Optometry Handbook

Produced by Janice McCrudden,

Ophthalmic Advisor,

Health and Social Care Board,

Updated June 2016

2

Contents

Page 4

Health Care Structures– Where does Optometry sit?

Page 5

GOS Payments– Electronic

Page 7

GOS Payments– Paper Claims

Page 8

GOS Claim Forms

Page 11

Probity Services

Page 12

HSC Complaints Procedure

Page 14

Adverse Incidents

Page 19

Guidance on Referral Pathways

Page 20

Importance of record keeping

Page 21

Interpreting Service

Page 24

Ophthalmic Listing

Page 25

Annual Quality Assurance Declaration

Page 26 Information and Guidance for Business Continuity and Pandemic

Flu

3

Contents

Page 29 Practice Contacts

Page 31

Useful Websites

Page 32

HSCB Optometric Practices Newsletter

Page 33 FAQS

4

Health and Social Care in Northern Ireland

Health and Social Care

Board (HSCB) Public Health Agency

(PHA)

Primary Care-

Optometry/

GPs/

Dental/

Pharmacy

Health

and Social

Care Trusts

(x5)

Business Services

Organisation (BSO)

Department of Health and Social Services

and Public Safety

(DHSSPS)

Health Care Structures– Where Does Optometry Sit?

LCGs ICPs

5

How to submit GOS claims for payment:

There are currently two methods for submission of GOS Claims;

1. Electronic (Ophthalmic Claims Systems—OCS)

2. Paper- (Claim forms scanned by BSO)

Please note the last day for electronic submission via OCS is the 21st of

every month.

GOS Claims and Electronic Payments

Real time

processing

Errors are automatically

highlighted and can be

rectified immediately

Reduction in

postage costs/

time for claim

forms

Electronic

monthly

payments

reporting

Improved cash flow

through faster

payments

Ability to view

monthly

payments

online

Advantages of OCS

6

ElectronicElectronicElectronic———Ophthalmic Claims System (OCS)Ophthalmic Claims System (OCS)Ophthalmic Claims System (OCS)

Screenshot examples:

7

Please note:

The last day for submitting paper claims for payment by the end of

the month is the 10th. Forms should be posted by special/recorded

delivery or delivered by hand to the Business Services Organisation,

2 Franklin street, Belfast, BT2 8DQ.

GOS Payments and Paper Claims

Things to remember when

submitting Paper Claim

forms

Tippex is NOT

permitted.

MOS 290 must be

read prior to

completion. Please

Click Here

Boxes 1-4 MUST

be completed

Details must be

neatly and accurately

written

8

GOS Claim FormsGOS Claim FormsGOS Claim Forms

Claims will automatically be rejected if the following is incomplete:-

Part 1 - Surname, Forename, DOB, Address

Part 2 - Date of Test, OO/OMP Code , Value code, Prescriber Signature, Name, Address, Premises Code

Part 2 - Box 1-4

Part B/C - Patient signature

*In the case of 4 (patient referred to GP), one of the other boxes should be ticked (1- 3) as appropriate.

Must be completed.

One of these must be completed.

If relevant these must be completed.

Must be completed if a Domiciliary visit is claimed.

Must be completed.

Must be completed.

Must be completed.

Must be completed.

Must be completed.

Must be completed.

Must be completed.

Must be completed if a Domiciliary visit is claimed.

9

GOS Claim FormsGOS Claim FormsGOS Claim Forms

Must be completed

Must be completed

Must be completed if relevant.

Must be completed

All relevant sections of part 3 must be completed.

