NHS Standard Contract 2015/16 Particulars · 2015/16 NHS STANDARD CONTRACT PARTICULARS 3 Contract...

2015/16 NHS STANDARD CONTRACT PARTICULARS

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NHS Standard Contract 2015/16 Particulars


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NHS Standard Contract

2015/16

Particulars

Version number: 1

First published: March 2015

Prepared by: NHS Standard Contract Team

Publications Gateway Reference: 03175

Document Classification: Official


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Contract Reference

DATE OF CONTRACT

20th March 2015

SERVICE COMMENCEMENT DATE

1st July 2016

CONTRACT TERM

3 Years

COMMISSIONERS

NHS Horsham & Mid Sussex CCG and NHS Crawley CCG

CO-ORDINATING Commissioner

NHS Horsham & Mid Sussex CCG

PROVIDER

Primary Eye Care (Sussex) Ltd


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CONTENTS PARTICULARS

A. Conditions Precedent..............................................................................................14B. Commissioner Documents...................................................................................15

SCHEDULE 2 – THE SERVICES .................................................................. 17A. Service Specifications...............................Error!Bookmarknotdefined.

SCHEDULE 2 – THE SERVICES .................................................................. 40SCHEDULE 2 – THE SERVICES .................................................................. 32

B. Indicative Activity Plan............................................................................................33SCHEDULE 2 – THE SERVICES .................................................................. 34

C. Activity Planning Assumptions.........................................................................34SCHEDULE 2 – THE SERVICES .................................................................. 43

D. Essential Services (NHS Trusts only)...........................................................35SCHEDULE 2 – THE SERVICES .................................................................. 36

E. Essential Services Continuity Plan (NHS Trusts only)......................36SCHEDULE 2 – THE SERVICES .................................................................. 37

F. Clinical Networks........................................................................................................37SCHEDULE 2 – THE SERVICES .................................................................. 38

G. Other Local Agreements, Policies and Procedures.............................38SCHEDULE 2 – THE SERVICES .................................................................. 39

H. Transition Arrangements.......................................................................................39SCHEDULE 2 – THE SERVICES .................................................................. 40

I. Exit Arrangements..........................................................................................................40SCHEDULE 2 – THE SERVICES .................................................................. 41

J. Transfer of and Discharge from Care Protocols....................................41SCHEDULE 2 – THE SERVICES .................................................................. 42

K. Safeguarding Policies and Mental Capacity Act Policies................42SCHEDULE 2 – THE SERVICES ................................................................ 451

L. Provisions Applicable to Primary Care Services................................451A. Operational Standards............................................................................................44B. National Quality Requirements..........................................................................60C. Local Quality Requirements................................................................................63D. Never Events..................................................................................................................74Never Event Breach................................................................................................................74Threshold......................................................................................................................................74Method of Measurement......................................................................................................74Never Event Consequence (per occurrence)........................................................74Applicability.................................................................................................................................74


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Applicable Service Category............................................................................................74E. Commissioning for Quality and Innovation (CQUIN)..........................75F. Local Incentive Scheme.........................................................................................76G. Clostridium difficile...................................................................................................77D. Commissioner Roles and Responsibilities...............................................83E. Partnership Agreements........................................................................................84A. Recorded Variations.................................................................................................85B. Reporting Requirements (all Providers other than Small Providers)......................................................................................................................................86B Reporting Requirements (Small Providers only).......................................89C. Data Quality Improvement Plan.........................................................................91D. Incidents Requiring Reporting Procedure.................................................92E. Service Development and Improvement Plan..........................................93F. Surveys..............................................................................................................................94


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SERVICE CONDITIONS SC1 Compliance with the Law and the NHS Constitution SC2 Regulatory Requirements SC3 Service StandardsSC4 Co-operation SC5 Commissioner Requested Services/Essential Services SC6 Choice, Referrals and Booking SC7 Withholding and/or Discontinuation of Service SC8 Unmet Needs SC9 Consent SC10 Personalised Care Planning and Shared Decision Making SC11 Transfer of and Discharge from Care SC12 Service User, Staff and Public Involvement SC13 Equity of Access, Equality and Non-Discrimination SC14 Pastoral, Spiritual and Cultural Care SC15 Places of Safety SC16 Complaints SC17 Services Environment and Equipment SC18 Sustainable Development SC19 Food Standards SC20 Service Development and Improvement Plan SC21 HCAI Reduction Plan SC22 Venous Thromboembolism SC23 Service User Health Records SC24 NHS Counter-Fraud and Security Management SC25 Procedures and Protocols SC26 Clinical Networks, National Audit Programmes and Approved Research

Studies SC27 Formulary SC28 Information Requirements SC29 Managing Activity and Referrals SC30 Emergency Preparedness, Resilience and Response SC31 Force Majeure: Service-specific provisions SC32 Safeguarding, Mental Capacity and Prevent SC33 Incidents Requiring Reporting SC34 Care of Dying People and Death of a Service User SC35 Duty of Candour SC36 Payment Terms SC37 Local Quality Requirements and Quality Incentive Schemes SC38 Commissioning for Quality and Innovation (CQUIN)


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GENERAL CONDITIONS GC1 Definitions and InterpretationGC2 Effective Date and DurationGC3 Service CommencementGC4 Transition Period GC5 StaffGC6 Not used GC7 Partnership Arrangements GC8 Review GC9 Contract Management GC10 Co-ordinating Commissioner and RepresentativesGC11 Liability and IndemnityGC12 Assignment and Sub-ContractingGC13 VariationsGC14 Dispute Resolution GC15 Governance, Transaction Records and Audit GC16 SuspensionGC17 TerminationGC18 Consequence of Expiry or TerminationGC19 Provisions Surviving TerminationGC20 Confidential Information of the PartiesGC21 Patient Confidentiality, Data Protection, Freedom of Information and

TransparencyGC22 Intellectual PropertyGC23 NHS Branding, Marketing and PromotionGC24 Change in Control GC25 WarrantiesGC26 Prohibited ActsGC27 Conflicts of InterestGC28 Force MajeureGC29 Third Party RightsGC30 Entire ContractGC31 SeverabilityGC32 WaiverGC33 RemediesGC34 Exclusion of PartnershipGC35 Non-SolicitationGC36 NoticesGC37 Costs and ExpensesGC38 CounterpartsGC39 Governing Law and Jurisdiction


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CONTRACT This Contract records the agreement between the Commissioners and the Provider and comprises

1. the Particulars; 2. the Service Conditions;

3. the General Conditions,

as completed and agreed by the Parties and as varied from time to time in accordance with GC13 (Variations). IN WITNESS OF WHICH the Parties have signed this Contract on the date(s) shown below

