NHS: 2002 PCA(O)6 abcdefghijklm

Transcription

1 NHS: 2002 PCA(O)6 abcdefghijklm Health Department St Andrew's House Regent Road Directorate of Service Policy & Planning EDINBURGH EH1 3DG * please see 2003 PCA(O)1 for an amendment * Dear Colleague GENERAL OPHTHAIC SERVICES FREQUENCY OF NHS SIGHT TESTS Summary 1. This letter advises Primary Care Trusts, Island NHS Boards and Practitioner Services of the introduction of a Memorandum of Understanding on frequencies of NHS sight tests, which will take effect from 2 December Background 2. NHS: 2002 PCA(O)2, issued on 11 March 2002, advised that agreement had been reached with the Association of Optometrists, Federation of Ophthalmic and Dispensing Opticians and the Scottish Committee of Optometrists on frequency of sight testing in Scotland and that a Memorandum of Understanding on this would be issued when the changes required to Practitioner Services' systems had been made. The relevant system changes have now been completed and the new sight test frequencies will be introduced with effect from 2 December Action 3. Primary Care Trusts, Island NHS Boards and Practitioner Services are asked to note the guidance contained in the Memorandum to this letter and the new sight test frequencies contained in Annex A. 25 October 2002 Addresses For action Chief Executives, Primary Care NHS Trusts and Island NHS Boards Director, Practitioner Services For information Chief Executives, NHS Boards Chief Executive, Common Services Agency Enquiries to: Lynne Morrison Directorate of Service Policy & Planning Primary Care Division 1 East Rear St Andrew's House EDINBURGH EH1 3DG Tel: Fax: Lynne.A.Morrison@scotland.gsi.gov.uk 4. Part 4 of the GOS(S)1 has been revised to provide for early re-test and clinical conditions codes to be entered in certain circumstances. The revised form can be identified by the revision date of "7/02" which appears in the top-right corner. Initial supplies of the revised form will be sent to Primary Care Trusts/NHS Boards without requisition and further supplies can be obtained from Banner Business Supplies in the normal way. Primary Care Trusts/NHS Boards are asked to ensure that supplies of the revised GOS(S)1 are sent to all ophthalmic

2 contractors on their lists by 22 November Stocks of the current version of the GOS(S)1 can be used until 2 December 2002 when remaining stocks should be destroyed. 5. Copies of the Memorandum to this letter are being sent under separate cover for urgent distribution to all optometrists and ophthalmic medical practitioners on Primary Care Trust/Island NHS Board lists. Yours sincerely DR HAMISH WILSON

3 MEMORANDUM TO NHS: 2002 PCA(O)6 NATIONAL HEALTH SERVICE GENERAL OPHTHAIC SERVICES FREQUENCY OF NHS SIGHT TESTS 1. This letter advises of the introduction of a Memorandum of Understanding on frequencies of NHS sight tests, which will take effect from 2 December The Memorandum to NHS: 2002 PCA(O)2, issued on 11 March 2002, advised that agreement had been reached with the Association of Optometrists, Federation of Ophthalmic and Dispensing Opticians and the Scottish Committee of Optometrists on frequency of sight testing in Scotland and that a Memorandum of Understanding on this would be issued when the changes required to Practitioner Services' systems had been made. The relevant system changes have now been completed and the new sight test frequencies will be introduced with effect from 2 December Memorandum of Understanding on Frequency of NHS Sight Tests 3. The Memorandum of Understanding sets out intervals for sight tests for different categories of patients. NHS sight tests carried out at intervals shorter than those given will require justification by entry of a early re-test code or reason - further information on this is provided at paragraph 5. It will also be necessary to provide a clinical condition code in certain circumstances - further information on this is provided at paragraph 4. Part 4 of the GOS(S)1 has been revised to include clinical condition and early re-test codes. 4. Where optometrists or ophthalmic medical practitioners (OMPs) carry out NHS sight tests at intervals equivalent to or greater than those given in paragraph 2.2 of the Memorandum of Understanding no early re-test code will be required at Part 4 of the revised GOS(S)1. However, where the patient is: under 7 years of age with binocular vision anomaly or corrected refractive error; or 7 years of age or over and under 16 years of age with binocular vision anomaly or rapidly progressing myopia; then a clinical condition code will require to be entered at Part 4 of the revised GOS(S)1, even when it is not an early re-test. This is because such children can be tested at intervals of 6 months while other children can only be tested at 12 months intervals. The clinical condition codes which should be used are: Binocular Vision Anomaly - BVA Corrected Refractive Error - CRE Rapidly Progressing Myopia - RPM 5. Where optometrists or OMPs carry out NHS sight tests at intervals shorter than those given in paragraph 2.2 of the Memorandum of Understanding the practitioner will be required to enter a code indicating the reason for the early re-test. A number of codes are provided in paragraph 3.1 of the Memorandum of Understanding. Where there is no appropriate code