Must be completed

Must be completed

Must be completed

Must be completed

Must be completed

Must be completed

Must be completed

Must be completed

Must be completed if claimed

Part 1 - Surname, Forename, DOB, Address

Part 2 - Date of Sight Test, Single Vision AND Multifocal are both empty, Value code,

Personal Code, Prescriber Signature, Name, Address, Premises Code

Part 2 - If SPH/CYL contains the word ‘PLANO’, ‘ADD’ or BALANCE

Part 3 - Item B & D must be populated

Part 3 - If HC3 exemption is selected then there must be an amount in Part 3, Item C

Part 3 - If Item G is ticked then the Registered Signature/Date must be completed

Part 3 - Date of Supply, Premises Code, Supplier Signature, Name/Address of Supplier, Patient signature (Part B/C)

Claims will automatically be rejected if the following is incomplete:-

10

GOS Claim FormsGOS Claim FormsGOS Claim Forms

Must be completed

Only complete if lens supplied

Must be completed

If relevant, must be completed

All relevant sections of Part 3 must be completed.

Must be completed

Must be completed

Must be completed

Must be completed

If relevant, must be completed.

Must be completed

Must be completed

Claims will automatically be rejected if the following is incomplete:-

Part 1 - Surname, Forename, DOB, Address

Part 2 - Date of Sight Test, Single Vision AND Multifocal are both empty, Value code,

Personal Code, Prescriber Signature, Name, Address, Premises Code

Part 2 - If SPH/CYL contains the word ‘PLANO’

Part 3 - Item B must be populated

Part 3 - If HC3 exemption is selected then there must be an amount in Part 3, Item C

Part 3 - If Item G is ticked then the Registered Signature/Date must be completed

Part 3 - Date of Supply, Premises Code, Supplier Signature, Name/Address of Supplier, Patient signature (Part B/C)

11

Ophthalmic Probity Services

Practice Visits Why, How and When?

Statutory obligation for the Health and Social Care Board to under

take verification of claims for General Ophthalmic Services,

(HSS(F)43/2001).

There is an agreed protocol for the implementation and delivery of

probity services.

Quarterly monitoring of claims for General Ophthalmic

Service provision .

Routine and Targeted Post Payment Verification Visits (PPV) to

General Ophthalmic Service Providers.

Ophthalmic checking clinics take place.

Clinical Advisor Lead for Probity– Ms Fiona North.

Generally practice probity visits are on a 3 year

cycle. However depending on your claims you

may receive a visit sooner. Governance visits

may also occur but these normally relate to

record keeping or clinical matters, not financial.

12

Complaints

Providers have a statutory obligation to have a complaints procedure in place. Each

practice should have its own complaints process and a designated person assigned

to deal with any complaints.

Click here for more information on Complaints.

HSC Complaints Procedure

13

14

Adverse Incidents:

An adverse incident is “any event or circumstance that could have or

did lead to harm, loss or damage to people, property,

environment or reputation.”

Adverse Incidents should always be reported to the HSCB. Details and

the link to reporting these are available on the BSO website,

Ophthalmic section within the forms and information library page.

HSC Adverse Incidents

15

Key questions in reporting Adverse Incidents

What constitutes an Adverse Incident?

Definition: “any event or circumstance arising during the course of the business of an HSC organisation that led, or could have led, to serious unintended or unexpected harm, loss or damage to people, property, environment or reputation,” i.e. it includes “near misses”.

Why should I report adverse incidents?

Adverse incident reporting is a crucial element of a robust clinical governance system. It is a method by which the Board receives an assurance from a Practice/Out of Hours Provider that there are systems in place to prevent or reduce the risk of injury or harm to patients.

AI reporting also provides an opportunity for practices/OOH to report, and have investigated, incidents which occur within the Health Service outside their Practice. You will be notified of the outcome in respect of such incidents.

When should I report an adverse incident?

Your Adverse Incident report should be an immediate response to the occurrence of an adverse incident relating to your patient. Do not investigate first! You have a responsibility to report, within 24 hours, adverse incidents relating to the sudden or unexpected death of a patient. All other adverse incidents should be reported with 72 hours.

How do I report an incident?

You should complete form AIF1. This should be sent to the address at the bottom of the form. Click here for more information on Adverse Incident Reporting.

16

Key questions in reporting Adverse Incidents

What happens to my adverse incident report?

When an adverse incident report is received by the Integrated Care Directorate it is discussed with an appropriate Clinical Professional.

If an incident meets the criteria for serious adverse incidents (SAI), completion of the SAI form and subsequent report will be done by Integrated Care Staff. You will be notified of this and involved in any investigation.