SIGNED by ………………………………………………………. Signature

CHIEF OPERATING OFFICER for and on behalf of NHS Horsham & Mid Sussex CCG and NHS Crawley CCG

………………………………………………………. Title ………………………………………………………. Date

SIGNED by ………………………………………………………. Signature

DIRECTOR for and on behalf of PRIMARY EYE CARE (SUSSEX) LTD

………………………………………………………. Title ………………………………………………………. Date


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SERVICE COMMENCEMENT AND CONTRACT TERM

Effective Date

01 July 2016

Expected Service Commencement Date

01 July 2016

Longstop Date

N/A

Service Commencement Date

01 July 2016

Contract Term [3] years commencing on the Effective Date

Option to extend Contract Term

NO

Expiry Date 31 May 2019

Commissioner Notice Period (for termination under GC 17.2)

6 months

Commissioner Earliest Termination Date

6 months after the Service Commencement Date]

Provider Notice Period (for termination under GC17.3)

6 months

Provider Earliest Termination Date 6 months after the Service Commencement Date


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SERVICES

Service Categories Indicate all that apply

Accident and Emergency (A+E)

Acute Services (A)

Ambulance Services (AM)

Cancer Services (CR)

Continuing Healthcare Services (CHC)

Pharmacy-delivered Community Services (Ph)

Community Services (CS)

Yes

Diagnostic, Screening and/or Pathology Services (D)

End of Life Care Services (ELC)

Mental Health and Learning Disability Services (MH)

Mental Health and Learning Disability Secure Services (MHSS)

NHS 111 Services (111)

Patient Transport Services (PT)

Radiotherapy Services (R)

Surgical Services in a Community Setting (S)

Urgent Care/Walk-in Centre Services/Minor Injuries Unit (U)

Specialised Services

Services comprise or include Specialised Services commissioned by NHS England

NO

Service Requirements

Indicative Activity Plan

Not applicable

Activity Planning Assumptions Not applicable Essential Services (NHS Trusts only) Not applicable Services to which 18 Weeks applies NO


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PAYMENT

National Prices Not applicable

Small Provider YES

Expected Annual Contract Value Agreed NO

SUS applies

YES/NO

QUALITY

Provider type Optometrists

Clostridium Difficile Baseline Threshold (Acute Services only)

Not applicable


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GOVERNANCE AND REGULATORY

Nominated Mediation Body

CEDR/Other

Provider’s Nominated Individual Geoff Brown Provider’s Information Governance Lead Geoff Brown Provider’s Caldicott Guardian

Geoff Brown

Provider’s Senior Information Risk Owner

Geoff Brown

Provider’s Accountable Emergency Officer

Geoff Brown

Provider’s Safeguarding Lead

Geoff Brown

Provider’s Mental Capacity and Deprivation of Liberty Lead

Geoff Brown

Provider’s Prevent Lead Geoff Brown


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CONTRACT MANAGEMENT

Addresses for service of Notices

NHS Horsham & Mid Sussex CCG Lower Ground Floor, Crawley Hospital, West Green Drive, Crawley, West Sussex, RH11 7DH Tel: 01293 600300 Provider: Primary Eye Care (Sussex) Ltd 2 Woodbridge Street London EC1R 0DG [Registered address] 19 Grundreda Road Lewes BN7 1PT

Frequency of Review Meetings

Quarterly

Commissioner Representative(s)

Ms Diane Gilmour NHS Horsham & Mid Sussex CCG Lower Ground Floor, Crawley Hospital, West Green Drive, Crawley, West Sussex, RH11 7DH Tel: 01293 600300 Ext 3076 Email: [email protected]

Provider Representative David Bridle Primary Eyecare (Sussex) Ltd


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SCHEDULE 1 – SERVICE COMMENCEMENT AND CONTRACT TERM

A. Conditions Precedent

The Provider must provide the Co-ordinating Commissioner with the following documents, in respect of the contractor and the contractor’s sub-contractors 1. [Evidence of appropriate Indemnity Arrangements] 2. [Evidence of CQC registration in respect of Provider and Material Sub-

Contractors (where required)] N/A 3. [Evidence of Monitor’s Licence in respect of Provider and Material Sub-

Contractors (where required)] N/A 4. [Copies of all Mandatory Material Sub-Contracts, signed and dated and in a

form approved by the Co-ordinating Commissioner] N/A 5. [Copies of the following Permitted Material Sub-Contracts, signed and dated and

in a form approved by the Co-ordinating Commissioner: [LIST ONLY THOSE REQUIRED FOR SERVICE COMMENCEMENT] N/A

6. [A copy of the/each Direction Letter] N/A

7. [Insert text locally as required]

The Provider must complete the following actions: Provider to supply permitted material sub-contractor list including registered office and company number by 30 June 2016


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B. Commissioner Documents

Date

Document

Description

Not Applicable


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C. Extension of Contract Term

NOT USED


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SCHEDULE 2 – THE SERVICES

A. Service Specifications Service Specification No.

Service MinorEyeConditionsService(MEC)

Commissioner Lead DianeGilmour,ProgrammeManager,Plannedcare

Provider Lead

Period

Date of Review

1. Outcomes 1.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long-term

conditions

Domain 3 Helping people to recover from episodes of ill-health or following injury

Domain 4 Ensuring people have a positive experience of care x Domain 5 Treating and caring for people in safe environment and

protecting them from avoidable harm

1.2 Local defined outcomes The outcomes are:

• Improved access to high quality eye health care in the community for the management of minor eye conditions.

• Reduction in GP attendances for minor eye conditions. • Reduction in unnecessary emergency attendances for minor eye conditions. • Reduction outpatient attendances for minor eye conditions or minor eye procedures. • Increased capacity of primary care ophthalmology services to manage minor eye

conditions within the community. 2. Scope 2.1 Aims and objectives of service The key aim of the service is to provide a responsive, high quality assessment and referral service for a range of minor eye conditions and potentially sight threatening acute eye conditions within the community. The primary objective is to move care closer to home enabling patients to utilize the skills and capacity of community optometrists to treat and manage patients who would otherwise attend hospital and GP surgeries.


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2.2 Service Description/Care Pathway

A MECS examination will provide a timely assessment of the needs of a patient presenting with an eye condition. This examination will be undertaken by an accredited optometrist within suitably equipped premises who will manage the patient appropriately and safely. Management will be maintained within the primary care setting for as many patients as possible, thus avoiding unnecessary referrals to hospital services. Where referral to secondary care is required it will be to a suitable specialist with appropriate urgency.

Notes:

1. Assessment, treatment and management pathways set out in Appendix 1

2.3 Response Times

For acute potentially sight threatening eye conditions, the optical practice must be able to offer an MECS examination within 24 hours of the patient self-referral, referral from a GP, pharmacist or non-accredited optometrist. For non-urgent cases,

Self-referral,referralfromGPornon-accreditedcommunityoptometrists

Referral to Accredited Optometrist

MECS or GOS

Hospital Eye Service

MECS ‘Assessment’

Acutevisionlossetc.

