11 January 2012

Dear Practitioner

URGENT

ATTENTION REQUIRED – FOLLOW UP GUIDANCE TO MOS/270 ISSUED OCTOBER 2011

GOS Sight Tests

As required by the Regulations, you should only carry out a sight test, if you think it is clinically necessary. You should ensure that the reason for the test is clearly shown on the patient’s record and the GOS claim form. General Ophthalmic Services Regulations require a contractor to -

“satisfy himself that the testing of sight is necessary”

(2007 Regulations, Sight Test applications,17 (4 (c)).

In satisfying yourself that a GOS sight test is necessary you must use your clinical judgement to determine how frequently a patient needs a sight test and to determine when to issue a changed prescription. Consideration must be given to recommended DoH sight test intervals (MOS/270) and current evidence of best practice. MOS/270 specifies the minimum intervals between sight tests expected for different categories of patients.

In the event of testing a patient's sight at a shorter interval than that specified by the HSCB/BSO, you must write the actual clinical reason for the early sight test in the remarks box on the GOS (NI) ST forms. As stated in MOS/270 the facility for early re-tests is for cases where a GOS sight test needs to be carried out before the recommended time interval. This has been designed to allow provision of GOS for patients who present with eye problems which cannot be predicted and planned for e.g. sudden loss of vision or sudden onset of diplopia. In particular, the testing of children earlier than the recommended DoH intervals must be supported by appropriate clinical reasons. Other allied professionals including orthoptists and general medical practitioners will be updated with this information. Further guidance specific to the management of children will be issued in the near future.

If the sight test is being carried out at an interval of less than three months, approval must be sought from an Optometric Adviser before the test is undertaken, in line with the procedures detailed in MOS/270. You might be challenged by the HSCB/BSO to justify your clinical decision. Please remember GOS claims are subject to post payment verification.

While you have complete freedom to exercise your clinical judgement in individual cases, it is not appropriate to routinely apply re-call intervals to patients which are outside the DoH guidance. HSCB/BSO has the discretion to ask you to justify each individual decision.

Domiciliary Eye Examinations

You can only claim a domiciliary fee in respect of a patient who is eligible for a GOS sight test and requires a sight test at the place where they normally reside, because they are unable to attend a practice unaccompanied (for reasons of physical or mental ill health or disability). You and the patient have a responsibility to ensure that the domiciliary visit is necessary. In line with Regulations –

“ the contractor shall record on the sight test claim form the reason given by the patient , or on his behalf, for not being able to leave home unaccompanied”

(2007 Regulations, Term of Service, 17 (5)).

Therefore you must ask the patient to indicate the specific illness or disability which prevents him/her from leaving home unaccompanied. Terms like ‘housebound’, ‘immobile’, or ‘resident of a home’ are insufficient. Giving the reason why the patient cannot leave their residence unaccompanied is the patient’s, or their carer’s, responsibility. If a reason is not provided then a domiciliary fee will not be payable.

Processing & auditing of GOS claims

During processing, claims may be rejected for a variety of reasons. These reasons relate to the regulations for the delivery of General Ophthalmic Services. In such cases, the claim will be returned and you will receive an explanation outlining the reason the claim has been returned. Any amendment must be signed and dated, prior to returning it to the BSO for re-processing.

You can expect your claims in relation to any aspect of GOS to be audited by the HSCB/BSO. The HSCB/BSO is legally entitled to inspect records relating to your GOS patients. You are obliged under the Regulations to -

“(a) produce them on request to an optician in the employment of the Board for inspection or

(b) produce them to the Department, the Board, the Agency or the Committee within 14 days of being required to do so …”

(2007 Regulations, Terms of Service, 7 (3)),

HSCB/BSO take this opportunity to remind all contractors that auditing of payments is a routine activity for all HSC organisations and we are required to carry this work out to give assurance that public money is being spent appropriately.

R CURRAN P SHEILS

Assistant Director of Integrated Care – Optometry Assistant Director – FPS

Directorate of Integrated Care Family Practitioner Services

HSCB Business Services Organisation

Gransha Park House 2 Franklin Street

15 Gransha Park BELFAST

LONDONDERRY BT2 8DQ

BT47 6FN