Optometric adviser

1
Optometric adviser

• Debbie Graham

2
I provide advice to

• BPCSSA (contracts and payments)
• BENPCT (clinical governance)
• HOBtPCT (clinical governance)
• But the role is changing to include service
  development

3
What do PCTs do in terms of primary eyecare

• New contracts (mandatory, additional, enhanced)
• New performers (ophthalmic)
• Payments plus pre/post payment verification
• Care Quality Commission standards
• monitor and support
• Managing poor performance
• training
• Contract monitoring
• Commissioning enhanced services
• Patient advice and liaison

4
Optometric adviser input

• New Contracts
• Applicants have to provide suitable premises,
  equipment and record keeping / storage.
• PCTs will need the technical expertise input to
  ensure that everything is indeed suitable to
  deliver a world class service
• Your OA can devise protocols and checklists to
  assess applicants for mandatory and additional
  contracts
• Equipment lists
• Record keeping management
• All agreed with LOC

5
Optometric adviser input

• New Performers
• Performers have to provide clinical references
  and these should be assessed by a clinician
• Optometric input around conditional inclusion and
  its review is essential

6
Optometric adviser input

• Payments
• Your optometric adviser will be invaluable in
  interpreting
• unusual claim trends
• Frequency of sight tests
• Number of domiciliary visits per day
• clinical reasons around supply such as tints,
  small frame supplement, prism controlled bifocals

7
Optometric adviser input

• Care Quality Commission Standards
• PCTs report against Standards for Better Health
• Care Quality Commission need to know what your
  contractors are achieving
• PCTs will need optometric input in interpreting
  the standards against optometric practice
• There are already toolkits available
• Quality in Optometry website
• www.qualityinoptometry.co.uk

8
Optometric adviser input

• Care Quality Commission Standards
• PCTs will need to provide support to contractors
  around these standards
• Targeted training
• Audit
• Clinical
• Service
• OA can interpret Standards in terms of
  optometric practice

9
Optometric adviser input

• Managing Performance
• PCTs will need the input of a clinician when
  dealing with poor performance
• The contract allows for data to be collected
• Incident reporting
• Complaints monitoring
• Training and Support at a clinical level
• Robust procedures to meet the needs of the
  performers list regulations

10
Optometric adviser input

• Contract monitoring
• Three year cycle
• Develop a monitoring tool
• I am in the process of agreeing the PCT protocol
  to cover
• Policies and Procedures
• Performers and Staff training
• Premises, Equipment and Record Management
• Establish a contract review procedure for
  remedial notices and termination

11
At a local level

• This will most likely include data collection and
  visits to contractors for both mandatory and
  additional service contractors
• The new contracts allow for information to be
  requested
• The keyword is reasonable
• So it is unlikely you will be asking for data on
  a monthly basis
• Probably on a 3 year cycle but may be annual
  updates

12
Including optometry in the patient care team

• There is a mismatch between the annual
  healthcheck requirements for Care Quality
  Commission and the GOS contract requirements
• PCTs will need to provide resources for the
  clinical governance elements that are outside of
  the remit of sight test fee payments for example
  if you use the quality in optometry toolkit
• Feedback from other contractors is that they
  prefer a joined up approach so that one visit to
  cover several elements is preferable to lots of
  uncoordinated little visits which disrupt the
  flow of the practice

13
Optometric adviser input

• Commissioning Enhanced Services
• Referral refinement and/or assessment
• Red eye/acute anterior segment
• Diabetic retinopathy screening
• Stable glaucoma monitoring
• Cataract monitoring pre- and post-extraction
• Low vision services
• John Hearnshaw is going to talk more about this
  before lunch

14
Optometric adviser input

• Commissioning Enhanced Services
• Input into local plan for developing optometric
  services
• Work with commissioners to develop optometric
  services to meet Patient needs
• Provide advice and support to PCT on Optometry
  issues
• most PCTs will have services already for
  cataract and diabetic retinopathy screening

15
How is this all achieved

• Protocols development
• Questionnaire /survey of your contractors
• Premises visits
• Additional services monitoring
• Data collection
• Investigations
• Audits
• Resource links
• Health needs assessment
• Project boards for service development
• Local and national liaison

16
Using your OA

• Your optometric adviser can be a useful link
• Internally
• with the varying departments/arms of your
  organisation such as monitoring, commissioning
• Externally with
• other PCTs
• the LOC
• NHS Agencies
• Your contractors
• Your patients

17
What sort of person is an OA

• The OA has a role to represent optometry to the
  PCT and also the PCT to optometry so will need to
  be
• A good communicator
• Compassionate when dealing with a poor performer
• Assured when dealing with a potential fraud case
• Flexible
• Familiar with PCT area and contractors
• and have
• A sound knowledge base around contracts and
  regulations
• Robust qualities of equity and probity

18
Recruiting an OA

• Make the job attractive
• Offer support and training
• Consider job share
• Allows for a better skill mix
• Could be shared by locality
• Could be shared by function such as monitoring
  contracts and strategic planning
• Job Description
• Remember CQC need to know your PCT is keeping an
  eye on its contracts