Treatment by MECS

Follow Up by GP

Feedback

Follow Up by MECS

AMD Triage Treatable AMD

Low Vision Services


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a MECS examination must be offered within 5 days. Where this is not possible, it will be the responsibility of the optical practice to arrange for the patient to be seen by an alternative optical practice that provides a MECS examination.

2.4 Minor Eye Conditions Assessment The level of examination should be appropriate to the reason for referral.

1. A full and thorough medical history; 2. Recording and identifying clinically significant symptoms 3. Clinical examination in line with pathways (Appendix 1) 4. Jointly agreeing the evidenced based management plan in accordance with the care

pathways. Following the MECS assessment, the optometrist shall either:

• Manage the condition, providing patient advice and/or prescribes/recommends medication in line with the local formulary.

• Carry out a minor clinical procedure e.g. eyelash removal or foreign body removal. • Diagnose the condition and suggests/prescribes appropriate medication or the GP is

requested to prescribe in line with the local formulary. • The optometrists makes a tentative diagnosis and refers the patient urgently/non-

urgently into the Hospital Eye Service. • Discharge the patient with information and advice. • Recommends an NHS or private sight test.

All procedures undertaken and advice given to the patient should be recorded and stored in a safe retrieval system to support clinical audit and governance.

2.5 Management Patients being managed by the service will be managed in accordance with:

• Care pathways (Appendix 1) • The College of Optometrists’ Clinical Management Guidelines (www.college-

optometrists.org/en/professional-standards/clinical_management_guidelines/index.cfm.)

2.5.1 Prescribing

Registered optometrists may sell or supply all pharmacy medicines (P) or general sale list medicines (GSL) in the course of their professional practice, including 0.5% Chloramphenicol antibiotic eye drops or 1% eye ointment. Optometrists may give the patient a written (signed) order for the patient to obtain the above from a registered pharmacist, as well as the following prescription only medicines (POMs).

• Chloramphenicol • Cyclopentolate hydrochloride • Fusidic Acid • Tropicamide

Current local arrangements are that NHS exempt patients will have to pay for (signed) orders at the pharmacy.


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Alternatively the optometrist may write to the GP recommending that the NHS exempt patient be treated with a NHS prescription from the GP. In making the supply of medicines to the patient the optometrist must ensure:

• Sufficient medical history is obtained to ensure that the chosen therapy is not contra-indicated in the patient.

• All relevant aspects, in respect of labelling of medicine outlined in the Medicine Act 1968 are fully complied with.

• The patient has been fully advised on the method and frequency of administration of the product.

• Prescribing complies with the local formulary. • Prescribing complies with guidance from The College of Optometrists on the use &

supply of drugs as part of its ‘Guidance for Professional Practice’.

2.6 Patient Information Examples of leaflets that must be available and will be handed to patients as appropriate are:

• Low vision service – patient leaflet available from https://www.rcophth.ac.uk/wp-content/uploads/2014/12/2013_PROF_261_Visual_Impairment_Leaflet.pdf

• Mydriatic drops - warning re pupil dilation • Tear Dysfunction/Dry eye • Blepharitis • Conjunctivitis • Trichiasis • Epiphora • Foreign body removal • Flashes & floaters • Age related macular degeneration • Glaucoma

2.7 Population Covered

People registered with GP practices in NHS Crawley CCG and NHS Horsham and Mid Sussex CCG.

2.8 Acceptance and Exclusion Criteria

2.8.1 Acceptance Criteria

The criteria for inclusion of patients includes the following:

• Loss of vision including transient loss. • Sudden onset of blurred vision (but always consider if a GOS sight test would be

appropriate). • Ocular pain or discomfort. • Systemic disease affecting the eye. • Differential diagnosis of the red eye. • Foreign body and emergency contact lens removal. • Dry eye. • Epiphora (watery eye). • Trichiasis (in growing eyelashes). • Differential diagnosis of lumps and bumps in the vicinity of the eye.


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• Recent onset of Diplopia. • Flashes/floaters. • Retinal lesions. • Patient reported field defects.

2.8.2 Exclusions

Conditions excluded from the service include:

• Diabetic retinopathy. • Adult squints. • Long standing diplopia. • Repeat field tests to aid diagnosis following an GOS sight test.

Patients should not normally receive MECS and GOS on the same day.

Following a MECS assessment the following cases should be referred directly to the nearest Eye Casualty:

• Severe ocular pain requiring immediate attention • Suspect Retinal detachment • Retinal artery occlusion • Chemical injuries • Penetrating trauma • Orbital cellulitis • Temporal arteritis • Ischaemic optic neuropathy • Sudden loss/dramatic reduction in vision in one eye (if wet ARMD consider referral

through COSI ARMD pathway or eye casualty)

2.9 Clinical Audit The LOC Company, Primary Eyecare (Sussex) Ltd will review all reasons for referral, both urgent and routine, and will report any that appear inappropriate (e.g. excessive referrals from one practitioner for dry eye, or for flashes and floaters). In addition, the Primary Eyecare (Sussex) Ltd will review all conditions managed in MECS to see if any appear inappropriate. On annual basis the Primary Eyecare (Sussex) Ltd will review a 15% sample of referrals with the clinical lead for ophthalmology for Crawley CCG and Horsham and Mid Sussex CCG, a representative from the LOC Company and if possible a representative of hospital eye services to identify if:

• Referrals to secondary care were appropriate • Patients managed within primary care were appropriate.

Primary Eyecare (Sussex) Ltd will audit the number of NHS exempt patients requiring NHS prescriptions following a MECS assessment. The findings of the clinical audit will be reported to the Planned Care team at Horsham and Mid Sussex CCG. 3. Applicable Service Standards 3.1 Applicable national standards (e.g. NICE) There are no applicable national standards.


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3.2 Applicable Local Standards On conclusion of a MECS examination the optometrist must complete a MECS report form, entering the information on the IT system where applicable for audit purposes & report to the referring GP, and to the hospital eye service, should an onward referral be necessary. 3.2.1 Equipment All practices contracted to supply the service will be expected to employ an accredited optometrist and have the following equipment available:

• Access to the Internet. • Means of indirect ophthalmoscopy (Volk/headset indirect ophthalmoscope). • Slit lamp. • Applanation Tonometer. • Distance test chart (Snellen/logmar). • Near test type. • Equipment for epilation. • Threshold fields equipment to produce a printed report. • Amsler Charts. • Equipment for FB removal. • Appropriate ophthalmic drugs

o Mydriatic o Anaesthetic o Staining agents

3.2.2 Competencies

All participating optometrists will have the core competencies as defined by the GOC and may require some extra training or updating of skills.

