The national health service Flashcards
list the order of changes in which the NHS offered eyesore to the public
Established by an act in 1946
1946: Supplementary Ophthalmic Services
1948-Free sight tests and spectacles for all
1952- Charge for spectacles - £1
1968: General Ophthalmic Services 1976-85 Charge for spectacles double - no longer £1 1985- Voucher system - still used today 1988- Free universal eye tests abolished 1999- Free eye tests for over 60’s
what was meant by supplementary ophthalmic services which was set up in 1946
it meant that ophthalmologists carried out the eye examinations and optometrists were not required to do this
when were optometrists required to test sight and dispense glasses under the NHS and what changes occurred as a result of this
what is a disadvantage to this scheme
when there were free eye tests and spectacles for all
this meant that more people came forward to get their eyes tested as they got free spectacles, so this made it impossible for ophthalmologists to test sight and so optometrists were more required to do this
therefor optoms tested sight and dispensed glasses from then on
disadvantage: this scheme was too expensive and not sustainable
why did the NHS launch the general ophthalmic service in 1968
because opticians weren’t just providing supplementary ophthalmic services anymore, but were also testing eyes and dispensing glasses and identifying pathology
what 2 things do you need as an optometrist to be able to provide GOS/NHS sight tests
Contract with NHS England: Individuals and Business
and
To be on the Ophthalmic performers list - where you will be issued a ophthalmic performers number
what is the process of applying to be on the ophthalmic performers list
- you should only apply to one area team
- an electronic application form has to be completed for all
applicants and sent to the relevant primary care support - an appointment must be made with the PCS to provide the following documents:
- an enhanced disclosure and barring certificate DBS (provided by yourself)
- passport or photo ID e.g. driving licence
- poof/evidence of insurance e.g. with the AOP etc
- evidence of chid protection training level 2
list the 4 things that you must provide to the PCS when you make your appointment with then during your application to be on the ophthalmic performers list
- an enhanced disclosure and barring certificate DBS (provided by yourself)
- passport or photo ID e.g. driving licence
- poof/evidence of insurance e.g. with the AOP etc
- evidence of chid protection training level 2
when can pre reg optometrists be able to apply to the on the ophthalmic performers list
unto 3 months prior to the expected date of successful completion of pre reg year
as long as the pre reg student has provided all the required documents in their appointment with the PCS, then no further information is required
the NHS must make a decision about the application wishing 7 days of the pre reg optom notifying that they have been included in the full GOC register
list all 6 non clinical contractual requirements you have to meet as an optometrist who is on the ophthalmic performers list
- To provide adequate waiting and consulting space
- To notify the HA of changes of address
- Establishing Patient Eligibility for GOS (Points of service checks)
- Patient signs declaration that they are entitled to claim
- Practitioners and practice staff should ask for evidence of eligibility
- If no evidence seen form should be marked with a cross
- To display required posters and leaflets - e.g. about health and safety, fire safety etc
- To complete relevant forms accurately
- Allow PCT to carry out ‘terms of service’ visit following a Post Payment Verification (PPV) audit
what is a Post Payment Verification (PPV) audit and why is it carried out
PPV is a financial audit to ascertain that the GOS services claimed have been provided in accordance with regulations
the NHS can come into the practice and audit all your GOS s/t forms and voucher forms your submitting to make sure your not doing fraud
they look at your profile of claims and if your doing uncommon stuff too regularly then you will get flagged for investigation
list all 5 clinical contractual requirements you have to meet as an optometrist who is on the ophthalmic performers list
- To have adequate equipment available to provide GOS
- What is ‘adequate’ not defined. College equipment list can be used as guideline
- To test sight as defined by the Opticians act
- To issue a valid Rx as required
- Rx according to BS2738 Part 3 1991
- 2 digits following decimal point
- No degree symbol
- Prisms: IN/OUT; UP/DOWN or if oblique
- Vertex distance at ‘x’ mm if more than 5D
- Inform GP where:
- Patient shows signs of injury, disease or abnormality of the eye which may require medical treatment
- A satisfactory standard of vision is not achieved with corrective lenses
- GP can be informed using the GOS 18 form or on letterheads
- Keep proper records for a minimum of 7 years
- Make available for inspection to approved officer within 14 days of them making a request
list the 5 requirements of how to issue a valid rx by the NHS as stated as a clinical contractual requirement
- Rx according to BS2738 Part 3 1991
- 2 digits following decimal point
- No degree symbol
- Prisms: IN/OUT; UP/DOWN or if oblique
- Vertex distance at ‘x’ mm if more than 5D
list the 2 conditions you have meet about when to inform a GP when carrying out a NHS sight test as a clinical contractual requirement and how they can be performed
also name a time of when you dont need to inform the GP about a px
- Patient shows signs of injury, disease or abnormality of the eye which may require medical treatment
- A satisfactory standard of vision is not achieved with corrective lenses