4 then code 5 should be used and a brief annotation of the reason for the early re-test given in the remarks section of Part 4 of the revised GOS(S)1. 6. Further guidance on the new sight test frequencies will be issued by Practitioner Services to optometrists and ophthalmic medical practitioners in due course. Revised GOS(S)1 7. Part 4 of the GOS(S)1 has been revised to provide for early re-test and clinical conditions codes to be entered in certain circumstances (see paragraphs 4 and 5 above). The Note in Part 4 states that "In order to ensure that the re-test is within the minimum sight test frequency period the clinical condition code and/or reason code must be entered. The CSA will refuse to pay a claim if no code or reason is given". A code or reason is only required in the circumstances set out in paragraphs 4 and 5 above, the note will be changed to clarify this point when the form is reprinted. 8. Initial supplies of the revised GOS(S)1 form will be sent to optometrists and OMPs by Primary Care Trusts/NHS Boards without requisition. Further supplies can be obtained from Primary Care Trusts/NHS Boards in the normal way. 9. The revised form can be identified by the revision date of "7/02" which appears in the top-right corner. The revised GOS(S)1 should be used for sight tests undertaken on or after 2 December. Stocks of the current version of the GOS(S)1 can be used until 2 December when any remaining stocks should be destroyed. Monitoring Schemes 10. Where a patient attends an optometrist or OMP for monitoring as part of a comanagement scheme it is for the relevant NHS Trust to meet the cost and not GOS. However, where a refraction is required as part of the agreed protocol, an NHS sight test fee may be claimed for eligible patients. Broken or Lost Glasses 11. Paragraph 25 of the Annex to the Memorandum to NHS: 1998 PCA(O)3, issued on 20 April 1998, advised that patients, who have been refused a voucher for lost or broken glasses, could seek a further sight test in order to obtain a voucher for new glasses. In these circumstances optometrists/omps should determine the need for testing on the basis of clinical judgement informed by the attached Memorandum of Understanding. The Primary Care Trust/Island NHS Board should be consulted where patients are experiencing major hardship as a result of not having serviceable glasses. Enquiries 12. Any enquiries arising from this Memorandum should be taken up with your Primary Care Trust/Island NHS Board. Scottish Executive Health Department 25 October 2002