In addition the following apply:

• Aware of own limitations. • Does not compromise patient safety.

Training and accreditation for participating optometrists must include demonstrating the ability to identify and manage a range of ocular abnormalities and proficiency in the use of certain elements of the above-mentioned equipment. Participating optometrists must complete the Wales Optometry Postgraduate Education Centre (WOPEC) Minor Eye Conditions (MECS) Distance Learning modules (Part 1) and the associated Practical Skills Demonstration (Part 2). Optometrists with a relevant higher qualification e.g. those with the College of Optometrists Independent Prescribing qualification and listed with the GOC as an Independent prescriber are exempt from WOPEC training Part 1 and Part 2. Participating optometrists will also be expected to keep their knowledge and skills up to date. 3.3 Applicable Standards set out in Guidance and/or issues by a Competent Body (e.g.

College of Optometrists) 4. Applicable quality requirements and CQUIN goals


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4.1 Applicable Quality Requirements (See Schedule 4 Parts [A-D])

4.2 Applicable CQUIN goals (See Schedule 4 Part [E]) 5. Location of Provider Premises The provider’s premises are located within NHS Crawley CCG and NHS Horsham and Mid Sussex CCG. 6. Individual Service User Placement Not Applicable 7. Performance Management Service Accredited Optometrists will be required to complete a detailed audit tool for each referral which will provide data for the following process, output and outcome metrics.

7.1.1 Minimum Dataset Providers will be required to record:

• Basic patient administration information (unique identification number, name, address, postcode, telephone numbers, e-mail);

• Patient demographic information (gender, ethnicity, age, date of birth); • Type of referral. New, follow up, follow up and treatment. • Referral data: Date and time of referral; • Clinical data. Presenting condition and diagnosis. • Outcome of referral. Referral to GP, follow up at optometrist, referral to hospital eye

service

7.1.2 Process Metrics

• The time from self-referral to patients receiving a full primary eyecare MECS assessment;

• The number of people referred by non-accredited community optometrists to accredited community optometrists.

• The number of people referred by GPs to accredited community optometrists. • The number of people referred by pharmacists to accredited community

optometrists.

7.1.3 Output Metric

• The number of MECS assessments completed; • The number of patients referred to the hospital eye service following a MECS

assessment (maximum 20% onward referral into acute). • The number of patients who receive follow up care by the accredited community

optometrists (maximum 10% requiring a follow up appointment). • The number of follow ups at accredited community optometrists.

8. Pricing Payment for the service is on a cost per case arrangement. The CCG shall pay the Contractor £64 per patient seen for an initial appointment (FU included in this price). For the avoidance of doubt, though, no payment shall be made by the CCG in respect of DNAs.


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Appendix 1 9. Flashers and Floaters Pathway

9.1 Care Pathway

Patient presents with flashes/floaters or referred

via GP

Clinically Significant Symptoms

• Recent onset

• Increasing flashes and/or floaters

• 6 weeks duration

• Field Loss

• Cloud, curtain or veil over vision

Symptoms of Less Concern

• Flashes and floaters

• Symptoms 6 to 12 week timescale

• Normal vision

Investigations per protocol

Negative Signs Positive Signs

Hospital Eye Service

Discharge with advice


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9.2 History and Symptoms A full and thorough history and symptoms is essential. In addition to the normal history and symptoms, careful attention must also be given to the following: 9.2.1 History

• Age (over 50 year olds more likely to develop breaks) • Myopia (over -3D) • Family history of retinal break or detachment • Previous ocular history of break or detachment • Systemic disease (e.g. Diabetes, Marfan syndrome) • History of recent ocular trauma, surgery or inflammation

9.2.2 Symptoms The following table summarises the key symptoms and additional questions that should be asked

Symptoms Additional Questions Floaters • Are floaters of recent onset?

• What do they look like? • How many are there? • Which eye do you see them in?

Flashes • Describe the flashes? • How long do they last? • When do you notice them?

Loss or distortion of vision (a curtain shadow or veil over vision)

• Where in the visual field is the disturbance? • Is it static or mobile? • Which eye? • Does it appear to be getting worse?

Symptoms of less concern:

• Long term stable flashes and floaters • Symptoms 6 to 12 weeks

9.3 Clinical examination All patients presenting for a MECS examination with symptoms indicative of a potential retinal detachment should have the following investigations (in addition to such other examinations that the optometrist feels are necessary):

1. Tests of pupillary light reaction including swinging light test for Relative Afferent Pupil Defect (RAPD), prior to pupil dilation

2. Visual acuity recorded and compared to previous measures 3. Tonometry, noting IOP discrepancy between eyes 4. Visual Field examination at discretion of optometrist 5. Slit lamp bio microscopy of the anterior and posterior segments, noting:

a. Pigment cells in anterior vitreous, 'tobacco dust' (Shafer’s sign) b. Vitreous haemorrhage c. Cells in anterior chamber (mild anterior uveitic response)

6. Dilated pupil fundus examination with slit lamp binocular indirect ophthalmoscopy using a Volk or similar fundus lens (wide field fundus lens optimal) asking the patient


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to look in the 8 cardinal directions of gaze and paying particular attention to the superior temporal quadrant as about 60% of retinal breaks occur in that area. Noting:

a. Status of peripheral retina, including presence of retinal tears, holes, detachments or lattice degeneration

b. Presence of vitreous syneresis or Posterior Vitreous Detachment (PVD) c. Is the macula on or off (i.e. does the detachment involve the macula or not)

7. Alternatively, if the optometrist is familiar and confident then a dilated pupil fundus examination with headset binocular indirect ophthalmoscopy using a 30D lens with scleral indentation or a fundus contact lens could be used.

9.4 Management 9.4.1 Symptoms requiring assessment within 24 hours:

a) Sudden increase in number of floaters, patient may report as "numerous", "too many to count" or “sudden shower or cloud of floaters” Suggests blood cells, pigment cells, or pigment granules (from the retinal pigment epithelium) are present in the vitreous. Could be signs of retinal break or detachment present

b) Cloud, curtain or veil over the vision. Suggests retinal detachment or vitreous

haemorrhage – signs of retinal break or detachment should be present 9.4.2 Signs requiring referral within 24 hours

a) Retinal detachment with good vision unless there is imminent danger that the fovea is about to detach i.e. detachment within 1 disc diameter of the fovea especially a superior bulbous detachment, when urgent surgery is required.

b) Vitreous or pre-retinal haemorrhage c) Pigment 'tobacco dust' in anterior vitreous d) Retinal tear/hole with symptoms

9.4.3 Signs requiring referral ASAP next available clinic appointment

1. Retinal detachment with poor vision (macula off) unless this is long standing 2. Retinal hole/tear without symptoms 3. Lattice degeneration with symptoms of recent flashes and/or floaters

9.4.4 Require discharge with SOS advice (verbal advice and a leaflet)

1. Uncomplicated PVD without signs and symptoms listed above 2. Signs of lattice degeneration without symptoms listed above

Explain the diagnosis and educate the patient on the early warning signals of further retinal traction and possible future retinal tear or detachment:

• Give the patient a Retinal Detachment warning leaflet • Instruct the patient to return immediately or go to A&E if flashes or floaters worsen

9.5 Referral to Hospital Eye Services Patients requiring referral for retinal breaks or detachment must have the following noted on the referral form to the ophthalmologist. Letters should be typed whenever possible and may be faxed or sent with the patient in urgent cases.


