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Flashcards in The national health service Deck (47):
1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

what is required if wanting to carry out domiciliary eye examinations under the NHS

Separate contract to provide Domiciliary Eye Care

15

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

16

when is the only time that asylum seekers are allowed a free NHS sight tests under the GOS

if they have HC2 form

17

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)

18

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

19

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

20

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

21

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

22

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

23

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

24

which patient group is entitled for an eye test every 2 years under the NHS

16 years and over and under 70 years

25

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)

26

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)

27

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

28

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

29

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

30

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

31

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

32

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

33

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

34

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)

35

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

36

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

37

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

38

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

39

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

40

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

41

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

42

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

43

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

44

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

45

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

46

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

47

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