5 ANNEX A TO THE MEMORANDUM TO NHS: 2002 PCA(O)6 MEMORANDUM OF UNDERSTANDING BETWEEN SCOTTISH EXECUTIVE HEALTH DEPARTMENT AND ASSOCIATION OF OPTOMETRISTS, FEDERATION OF OPHTHAIC AND DISPENSING OPTICIANS AND THE SCOTTISH COMMITTEE OF OPTOMETRISTS ON FREQUENCY OF NHS SIGHT TESTS 1. Introduction 1.1 This Memorandum of Understanding refers to sight tests for different categories of patients under the General Ophthalmic Services (GOS). A sight test means a test by an optometrist or ophthalmic medical practitioner as defined in Regulations. 1.2 Practitioner Services will automatically pay all bona fide and complete claims for NHS sight tests carried out at the intervals listed below or longer intervals, subject to normal payment verification. Random checks of contractors are made from time to time as part of the normal auditing procedures. Practitioners should always include clinical information in patients' record cards, partly so that Practitioner Services can verify claims retrospectively. Like Health Boards and Primary Care Trusts, Practitioner Services has the statutory right of access to the records of NHS patients. 1.3 Claims for NHS sight tests carried out at an interval, which is shorter than those listed below, will require a code indicating the reason for the early re-test. Such a sight test may be initiated by an optometrist/omp or by a patient who presents with a problem requiring immediate attention in the judgement of the optometrist/omp. On occasions, there may be no appropriate code which explains the reason. In such cases code 4 should be used and a brief annotation of the reason for the early re-test given on the GOS(S)1 form. 2. Minimum Intervals between NHS Sight Tests 2.1 The GOS Regulations require practitioners to satisfy themselves that a sight test is clinically necessary before undertaking the test. Therefore, the intervals given below are not to be read as applying automatically to all patients in a category. Clinical judgement should be used when determining frequency of sight tests. Simply testing patients in these groups at the listed intervals without cause is not acceptable and testing patterns of individual optometrists and OMPs will be monitored in order to examine whether testing of patients at more frequent intervals than clinically necessary may have taken place. In cases where practitioners are being investigated, it should be noted that their record cards would be examined for the clinical reason behind the tests. This applies mainly, but not exclusively, to the under 16s with no history of refractive error, or binocular vision anomaly. 2.2 However, optometrists will not normally test the sight of patients under the GOS more frequently than according to the following schedule of intervals. Where sight tests are clinically required at more frequent intervals a reason has to be provided.

6 Patients Age at Time of Sight Test Minimum Interval between Sight Tests or Clinical Condition Under 7 years of age, with binocular vision 6 months anomaly or corrected refractive error 7 years of age and over and under 16 years of 6 months age with binocular vision anomaly or rapidly progressing myopia Under 16 years of age unless in one of the 1 year categories above 16 years of age and over and under 70 years 2 years of age 70 years of age and over 1 year Those with glaucoma 1 year Those 40 years of age and over with a close 1 year family history of glaucoma Those with ocular hypertension and not in 1 year monitoring scheme Diabetic patients 1 year 3. Reason for Earlier Sight Test 3.1 An optometrist may carry out a sight test at a shorter interval than those listed above, either at the optometrist's initiative for a clinical reason, or because the patient presents him/herself to the optometrist with symptoms or concerns which might be related to an eye condition. If an optometrist carries out an NHS sight test at an interval shorter than one of those listed above, he/she must annotate the GOS(S)1 form with one of the following codes: 1. Patient at risk of frequent changes of prescription for reasons not requiring medical referral or for reasons already known to a medical practitioner justified by the patient's history as recorded on the patient's record. 2. Patient with pathology likely to worsen, for example age-related macular degeneration, cataract, corneal dystrophy, or congenital anomalies. 3. Patient has presented with symptoms or concerns requiring ophthalmic investigation: 3.1 resulting in referral to a medical practitioner; or 3.2 resulting in issue of a changed prescription; 3.3 resulting in either no change or no referral (the patient's record should indicate any symptoms shown to support this category of claim, if necessary). 4. Patient has presented for a sight test at the request of a medical practitioner. 5. Other unusual circumstances requiring clinical investigation: annotate the GOS(S)1 form 6. Early response, by up to four weeks, to recall. This allows testing where the appointment has been rearranged to suit an individual patient's circumstances. 3.2 Broken glasses do not by themselves constitute a reason for an NHS sight test. If, in exceptional cases, the optometrist/ophthalmic medical practitioner considers a sight test to be necessary, he/she will be required to justify the sight test on purely clinical grounds.