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• A clear indication of the reason for referral e.g. Retinal tear in superior temporal periphery of right eye

• A brief description of any relevant history and symptoms • A description of the location of any retinal break / detachment / area of lattice • In the case of retinal detachment whether the macula is on or off. • The urgency of the referral

9.5.1 Record Keeping Requirements Optometrists are reminded to keep full and accurate records of all patient encounters. This includes when the patient is spoken to on the telephone (by the optometrist or another member of staff) as well as when they are in the consulting room. All advice that is given to the patient should be carefully noted, together with any information that was given to the patient. 10. Age-related Macular Degeneration (AMD) 10.1 Pathway

Patient Presents to MECS

Clinically Significant Symptoms

• Loss of vision of recent onset

• Spontaneously reported visual distortion

Symptoms of less concern

• Longstanding loss of vision

• Gradual deterioration in vision

• Normal vision

Investigations per protocol

Positive Signs. Suspected wet AMD or other macula pathology

Negative Signs

Community Optometrist of

Special Interest

Discharge with Advice Hospital Eye

Service


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10.2 History and symptoms

A full and thorough history and symptoms is essential. In addition to the normal history and symptoms, careful attention must also be given to the following: History

• Age (over 55 years) • Family history of maculopathy • Previous ocular history • Systemic disease e.g. hypertension, diabetes • History of ocular surgery- cataract extraction, retinal detachment repair • Myopia • Medication e.g. chloroquine derivatives, tamoxifen • Smoking status (current, ex-smoker or non-smoker) • Excessive exposure to sunlight (UV)

Symptoms

• Any change in vision • Loss of central vision • Spontaneously reported distortion of vision

These additional questions should be asked:

• When did loss of vision start? • In which eye are symptoms present? • Has the loss of vision occurred suddenly or gradually?

10.3 Clinical Examination All patients presenting for a MECS examination with symptoms indicative of a potential macular degeneration should have the following investigations (in addition to such other examinations that the optometrist feels are necessary):

1. Visual acuity (distance and near) recorded monocularly and compared to previous measures

2. Refraction as a hyperopic shift can be indicative of macular oedema 3. Amsler grid or similar assessment of central vision of each eye 4. Tests of pupillary light reaction including swinging light test for Relative Afferent

Pupil Defect (RAPD), prior to pupil dilation 5. Dilated pupil fundus examination of both eyes with slit lamp binocular indirect

ophthalmoscopy using a Volk or similar fundus lens noting: Status of macula, including presence of:

a. Drusen, noting size b. haemorrhages, sub-retinal, intra-retinal, pre-retinal c. pigment epithelial changes i.e. hyper or hypo pigmentation, d. exudates e. oedema i.e. sub-retinal fluid f. signs of sub retinal neovascular membrane

10.4 Management


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Suspect wet AMD cases should be referred to the closest hospital eye service located in:

• Queen Victoria Hospital (East Grinstead) • Royal Sussex County Hospital (Brighton) • Surrey and Sussex Healthcare NHS Foundation Trust (Redhill)

Action Criteria Urgent Referral to Hospital Eye Service

1. Sudden deterioration in vision + VA better than 6/96 in affected eye

2. Spontaneously reported distortion in vision + VA better than 6/96

3. Sub-retinal neovascular membrane 4. Macular haemorrhage 5. Macular oedema

Referral to Community Optometrist of Special Interest (AMD)

1. For any suspect wet macula pathology

Follow Up by MECS service

1. Patients with VA 6/96 or worse in the affected eye 2. Patients with dry AMD, drusen and/or pigment

epithelial changes a. Explain the diagnosis and educate the patient on

the early warning signs of wet AMD. b. Give stop smoking advice via leaflet if appropriate

+ advice on healthy diet + protection from blue light

c. Assess the risk of AMD progression by looking for large drusen (about the size of a vein at the disc margin or larger) and pigmentary changes. If these are both present bilaterally there is a 50% chance of progressing to advanced AMD within 5 years5. Give advice on a healthy diet unless there is moderate loss of vision or significant risk of loss. Provide information on AREDS findings & leaflet on AREDS 2 supplements

d. Give information on local services for the visually impaired- public and third sector.

e. Give appropriate information on national voluntary agencies e.g. RNIB, Macular Disease Society

f. Give advice on driving g. Instruct the patient to inform the practice or GP

immediately if vision suddenly deteriorates or becomes distorted.

10.5 Referral For referral to the Royal Sussex AMD Triage service, the COSI referral form (downloadable from the LOC website) should be used. This is the principal pathway for optometrists who would normally refer to Brighton Sussex University Hospitals NHS Trust. For referral to Surrey and Sussex Healthcare: Preferred contact via email [email protected] (and attach patient history) Fax 01737 231856 Phone 01737 768511 ext 6679 (08:30-17:00hrs)


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For referral to Queen Victoria Hospital Trusts the following form should be used. www.college-optometrists.org/en/utilities/document-summary.cfm/docid/81143450-07B2-4A16-BA3ED6F3F7A86D77

a) Date b) Full name of referring optometrist and practice address c) Full details of patient including name, address, telephone number, date of birth d) Visual acuities e) A clear indication of the reason for referral e.g. macular haemorrhage f) A brief description of any relevant history and symptoms including onset g) A description of the type of macular degeneration or signs such as drusen, pigment

epithelial changes, sub retinal neovascular membrane, haemorrhages, exudates, macular oedema.

h) The urgency of the referral

10.6 Differential Diagnosis • Macular hole. This is a hole at the macula caused by tangential vitreo-retinal

traction at the fovea. Causes impaired central vision & typically affects elderly females

• Macular epiretinal membrane. Can be divided into cellophane maculopathy and macular pucker

• Central Serous Retinopathy. Typically, sporadic, self-limited disease of young or middle-aged adult males. Unilateral localised detachment of sensory retina at the macula causing unilateral blurred vision.