For other incidents it may be that no further action is required by the practice or further information / action may be requested from the practice. There may be learning for other practices from this incident and / or action the Board needs to take to prevent recurrence. All incidents will be logged on a database held within Integrated Care.

Trend Analysis

Trend analysis of incidents will be carried out on a regular basis and practices will be notified of any common themes. Details of learning and action taken by the Board will also be notified to you.

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Overview of Adverse Incident Reporting in GOS

Adverse incident identified

by practice

Practice reports incident to

local FPS office by emailing

completed AIF1 form

B7G ensures information

logged on FPS database and

discusses incident with

appropriate Professional

Advisers

Practice may also decide to

reflect on incident at next

SEA meeting and write it up

as an SEA as well.

B7G may decide an SEA

report should also be

logged as Adverse Inci-

Immediate action by

Practice / Board if

required

B7G completes HSCB SAI Re-

port as “Lead Investigating

Officer

Process as HSCB Serious Adverse Incident

(See HSCB Procedure Document APRIL 2010)

Email to Practice to acknowledge receipt of

incident report, relay AI/ SAI decision and

notify of incident number. (May include

final email information in simple cases)

Process as FPS Adverse Incident (See Figure 2)

Incident

meets SAI

criteria?

Further

information

required?

B7G contacts

Practice for

further

information

Adverse incident

identified by practice

NO

YES NO

YES

18

FPS Adverse Incident

FPS Adverse Incident which does not

meet SAI Criteria. Already logged on

database

Further Action

required at

Practice?

Further Action

required at

Board/ Other?

Action agreed, taken

& recorded

Learning disseminated by Board to

practices in timely manner. To

Include email alerts, newsletter

updates or training as appropriate

as well as access to the annual FPS

Governance report.

Action agreed,

taken &

recorded.

Incident closed by B7G (in

consultation with professional

advisers as required)

Practice informed of any

outcomes by final email.

Potential learning discussed in

timely manner with GMS

Regional Governance Group

Quarterly trend analysis across 4

local offices and annual report to

GMS & HSCB Governance Groups

NO

YES NO

YES

19

Guidance on Referral Pathways

Referrals, Where and How?

Guidance on referral forms and pathways is provided by the

Health and Social Care Board.

All referral forms are hosted on the Buisness Services

Organisation (BSO) website in writeable PDF format.

For queries on any clinical issue or patient pathway please

contact one of the Optometric Clinical Advisors.

Please note:

The direct Orthoptic referral form is for children only and adults

must be referred in the normal way to Ophthalmology.

You should contact ‘eye casualty’ directly before sending a

patient.

The OHT1 Glaucoma referral forms are only for those practitioners

who are registered to carry out the Glaucoma referral refinement

in NI. All other glaucoma referral forms can be used by any NI

registered practitioner.

20

Good record keeping is essential!

It is recommended that all records are stored securely for up to 12 years .

Failure to store securely and maintain good records can result in referral to

the Information Commissioner or discipline. For compliance with GOC’s

relative standards (NB Standard 8). See the GOC website for this information.

The Importance of Record keeping

Points to remember:

Record keeping is a regulatory requirement of all contractors

within the GOS Regulations (Terms of Service).

Professional body offers advice and guidance (peer accepted–

College of Optometrists)

Continuity of care and recollection.

Protection (reassurance when questioned) information

sharing.

Post Payment Assurances (probity/financial)

Contractors can be asked to provide records to HSCB– must

comply with this request.

21

The Northern Ireland Health & Social Care Interpreting Service (NIHSCIS) is a free

of charge, face-to-face service which strives to improve access to HSC patients*

who do not speak English as a first, or competent second language. Legally, it is a

Patient’s right to have professional language assistance if required. NIHSCIS

Interpreting staff are professionally trained and bound by confidentiality.

To book a face-to-face interpreter please complete a booking form giving as much

notice as possible.

