Records to be produced to the PCT within 14 days
  of a written request for them
• PCT may refuse payments for current and
  subsequent vouchers if records not produced

57
Optical Charges and Payments Amendment No 2
Regulations 2008

• PCT may judge that the supplier is not a suitable
  person to receive public funds
• PCT may issue a cessation of payments notice
• The supplier may appeal to the FHSAA within 28
  days
• PCT may issue a cessation of payments notice but
  it must give one months notice of cessation
• PCT may also ask the FHSAA to issue a stop order,
  ie. no payments to be made by any PCT not just
  the one initially involved

58
Optical Charges and Payments Amendment No 2
Regulations 2008

• If a supplier is also a GOS contractor newly
  disqualified for fraud, a cessation notice MUST
  be given
• Cessation of payments notices can be reviewed on
  request every 2 years or earlier in a records
  case if records have now been produced
• Stop orders can be reviewed on request every 2
  years the FHSAA can extend this period to once
  every 5 years or reduced it to 1 year

59
Suspended Sentences

• The wording of the regulations is open on this
  point
• DH has always interpreted the reference to
  imprisonment to meaning actual imprisonment and
  not a suspended sentence
• The PCT has a discretion here to include or not
  to include a performer on its performers list or
  to grant or not to grant a contract to a
  contractor

60
Key issues for contractors (1)

• Contractors must satisfy PCTs that they have the
  premises, equipment and record keeping
  arrangements to provide GOS Reg 4(3)(j)(i)
• Contractors must employ appropriate staff Reg
  4(3)(j)(ii)
• Staff must work within the profession they have
  been trained for Reg 4(5)
• Contractors may opt for health service body
  status Reg 8
• Contractors must put the interests of the patient
  before their own financial interests Reg 16(4)

61
Key issues for contractors (2)

• Contractors may not refuse to provide GOS on
  grounds of race, gender, social class, age,
  religion, sexual orientation, appearance,
  disability or medical or ophthalmic condition or
  on patients decision to accept or refuse private
  services Sch 1 para 1(5)
• Contractors must keep written records if they
  refuse to provide GOS unless the patient is
  ineligible Sch 1 para 1(6)
• 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

62
Key issues for contractors (3)

• Premises and equipment must meet the reasonable
  needs of the contractor's patients but there is
  no specific reference to DDA Sch 1 para 3(1)(b)
• Contractors must have appropriate arrangements
  for infection control and decontamination Sch 1
  para 5(1)(a)
• Contractors must have regard to any relevant
  requirements of the MHRA or the Health and Safety
  Executive Sch 1 para 5(1)(b)

63
Key issues for contractors (4)

• Contractors must check registration of employees,
  take up references and make sure they have
  appropriate clinical experience and training Sch
  1 para 8(1)
• Contractors must provide the PCT with all the
  information which it reasonably requires Sch 1
  para 14(2)
• Contractors must notify the PCT of any serious
  incident Sch 1 para 16(1)(a)
• Contractors must also notify promptly the comings
  and goings of their performers Sch 1 para 16(3)

64
Key issues for contractors (5)

• Corporate bodies to notify PCT/agency of any
  winding up process or insolvency Sch 1 para
  17(1)
• Corporate bodies to notify PCT/agency of any
  change of director, chief executive or company
  secretary and put in a fresh application for them
  Sch 1 para 17(2)
• If the individual concerned is in an exclusion
  category the corporate body gets 28 days to
  remove them, failing which the PCT must end the
  contract Sch 1 para 17(3)

65
Key issues for contractors (6)

• Contractors to notify PCT/agency periodically of
  the numbers of complaints they receive Sch 1
  para 27
• No simultaneous carrying on of another
  detrimental business not defined but eg.
  massage parlour Sch 1 para 47(1)
• Contractors to hold clinical negligence and
  public liability insurance Sch 1 para 51
• Contractors to keep a register of gifts worth
  over 100 Sch 1 para 52
• Requirements for display notices and (for mobile
  operators) patient information leaflets Sch 1
  para 13 and Sch 2 para 3

66
Key issues for contractors (7)

• Mobile contractors must not offer improper
  inducements, particularly not to proprietors,
  managers and staff of residential homes or day
  centres Sch 2 para 7
• Mobile contractors must not seek to mislead
  anyone about the quality and extent of the
  services available under the mobile contract
• Includes any misleading advertising
• Discounts or special offers generally available
  to patients are exempt

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