• Cystoid Macular Oedema. An accumulation of fluid at the macula most commonly due to retinal vascular disease, intra-ocular inflammatory disease or post cataract surgery,

• Myopic Maculopathy. Chorio retinal atrophy can occur with high myopia, usually > 6.00D, which can involve the macula.

• Diabetic Maculopathy. This is the commonest cause of visual impairment in type 2 diabetic patients. It can be exudative, ischaemic or mixed.

• Vitelliform Macular Dystrophy (Best Disease). There is an inherited condition with a juvenile and adult type.

• Solar Maculopathy. Due to the effects of solar radiation from looking at the sun causing circumscribed retinal pigment epithelium mottling or a lamellar hole at the macula.

• Drug Induced Maculopathies. Antimalarials e.g. chloroquine, hydroxychloroquine, Phenothiazines e.g. thioridazine (melleril), chlorpromazine (Largactil), Tamoxifen

• Idiopathic Macular Telangiectasia. This can be unilateral or bilateral. 11. Red Eye Guidelines

11.1 Pathway


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PatientPresentstoMECS

Optometrist takes history and symptoms; examines patient and makes initial

diagnosis

Manage in Practice • Bacterial Conjunctivitis • Non-herpetic viral conjunctivitis • Subconjunctival haemorrhage • Tear Dysfunction (e.g. Dry Eye) • Episcleritis • Marginal Keratitis • Superficial abrasions • Recurrent epithelial erosion

(RES) • Small corneal foreign bodies

o Remove • In growing eyelash

o Remove

Urgent telephone referral • Infective keratitis • Anterior uveitis • Posterior uveitis • Scleritis

Treat and advise

• Antimicrobials • Mast cell stabilisers • Ocular lubricants • Artificial tears • Topical antihistamines • Ibuprofen

Follow Up • Maybe necessary

depending on condition • E.g epilation, dry eye,

marginal keratitis, RES

No improvement? General none expected

Complete record and report to GP

Follow up in Secondary Care


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11.2 Optometric Assessment The College of Optometrists have produced Clinical Management Guidelines (CMGs) to provide an evidence based information resource on the diagnosis and management of various eye conditions. There are currently 60 of these CMGs, the vast majority of which could apply to red eyes. These Clinical Management Guidelines were originally intended for specialist therapeutic prescribers but they are valuable to all optometrists.

11.3 History and Symptoms A full and thorough history and symptoms is essential. Careful attention must be given to the following as appropriate: 11.3.1 History

• Previous ocular history • Systemic disease, especially diabetes, thyroid dysfunction and inflammatory disease

e.g. rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease • Recent cold, flu or infections • Acne rosacea • History of contact lens wear • History of recent ocular trauma, pay particular note to hammer and chisel i.e. risk of

penetrating injury and to possible chemical contamination • History of recent ophthalmic surgery • History of recent UV exposure e.g. sunlamp, welding • Atopia e.g. hayfever, asthma, eczema • Recent foreign travel • Instillation of any eye drops, if so what are they? • Systemic medication • Allergies to drops, preservatives, medications • Family history

11.3.2 Symptoms

• Discomfort, gritty sensation • Itchiness • Pain - sharp or aching on a scale of 1-10 • Discharge - watery, purulent, mucoid • Unilateral or bilateral • Duration of onset

• Acute, recurrent or chronic • Photophobia • Reduced vision • Any predisposing factors

11.3.3 Clinical Examination Include the following as appropriate according to symptoms and history:

• Visual acuity • Pupil reactions – particularly check for RAPD (relative afferent pupillary defect)


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• Ocular motility • Exophthalmos • Eyelids – inflammation, incomplete closure, ptosis, position & size of any lumps &

bumps, misdirected eyelashes, lid margin disease (blepharitis, meibomianitis, phthiriasis i.e. crab louse, punctae (normal, occluded, absent, stenosed or plug inserted)

• Tears – quality and quantity plus tear break-up time • Discharge – serous, watery (viral toxic), mucopurulent (bacterial) or stringy (allergic) • Bulbar conjunctiva – redness (use grading scale e.g. CCLU) note depth of vessel

injection (conjunctival, episcleral, sclera) and location (perilimbal, sectoral, diffuse, localized) subconjunctival haemorrhage, pigment, raised areas

• Palpebral conjunctiva – evert upper and lower lids to look for foreign bodies, scarring, membranes, papillae, follicles & concretions.

• Corneal epithelium – note any defects (size, location, pattern e.g. superficial punctate keratitis, dendritic, geographic) FBs, infiltrates (pattern, size, location, depth), oedema, deposits (location, pattern, material e.g. iron, calcium, filaments)

• Corneal stroma – size, location & depth of opacities- infiltrates, scars, oedema. Note any vessel infiltration – ghost or active vessels

• Corneal endothelium – thickening guttatae, folds or breaks in Descemets’ membrane, location, pattern & type of any deposits (KPs, pigment, blood)

• Anterior chamber – depth & Van Herrick assessment of anterior angles. Any cells, flare or blood

• Iris – heterochromia, atrophy, nodules, pigment dispersion, posterior synechiae, new vessels (note is not unusual to see vessels in light coloured irides), peripheral iridotomy.

11.4 Management Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere.

Symptoms requiring emergency referral

• Sudden severe ocular pain • Severe photophobia • Unexplained sudden loss of vision • Painful red eye in CL wearer, unless due to FB/torn CL,

(retain CLs, case and solutions for culture) • Severe trauma

Signs requiring emergency referral (to eye casualty, ophthalmic outpatient clinic or accident and emergency)

• Circumcorneal flush • IOP>45mmHg • Chemical injury • Hyphaema • Hypopyon • Penetrating injury or deep corneal foreign body • Corneal ulcer unless small and marginal • Cells or flare in anterior chamber • Dendritic ulcer in CL wearer (possible acanthamoeba) • Deep corneal abrasion • Corneal abrasion contaminated with foreign material • Proptosis, restricted eye movements, pain with eye

movement, pyrexia (fever >38c) Signs requiring urgent referral (within one week)

• Rubeosis (new iris vessels) • IOP >35mmHg (and <45mmHg) unless due to acute

closed angle glaucoma • New case of facial palsy or those with loss of corneal

sensation


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• Pyrexia (fever >38c), with lid oedema, warmth, tenderness & ptosis

Symptoms requiring routine referral

• Slow developing, non-resolving lesion of eyelid skin • Epiphora causing symptoms

Signs requiring routine referral

• Non-resolving lid lump • Severe ectropion with symptoms • Entropion • Obstructed naso-lacrimal duct • Pterygium threatening vision or associated with chronic

inflammation

11.5 Referral Urgent and emergency referral letters may be faxed or sent with the patient. Telephone the ophthalmic casualty unit or ophthalmic unit to arrange for the patient to be seen. Routine referral letters should be typed whenever possible and sent to the GMP unless there are other local arrangements in place e.g. referral centres. All referral letters/forms should include the following:

• Date & full name of referring optometrist & practice address • Full details of patient including name, address, telephone number, date of birth,

reason for referral, supporting signs and symptoms; reports of relevant tests/ investigations, including copies of any supplementary data

• A clear indication of the reason for referral • Provisional diagnosis • Indication of urgency • Clearly state if the report is for information only

B. Service Specifications


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Service Specification No. 2

Service Local Commissioned Service for Level 1: Intraocular Pressures (IOP) Repeat Readings Service

Commissioner Lead DianeGilmour,ProgrammeManager,Plannedcare

Provider Lead

Period 2016 - 2017

Date of Review

1. Background

This Locally Commissioned service (LCS) relates to the financial year 2016-2017

The specification of this service is designed to cover the enhanced aspects of clinical care of the patient, all of which are currently presumed by this CCG to be beyond the scope of essential services and the quality and outcomes framework or funded under other service provision. 2. Service Outline Scope of service to be provided IOP repeat readings service (level 1a) part 1 This service provides for the assessment and management of patients who attend the practice for a GOS or private sight test and are found to have IOP > 21mmHg. The aim of this LCS is to enable ophthalmic practitioners to refine their own referrals for glaucoma prior to deciding whether or not a patient should be referred. This can be achieved by repeating suspicious intra-ocular pressure (IOP) measurements using contact applanation tonometry, at the time of the sight test, and in the event that the IOP continues to be at a level where referral is required, again on a different day. A primary care glaucoma repeat readings service would deflect unnecessary referrals and is within the basic competency of community optometrists. Agreed equipment would be specified. 2.1 Description

Goldmann style applanation tonometry repeat readings: A first level community service for IOP refinement where other signs of glaucoma are not present will reduce unnecessary referrals to the hospital eye service, reducing patient anxiety and minimising capacity issues within the already overburdened hospital glaucoma clinics. The service will be cost effective with a greater number of patients managed within the primary care setting. Level 1a (Part 1) Patients who are identified as having IOP > 21 mmHg and no other signs of glaucoma during a GOS or private sight test will have immediate slit lamp GAT or Perkins tonometry assuming the optometrist is contracted to provide the service. This service falls within core competencies for optometrists. Set up costs of purchasing tonometers should be considered.


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Outcomes Guidance from the College of Optometrists and the Royal College of Ophthalmologists recommends that the outcome should be dependent on the patient’s age and they define certain groups who may not need referral. However, pressures should still be repeated on these groups to ensure that decisions are made based on reliable readings. There are four possible outcomes from this first repeat of pressures:

1. All patients with IOP > 31mmHg should be referred for OHT diagnosis without further IOP refinement

2. Other patients with a pressure of 22 - 31 need to proceed to Part 2 (2nd repeat pressure)

3. Pressures which differ between the eyes by 5 mmHg or more should proceed to Part 2 (2nd repeat pressure)

4. All other IOP results are within normal limits and the patient can be discharged. Level 1a (Part 2) Patient attends for repeat Goldmann or Perkins applanation tonometry on a separate occasion. Outcomes There are four possible outcomes from repeating this test:

1. Patients who need to be referred for OHT diagnosis based on confirmed IOP result: • Age Group < 65 years, Pressure > 21 mmHg • 65 – 79 years, Pressure > 24 mmHg • 80 years +, Pressure > 25 mmHg

2. Patients who could be referred direct to an OHT monitoring service who will need to

be referred for OHT diagnosis in the absence of an OHT monitoring service: • Age Group 65 – 79 years, Pressure 22 - 24 mmHg • 80 years +, Pressure 22 - 25 mmHg

NB: The Joint RCOpht/COptom's advice suggest that optometrists might "consider not referring" this group of patients as under the NICE Guidelines they will never need treatment. Whilst this is true, these patients however do still have OHT and need careful monitoring to pick up any signs of progression towards COAG. It is not appropriate to monitor these patients under GOS. These patients are not really in any of the groups specifically covered by NICE but the most appropriate way to deal with them is to make the assumption that the College's advice constitutes the establishment of a "management plan" as per para 1.5.6 of NICE CG85 and monitor these patients as having diagnosed OHT.

3. Where repeat applanation measurements show a consistent difference in pressure of 5 mmHg or more, practitioners may wish to consider whether referral may be appropriate, or whether there is a reasonable explanation (e.g. surgery to one eye).

4. The results are within normal limits and the patient can be discharged. At risk

groups should be monitored at appropriate intervals. IOP repeat readings service level 1c This service provides for the assessment and management of patients who are referred from non-participating or out of areas practices having been found to have IOP > 21mmHg Patients referred from non-participating practices will have:

• Slit lamp GAT or Perkins tonometry • Optic disc assessment +/- photos


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• Anterior angle assessment – Van Herrick • Visual field assessment • Visual Acuities

Patients whose result show any sign of glaucoma other than IOP > 21mmHg should be referred to ophthalmology. Patients with IOP > 21mmHg and no other signs of glaucoma should follow IOP Level 1a 2.2 Access to the service The service is accessed by patients direct from the local ophthalmic practitioner following a GOS or private sight test. Patients presenting with any abnormality not covered by this contract should be managed as per the West Sussex LOC guidelines (see LOC website www.westsussexloc.org.uk). 2.3 Eligibility to provide the service

1.1 The service will be provided by local ophthalmic practitioners working within the NHS Crawley CCG and NHS Horsham and Mid Sussex CCG area. The local ophthalmic practitioners providing the service will be:

• in possession of a contact tonometer (Goldmann/Perkins hand held contact tonometer),

• able to provide a timely appointment • registered with the General Optical Council • following NICE Guidelines and GOC required procedures

2.4 Satisfactory facilities In addition to the requirements of clause 25, the Contractor shall meet the following non exhaustive list of requirements-

• Whilst managing a patient, the consulting room shall not be used for any other purposes.

• Hand washing with hot/cold water to be available. • Liquid Soap. • Alcohol Gel. • Paper towels.

• Single use items – including minims, tonometer heads • Washable work surfaces. • Floor and wall surfaces to be maintained in a clean and hygienic manner. • Cleanable lighting, especially lighting close to the patient.

2.5 Special requirements – equipment All practices participating in the Level 1 IOP repeat readings service will be expected to employ an accredited optometrist and have the following equipment available:

• Access to the Internet • Goldmann applanation tonometer (Perkins acceptable for IOP refinement) • Threshold fields equipment capable of producing a printed report • Distance test chart

Appropriate ophthalmic drugs (Anaesthetic, Staining agents) 3. Clinical Governance As per Schedule 5 of the contract. 4. Accreditation & Qualifications


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The Contractor shall ensure all ophthalmic practitioners employed or engaged by the Contractor are confident and competent in respect of the provision of the enhanced services.