For further information contact:

Email: interpreting@hscni.net

Telephone: Mon to Fri 9am to 5pm: 028 9536 3777

Telephone : Out of Hours: 028 9056 5656

Address: NIHSC Interpreting Service

The Business Services Organisation

2 Franklin Street

Belfast

BT2 8DQ

*NIHSCIS provides Interpreters for NHS Patients only

Interpreting Services

22

The Big Word Telephone Interpreting Service is the sole provider of telephone

interpreting for all HSC Organisations in Northern Ireland.

To access a Telephone Interpreter: You will need a Practice Access Code and

Language code to make a call. If you do not have an access code please contact

Yvonne Myers at The Big Word at Yvonne.myers@thebigword.com or telephone

on 07525 990076 to arrange for one to be set up. Note: This may take up to 3

days to process.

Step 1: Call 0800 757 3053

Step 2: Enter your Access Code

Step 3: Enter the Language Code you require, or press 0 for a Customer Care

Representative. If you do not know the language you require, press 700 for Lan-

guage Identifier

Step 4: Wait on the line and you will be put through to an Interpreter for that

language. When connected, outline the nature of your call.

Further information is available on BSO website.

** NHS Patients Only

Costs for services from NIHSC Interpreting Service and The Big Word are funded by

the Health and Social Care Board. As face-to-face interpretation is more costly

than telephone interpretation practitioners are asked to give prior consideration

to the most suitable approach in the circumstances presenting.

For further information on Interpreting services please access the BSO website by

clicking here.

Interpreting Services contd

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Interpreting Service

24

Ophthalmic Listing—Process for Notification of Changes

In early March 2015, all practices received information and guidance in relation to Ophthalmic Listing and the statutory obligations for GOS contractors in regard to their ophthalmic listing status. The guidance details the process for notification of changes to ophthalmic listing details—please ensure that you follow this process. The forms for notification of changes are available for download on the BSO website: http://www.hscbusiness.hscni.net/services/2561.htm. Remember to send your notifications to Karen Lee at BSO or electronically (web form) via the new FPS Optometry landing page accessed through the BSO web-portal. The link for this is: http://sharepoint.hscni.net/sites/fpsoptometry/SitePages/Home.aspx It is vital that the CCG information on practitioners who are generating eReferrals is always up to date. It is essential that HSCB and ITS know of any changes to the work place of an Optometrist as a practitioner log-in is NOT transferrable across practices. If an Optometrist changes his/her place of work notification is essential so that the ITS can make the necessary change in details for CCG to enable eReferral permissions at any new place of work. Hence it is mandatory that you, as a GOS contractor: Notify HSCB of any new Optometrists who work in your practice

– the information you provide will be taken as current and correct unless you notify otherwise

Notify HSCB if an Optometrist whom you stated was working in

your practice, no longer works in your practice.

25

Annual Quality Assurance (QA) Declaration

Quality Assurance across all primary care professions is a vital

part of good governance in service provision.

Every April all practices will receive the annual Quality

Assurance returns documentation. All Optometry practices will

be asked to return declarations in relation to:

Complaints

Adverse Incidents

Receipt and Dissemination of all MOS and Ophthalmic

Guidance

Business Continuity Planning (BCP).

26

Information and Guidance for Business Continuity and

Flu Pandemic planning in Ophthalmic Services

Background:

Business Continuity Planning (BCP) is necessary to allow Optometry

Practices to overcome any untoward event affecting the premises, key

personnel or to any important systems that it relies upon in its day to

day operations.

This guidance will assist providers of General Ophthalmic Services by

outlining the importance of planning for unexpected events such as:

1. Adverse weather (e.g. flooding)

2. Power Failure

3. Loss of computer system/essential data (including clinical records)

4. Loss of telephone system

5. Loss of main premises and/ or facilities (e.g. Lighting/heat/water/

security)

6. Pandemic flu

7. Other disease outbreak

Business Continuity Plan

In the ideal situation the responsibility for the development of the

Business Continuity Plan will rest with one nominated individual, for

example; the practice owner or the practice manager. The plan should

be reviewed and updated on a regular basis (6/12months) or in the

event of changes to key staff or personnel in the practice.