- GP can be informed using the GOS 18 form or on letterheads
- Dont need to inform the GP if the px comes on a regular basis and the GP is aware of their condition - only inform when theres a new finding
what is required if wanting to carry out domiciliary eye examinations under the NHS
Separate contract to provide Domiciliary Eye Care
list the 9 groups of people who are eligible for a GOS sight test
- Age
Under 16
Under 19 in full time education
Over 60 - Wears Complex Lenses
Has a power of 10.00D or more in any one meridian
Prism controlled bifocal lenses - Registered Sight Impaired or Severely Sight Impaired
- Prisoner on leave from prison
- Patients suffering from Diabetes or Glaucoma. Includes
Patients with previously treated Glaucoma
Patients with High IOP at risk of Glaucoma - 40 or over with parent, brother, sister or child of a person who has been diagnosed as suffering from Glaucoma
- Individuals who are in receipt of
Income support
Pension Credit Guarantee Credit
Disabled persons tax credit
Income based job seekers allowance (not Contribution based)
Income based employment and support allowance (not Contribution based) - A member of the same family of a person who is in receipt of the above financial support
- Patients named on a HC2 or HC3 form
when is the only time that asylum seekers are allowed a free NHS sight tests under the GOS
if they have HC2 form
what does the HC1 form allow
Allow patient to apply for help with cost of eye examination and spectacles on grounds of low income
Also prescriptions, wigs, dental treatment, travel to hospital and supports
Eye examination fee and spectacle costs can be refunded on filling in appropriate form (if become aware of HC1 form after s/t)
when does a HC1 form need to be submitted in order to claim back for an eye exam cost
submitted within 2 weeks of the eye exam
what are the 4 possible replies a px can get from filling and submitting a HC1 form
HC2 entitled to full help, NHS eye examination and voucher
HC3 entitled to some help
HC4 entitled to no help
HC5 from to claim money back for monies already paid
what GOS form do all eligible patients need to fill in to get an NHS sight test
and what GOS form they need to fill if they have a HC3 certificate
and what GOS form they need to fill is they are eligible for a domiciliary visit
all eligible patients - GOS 1 form
those with a HC3 certificate - GOS 5 form
those eligible for a domiciliary visit - GOS 6 form
which 3 people have to sign the GOS form
what must the contractor/optometrist not do regarding signing
The GOS forms need to be signed by
- Optometrist who conducted the eye test
- The GOS contractor (or authorised signatory)
- The patient
If the Optometrist and Contractor are the same person only one signature required
If an individual is a child or is unable to sign the GOS forms they must be signed by a parent or guardian or person who cares for the individual
- The contractor/optometrist must not sign the form on behalf of the individual
under which 2 conditions is a child entitled for an eye test every 6 months under the NHS
Under 7 years with binocular vision anomaly or corrected refractive error
7 years and over, and under 16 with binocular vision anomaly or rapidly progressing myopia
which 4 groups of patients are entitled for an eye test every 1 year under the NHS
Up to 16 years, in the absence of any binocular vision anomaly
70 years and over
Patients over 40 with a family history of glaucoma or with ocular hypertension not part of a monitoring scheme
Patients with diabetes not part of a diabetic retinopathy monitoring scheme
which patient group is entitled for an eye test every 2 years under the NHS
16 years and over and under 70 years
when must the GOS forms be submitted by the opticians in order to claim for their eye test fees
and what can all optoms get for doing GOS sight tests
Form to be submitted within 6 months of completing eye examination
Claim £529 for CET grant (2014)
when were the NHS vouchers introduced
which form is used
and when do patients sign the form and how many times
1st July 1986 - to help towards cost of glasses
Use the GOS 3 form
Patient signs part 1 to confirm eligibility and part 2 after receipt of Rx (once they got the glasses)
which 3 groups of patients are entitled to a GOS 3 voucher to help towards the cost of their glasses
- Age
- Under 16
- 16-18 in full time education
- Benefits
- Income support
- Pension Credit Guarantee Credit
- Disabled persons tax credit
- Income based job seekers allowance (not Contribution based)
- Income based employment and support allowance (not Contribution based)
- HC2
- HC3 - only in some cases which is told on the form
- Complex lenses
- Supplement
- Prisoners on leave from prison
what 2 things does the voucher values for glasses depend on
the power of the lenses
and
the type of lens dispensed e.g. s/v, b/f, v/f
how should the rx be written in a GOS 3 voucher
and what must be done is the rx has been transposed
Should be written in highest possible sphere power unless hospital voucher
-5.50 / - 2.00 x 180 R+L = Voucher A
but -7.50 / + 2.00 x 90 = Voucher B
Voucher prescriptions can be transposed
Should be initialled and annotated FPN: 713
what must be done when altering GOS vouchers due to back vertex distance changes during the dispense
If BVD change is required the supplier should note and initial the change
If the change takes it to a higher voucher band then the prescribers authority to make the change is required
Any change must be initialled and annotated FPN: 713
who are repair vouchers automatically available to
who else may it be available to and under what circumstances
Automatically available to under 16’s - if broken/lost glasses
Older patients may be eligible