A LOCSU training and accreditation package for Level 1 IOP repeat readings has been developed in conjunction with the Welsh Optometric Post-Graduate Education Centre (WOPEC), and is available to optometrists in England and Wales via their LOC or ROC. Ophthalmic practitioners will be required to attend a training session run by the LOC and CCG, primarily to cover the admin procedures and protocols involved in providing the locally commissioned service. The training session will cover:

• An introduction to the service • Administration of the service including protocols, processes and paperwork or IT

The Contractor shall be responsible for ensuring that all persons employed or engaged by the Contractor in respect of the provision of the services under the Contract are aware of the administrative requirements of the service. The Contractor shall ensure that any additional ophthalmic practitioners who are to provide the IOP Repeat Readings Service for patients presenting at the practice premises, have read and understood this service specification and are qualified to provide the enhanced service. The contractor shall also provide, at their cost, an annual education event for all participating ophthalmologists. The date, venue and agenda to be agreed with Horsham and Mid Sussex CCG. 5. Pricing Payment for the service is on a cost per case arrangement. NHS Crawley CCG and NHS Horsham and Mid Sussex CCG shall pay the Contractor £34 per patient for the first appointment involving contact tonometry (at the time of the eye test) and £25 for the follow up appointment involving contact tonometry. Payments for referrals from non-participating optometrists will be paid £64 for the first appointment at the participating optometrist. For the avoidance of doubt, no payment shall be made by the NHS Crawley CCG and NHS Horsham and Mid Sussex CCG in respect of patients that do not attend a scheduled appointment (DNAs). 6. Performance Monitoring & Key Performance Indicators (KPIs) The ophthalmic practitioner shall fully complete an accurate Optometric Patient Record using Optomanager (Webstar). 6.1 Performance reporting and audit The ophthalmic practitioner is required to input all activity data and patient outcomes onto Optomanager (Webstar), from which a report will be provided via Optomanager (Webstar) to the CCG on a monthly basis. Clinical Governance issues shall be reported by the Contractor to the CCG by exception, in accordance with paragraph insert. Complaints shall be reported annually by the Contractor to the CCG. Other relevant information required from time to time by the CCG shall be provided by the Contractor in a timely manner. 6.2 KPIs:

• Referrals made using the agreed template/recorded on Optomanager - 100% • 2nd repeat test to have taken place within 2 weeks - 95%


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• No. & % of appointments referred onto secondary Care - less than 30% • % of patients referred into secondary care within 2 working days of being assessed

and requiring referral - 100% • % of appointments directly referred onto secondary care within 24 hours with

readings over 31mmHg - 100% • Report to be sent to patients GP within 2 working days of onward referral - 100% • Referrals that meet threshold - 100%

7. Breach and Termination As per Schedule 6 of the Contract.


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A1. Specialised Services – Derogations from National Service Specifications

Not Applicable


41


C. Indicative Activity Plan

Not Applicable – zero based activity contract


42


D. Activity Planning Assumptions

Not Applicable


43


E. Essential Services (NHS Trusts only)

Not Applicable


44


F. Essential Services Continuity Plan (NHS Trusts only)

Not Applicable


45


G. Clinical Networks

Not Applicable


46


H. Other Local Agreements, Policies and Procedures Policy Date Weblink


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I. Transition Arrangements

Not Applicable


48


J. Exit Arrangements

Not Applicable


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K. Transfer of and Discharge from Care Protocols

Not applicable


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L. Safeguarding Policies and Mental Capacity Act Policies

CCG Safeguarding Benchmarking policyx.pdf

CCG Safeguarding Policyx.pdf

CCG Safeguarding Strategy.pdf

CCG Training Strategyx.pdf


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M. Provisions Applicable to Primary Care Services

Not Applicable


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SCHEDULE 3 – PAYMENT

A. Local Prices Enter text below which, for each separately priced Service: • identifies the Service; • describes any agreement to depart from an applicable national currency (in respect of

which the appropriate summary template (available at: http://www.monitor.gov.uk/locallydeterminedprices) should be copied or attached)

• describes any currencies (including national currencies) to be used to measure activity • describes the basis on which payment is to be made (that is, whether dependent on

activity, quality or outcomes (and if so how), a block payment, or made on any other basis)

• sets out any agreed regime for adjustment of prices for the second and any subsequent Contract Year(s).

Payments are: Cataract Referral and Post-Operative Examination Tariffs Pre-op/Pre-referral assessment £34 Post-op check appointment £34 All of the above include the fee to be paid to the Optometrist (£25), OptoManager (£6), LOC Company (£3) Intraocular Pressures (IOP) Repeat Readings Tariffs - Referrals from participating practices 1st repeat £34 tariff includes Optometrist (£25), OptoManager (£6) & LOC Company (£3) 2nd repeat £25 tariff comprises Optometrist (£25) only), where 1st IOP >21mmHg and ≤31 mmHg. Tariffs - Referrals from non-participating practices 1st repeat £64 tariff includes Optometrist (£55), OptoManager (£6) & LOC Company (£3) 2nd repeat £25 tariff comprises Optometrist (£25) only, where 1st IOP >21mmHg and ≤31 mmHg.


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A. Local Variations For each Local Variation which has been agreed for this Contract, copy or attach the completed publication template required by Monitor (available at: http://www.monitor.gov.uk/locallydeterminedprices) – or state Not Applicable. Additional locally-agreed detail may be included as necessary by attaching further documents or spreadsheets.

Not Applicable


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B. Local Modifications

For each Local Modification Agreement (as defined in the National Tariff) which applies to this Contract, copy or attach the completed submission template required by Monitor (available at: http://www.monitor.gov.uk/locallydeterminedprices). For each Local Modification application granted by Monitor, copy or attach the decision notice published by Monitor. Additional locally-agreed detail may be included as necessary by attaching further documents or spreadsheets.

Not Applicable


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C. Marginal Rate Emergency Rule: Agreed Baseline Value

Not Applicable


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D. Emergency Re-admissions Within 30 Days: Agreed Threshold

Not Applicable


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E. Expected Annual Contract Values Commissioner Expected Annual Contract Value

(Exclude any expected CQUIN payments. CQUIN on account payments are set out separately in Table 2 of Schedule 4E, as required under SC38.3.)

CWS CCG Nil - zero based activity contract

Total


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F. Notices to Aggregate / Disaggregate Payments

Not Applicable


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G. Timing and Amounts of Payments in First and/or Final Contract Year

Not Applicable

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