27

The plan is designed to enable the practice to resume activities

whether the situation is one of major significance or, whether there is

simply partial loss of certain facilities/capabilities.

As such, it covers a broad spectrum of potential situations that may

impact on the ability of the practice to continue its normal business

either short term, or long term. In addition to ensuring that plans are

in place to deal with an emergency situation which may be expected

‘short ‘ duration, the practice should also make business plans for any

‘longer term’ issues which may arise, such as an incapacity of staff and

professionals working in practice.

In order to provide for the necessary business continuity the plan

should identify;

1. The actions which will be taken which may include such

eventualities, for example; diverting telephone calls, the

re-direction of mail.

2. The relevant personnel who will implement the actions.

3. Evacuation procedures in the case of an emergency.

4. Procedures for direct contact with patients for continuity of care

and access to clinical records.

5. Procedures for back up systems.

6. The relevant contact details for all essential and support facilities

in the practice, for example; IT support, electricity, heating and

water providers.

28

In consideration of the planning required for a Pandemic Flu , Optometry practices should take into account advice from Health and Social Care Organisations and professional bodies such as the College of Optometrists.

Optometry Practices may also consider the use of a ‘Buddy’ arrangement for business continuity. This approach is adopted within General Medical Services and is a useful mechanism to ensure immediate business continuity can be provided for emergency situations. A ‘buddy’ arrangement allows Optometry practices to make reciprocal arrangements for Ophthalmic service provision.

It is essential that the Business Continuity plan is disseminated and made readily available to all practice staff thereby ensuring that all staff are aware of which staff members have key responsibilities in regard to the development, implementation and maintenance of the plan.

A copy of the plan should be held on the premises but an additional copy should be held off-site, for example, with the nominated lead in the eventuality that the premises become inaccessible, e.g. in the event of a fire.

An optional template is available on the BSO website to assist practices in formulating an approach to the collation of important information to allow practices to develop their own tailored Business Continuity Plan identifying the approach which will be taken in the event of unforeseen circumstances which interrupts provision of Ophthalmic Services in the practice.

Click here further information and guidance on Business Continuity Planning for GOS contractors is provided.

29

Contact DetailsContact DetailsContact Details

NAME ORGANISATION CONTACT DETAILS

Mr Raymond Curran Assistant Director, Head of

Ophthalmic Services, Health

and Social Care Board.

Raymond.curran@hscni.net

028 9536 3314

Ms Fiona North Optometric Clinical Advisor,

Health and Social Care

Board.

Fiona.north@hscni.net

028 9536 2104

Ms Janice McCrudden Optometric Clinical Advisor,

Health and Social Care

Board.

Janice.mccrudden@hscni.net

028 9536 2855

Mrs Margaret McMullan Optometric Clinical Advisor,

Health and Social Care

Board.

Margaret.mcmullan@hscni.net

028 9536 3239

Mrs Karen Lee Ophthalmic Services

Professional Support.

Karen.lee@hscni.net

028 9536 3745

Useful numbers:

Directorate of Integrated Care, HSCB Ballymena - 028 9536 2845

Health and Social Care Board Switchboard - 0300 555 0115

Public Health Agency switchboard - - 0300 555 0114

Business Service Organisation Switchboard - 0300 555 0113

30

Other Important Contact DetailsOther Important Contact DetailsOther Important Contact Details

Ophthalmology and Hospital Eye Service (HES) Optometry within

secondary care are delivered by two of the five Health and Social

Care Trusts, Belfast and Western.

Optometry Services include contact lens clinics, low vision (adult

and paediatric) and special school optometry provision*. Outreach

low vision clinics are also provided.

Belfast Hub– Shankill Wellbeing and Treatment Centre.

Western Hub– Altnagelvin Hospital

Contact details for Health and Social Care Trust Ophthalmology and

Optometry staff and HES Optometry Clinics are available on the

BSO website.