Not automatic
Only applicable if damage a result of illness
Nobody else eligible
when can a replacement spectacle GOS3 voucher be issued for CLs
when are they not eligible to be re issued
can be issued if the CL are unserviceable (only applies to conventional CL)
cannot be re issued If they are used towards buying disposable CL, a new voucher cannot be issued on the basis of fair wear and tear
when can a GOS 3 voucher be used for a small glasses supplement and when will you need to consult permission from the health authority HA to use it
Glasses for a child under 7 years who needs a custom made or stock spectacle frame which requires extensive adaptation to ensure an accurate fit and has a boxed centre of no more than 55 mm
E.g. Changes to side length, bridge width
Consult HA if required for patient older than 7
what is the conditions of issuing a GOS 3 form for small rx changes
Small clinically insignificant change: no new vouchers (if glasses are fine)
New vouchers only when spectacles are to be replaced due to fair wear and tear (FPN:713)
what is the conditions of issuing a GOS 3 form for tinted lenses
when can you not use a GOS 3 form for tinted lenses
Can only be prescribed if judged to be clinically necessary E.g. OC Albinos
ARC and UV blocking tints cannot be normally supplied
Coloured filters for children with Dyslexia are not covered
when can a GOS form be issued in non tolerance circumstances
If second test is undertaken due to Rx Intolerance, GOS form must be marked accordingly
A new voucher cannot be issued without the permission of the HA
when will a voucher value be determined by the near vision rx
how does the voucher system work for supplying varifocals
Voucher value to be determined by the power of reading add if it is 4.00D or greater
In all other cases voucher value to be determined by distance Rx
Varifocals can be supplied in place of Bifocals and can be claimed as bifocals
what is the ruled regarding change of eligibility status and the GOS service
when can a patient apply for a refund
If patient can show NHS eligibility following a private sight test and before ordering spectacles they do not need to undergo a second sight test
Practitioner simply fills GOS 3 form
A patient applying for a refund must establish eligibility within 3 months of the date on which they paid for their Rx
what is the lifetime of a GOS 3 voucher from being issued
what happens if a patient loses a voucher without having claimed previously
2 years
If patient looses a voucher without having claimed previously for it the HA can give permission to issue a new voucher
when do GOS 3 and GOS 4 vouchers have to be submitted within in order to make the claim by the opticians
to be submitted 6 months from the date the appliance was supplied, repaired or replaced
what is the GOS clinical requirements in Scotland
New Eye Examinations ‘’does not require mandatory refraction, but provides a health assessment of the eyes that may lead to refraction, other procedures, repeat procedures, care pathways for sight threatening conditions, or other referral as appropriate for each and every patient, for each and every visit. ‘’
so need to do tests that are necessary to check the health of the eye
may not need to do a refraction in some cases e.g. px complaining of RD symptoms
which people in Scotland entitled to with a GOS eye exam
and what can optometrists claim for
Free eye examination for every person in Scotland
Fee structure for supplementary examination allowing repeat tests and procedures
2013/14
£45 (Eye Exams for 60 and above where fundus picture taken)
£40 (Eye Exams for 60 and above where fundus picture not taken)
£37 (Eye exams below 60)
£21.50 Supplementary Eye Exams - e.g. to recheck high IOPs or VFs
with the GOS in Scotland, what 4 things do all practitioners have to demonstrate proficiency in
and how often is this assessed
Practitioners will have to demonstrate proficiency in: Slit Lamp Volk Lens BIO AT Threshold Visual Fields/record keeping
Annual review to take into account technological advances and service delivery - to see if its still appropriate
what is the welsh eye care initiative
list the 6 groups of people who are eligible for free sight tests in wales
“Aims to detect eye problems in susceptible individuals, to enable early assessment of acute eyesight problems and to provide a low vision service that is accessible for all.”
Free sight tests for certain groups:
- monocular patients
- hearing impaired
- RP patients
- black or Asian ethnicity
- risk of certain inherited eye diseases
- referred by GP
what do the optometrists in wales need to do to be part of the welsh eye care initiative
need to be registered to take part in the program- need to undertake accreditation program by Cardiff university
what is the primary eye care acute referral scheme that takes place in wales
Any patient presenting with acute symptoms requiring attention can have a PEARS eye examination free of cost
e.g. px presenting with a sudden red eye etc
Patient can self-refer or may be referred by their GP
what is the CHRE (Council for Healthcare Regulatory Excellence)
what relevance do they have to optometrists
Statutory overarching body, covering all of the UK and separate from Government, established from April 2003
Promotes best practice and consistency in the regulation of healthcare professionals such as GOC and Nursing and Midwifery Council
Relevance to optometrists:
CHRE review all fitness to practise committee/panel decisions
i.e. want to make sure the FTP decision is fair to both the public and the optom
Can refer such decisions to Court if considered unduly lenient and that referral is necessary in order to protect the public e.g. is optom keeps missing a RD etc and GOC is too lenient about it