BSO Contacts:

Colleen Greene 028 9536 3755 Colleen.Greene@hscni.net

Donna McKiernan 028 9536 3734 Donna.McKiernan@hscni.net

Dorothy Quinn 028 9536 3735 Dorothy.Quinn@hscni.net

Gareth Drake 028 9536 3753 Gareth.Drake@hscni.net

Larry Noade 028 9536 3754 Larry.Noade@hscni.net

Trudy Teer 028 9536 3733 Trudy.Teer@hscni.net

Angela Dowds 028 9536 3752 Angela.Dowds@hscni.net

Karen Lee 028 9536 3745 Karen.Lee@hscni.net

Kevin Carland 028 9536 3731 Kevin.Carland@hscni.net

Service Delivery Information

31

Useful WebsitesUseful WebsitesUseful Websites

The BSO contains most of the day to day information required in

practice. It has writeable and downloadable copies of all the referral

forms. Details of relevant MOS’s that address frequently asked

question and contact details of hospital clinics. Any urgent and

important alerts or updates are also hosted on the site. Please

familiarise yourself with this very useful site.

Other Useful websites:

AOP www.aop.org.uk

College of Optometrists www.college-optometrists.org/guidance

GOC www.optical.com

Optometry NI www.optometryni.co.uk

NI Optometry Society www.nios.org.uk

32

The Optometric Practice Newsletter is issued to practices every 3-4 months

and features items of regulatory and professional interest. It is hosted on

BSO website (please click here) and is also sent to individual email

addresses by BSO.

HSCB Optometric Practice Newsletter

33

Eligibility for spare pairs—(MOS 295): You are reminded that no patient

is automatically entitled to a spare pair of glasses; they may only have a

spare pair if they fall into one of the categories listed in the recently

issued update MOS 295 and if they do not currently have a serviceable

older pair of glasses. Any patient, who has a serviceable second pair,

even if there is a slight prescription change, should not be supplied with

a further spare pair. This also applies if the voucher has been issued by

the

Hospital Eye Service (HES) and a second voucher has not been provided

by the HES clinic. An approval number to issue a spare pair must be

sought from the Ophthalmic Department of the BSO detailing the

reason why it is deemed necessary. If you are not the original

prescriber, the second completed GOS(V) must be sent to BSO for an

Ophthalmic Advisor to sign and approve.

Non– collections - (MOS264): Voucher and repair/replacement claim

forms submitted for payment following non collection of an

appliance can only be paid if the patient has only signed part B of the

claim form. If there are two patient signatures i.e. the patient has also

signed part C to declare that they have collected the glasses, the claim

cannot be paid.

Frequently Asked Questions

34

Managing claim form queries– (MOS 302): If a claim form has to be

returned by BSO to a contractor due to query e.g. incomplete form,

incorrect information etc, the query must be resolved within 3 months of

the date of the form being returned by BSO, otherwise it will not be

paid.

Second Opinions—(MOS 303): Are not facilitated by GOS. The patient

should be advised to return to the original practice to have their

problems investigated and the issues resolved. If the patient does not

wish to do this they must have a private sight test and will have to pay

privately for any resulting prescription change/glasses. They will only

be entitled to another GOS test after their usual time interval. If,

however, the patient is unable to resolve the issue with the original

practice, they may write to BSO Ophthalmic services for consideration

of the situation.

Replacements/Spare pairs for adults—(MOS 295): Adult patients are not

routinely entitled to repairs/replacements/spare pairs but in a case

where damage was associated with the patient’s medical condition, a

replacement claim can be made under GOS. In exceptional cases a

spare pair may be applied for and approved. However it is an exception

and therefore an approval number must be sought from BSO

Ophthalmic services prior to submission of the claim.

35

Transposing Prescriptions- (MOS 248): It is allowable to write your

prescriptions in the format which gives the patient the maximum GOS

(V) allowance . However if it is not your own prescription (eg: a

Hospital voucher) the voucher must be transposed onto another GOS

(V) and sent with the original form to the BSO Ophthalmic office for

approval and payment by an Ophthalmic Advisor.

Check the BSO website for information on these and other common

queries:

Sight test intervals

Small frame supplements

Domiciliary eye care