BUCKS LOCAL OPTICAL COMMITTEE
Ordinary Meeting - 20th October 2015
Present: Bruce Gilson (Chair), Angela McNamee (Secretary), Raj Shah (MK Lead), Claire Ranger, Alison Goodridge, Irfan Ahmed (Hospital Representative), Bharat Gandhi, Henry Leonard (CG Lead)
1) Apologies
None
2) Minutes of the last meeting (3 March 2015)
Accepted
3) Matters arising
Irfan Ahmed was welcomed back to the group as hospital representative and briefly updated the committee on current hospital matters. In a recent external quality assurance for diabetic screening, BHT scored very highly. There are issues with community practitioners being unaware of the outcome of their hospital screening appointments when they come for their GOS sight test; it was suggested that it would be helpful if practitioners had a call centre they could ring to verify that their findings corresponded with hospital findings, when deciding on management.
4) Officers and subcommittee reports (circulated prior to meeting)
- Chair
There are still no regular meetings with Thames Valley Area Team (TVAT) but Raj, Angela and Bruce continue to meet with Herts & South Midlands Area Team (for MK).
Bruce did attend a meeting to discuss reclaim issues arising from PPV visits; NHS England have confirmed that they are revising their protocols.
Bharat mentions that at a practice visit he was told that patients cannot attend before their NHS due date. The committee confirms that their understanding is that patients are allowed a calendar month leeway for GOS patients who present early for their sight test.
b. Secretary
We have arranged a number of educational events this year, which have been well received and there are more in the pipeline. The subject of narrow angles was discussed at AreebMoosavi’s talk in April; Claire reports that hospitals seem happy to perform iridotomies as a preventative measure when narrow angles are found by optometrists during routine sight testing.
MKCCG have used the LOC to gauge interest in commissioning a community glaucoma service; of the 14 practices who responded, 10 expressed an interest in this.
AVCCG and CCCG are still not able to tell us who is responsible for commissioning of community services.
Angela continues to field a range of queries from local practitioners.
c. Treasurer
Alison reports that the bank account is looking quite healthy, but this may be because the NHS appear to have paid us twice in September 2015, which may correct itself if and when the October payment is processed. In the past we have agreed that there should be around 3 months’ average expenditure as a cushion, which is around £10,000.
Alison is still looking into internet banking, but dual signatory accounts are only available as business accounts, which are expensive. A better option might be to have a spreadsheet of accounts which can be emailed to Bruce for approval. Bruce can also check payments made via the online account. Angela questions whether this is secure, but Alison confirms that this setup is no less secure than the current situation. The committee agreed that this proposal sounds quite reasonable.
The other concern with changing bank accounts is that the NHS payments agency are notoriously incompetent with administrative changes, and when this factor is combined with the incompetence of Natwest, problems are almost inevitable.
Alison reports that there are two sponsors who haven’t paid the money they promised for events. However, we have already been paid for an event in December 2015 by another sponsor. Bruce and Angela wonder whether we should be asking for payment in advance of the events in future.
d. Sub-committee leads
i) Mid & South Bucks
Webstar have given notice that, due to non-payment of their fees by the CCG, they will no longer provide the software to allow practitioners to use the glaucoma referral refinement scheme, effective from 6 November 2015, so we may need to notify practitioners that this pathway will no longer be running. Bruce reports that 84 patients have been put through the system over a recent 17 month period, with 34 practices (64 optometrists) accredited, although only 9 practices are still active. This represents around half the practices in Bucks. Bruce has discovered that some practices have not entered patients in the system if a referral was unnecessary, so further education on how to use the scheme may be necessary if it continues.
Irfan says the low number of patients seen could raise concerns about whether practitioners are competent to continue using the scheme and thinks it may be better to ensure practitioners maintain their skills in some way. HL points out that contact tonometry is a core competency and Raj feels that practitioners will not be willing to attend further training and re-accreditation, particularly when you consider the time involved for the small financial return. Irfan points out that the setup costs and low numbers of patients seen suggest that the scheme is not cost effective. Webstar currently charge the commissioner £2000, plus £200 per practice, per year, although they would consider a per patient charge of £6 if the numbers were higher.
HL feels that the LOC needs to issue some guidance to contractors about the glaucoma referral refinement scheme, if it seems likely that this will end. He wonders whether the committee should consider funding Webstar in the short-term to keep the scheme going, until the CCG agrees to continue funding the scheme. Bruce mentions that we still have some funds from when the scheme was set up, which could be used to fund Webstar in the short-term, but there is a concern that if we fund this, the CCG are even less likely to agree funding in future. Irfan suggests another option would be to ‘top-slice’ the fee, so that a proportion of the payment for each patient seen goes to Webstar. The problem with this idea is that the number of patients currently seen is unlikely to give Webstar an amount they would be happy with, although at the moment they are getting nothing.
It was felt that, given the time pressures, the LOC needs to make a decision about whether to fund Webstar in the short-term to avoid the scheme collapsing. It was pointed out that, if the scheme does collapse, it could undermine practitioner’s trust in future NHS funded local community services.
HL suggests that the LOC offer to fund Webstar for the next 6 months from the LOC’s reserve glaucoma fund, to keep the scheme up and running in the short term. This would give us time to try to find a contact at the CCG to negotiate with. Costs are approximately £8000/year, so the projected cost to the LOC would be around £4000. Angela says there are 25 practices who are not using the system currently, so in any renegotiation with Webstar we shouldn’t be agreeing to continue funding these practices to use the software.
It was agreed that we will approach Webstar to see if they would continue running the software until long-term funding is agreed with the CCG. We should emphasise to Webstar that we do not want the scheme to fold, we are chasing the CCG for outstanding payments, and ask whether they would be prepared to continue the scheme for the next six months, with renegotiated funding on the basis of the 9 practices that are currently using the scheme. Bruce points out the funds are not coming from the statutory levy, so there is no additional cost to contractors.
Action: Angela & Bruce to discuss options with LOCSU, before contacting Webstar
Work continues on setting up an OHT/Stable COAG community monitoring scheme. In light of the problems outlined above, it was felt that we should concentrate our efforts on resolving these issues, as it may be difficult to get practitioners on board with future community schemes if existing ones had collapsed.
The Mid & South Bucks Eye Care Forum has virtually become the Local Eye Health Network for TVAT, and Bruce is on the executive committee for this.
ii) Milton Keynes
Raj has produced a ‘Vision and Objectives’ sheet, outlining the function and vision of the LOC. In addition to being a useful reminder of our aims, this is a good way to introduce the LOC at education meetings and other forums, to explain our purpose.
Raj has begun to attend eyecare forum meetings every 2 months, which is also attended by the MKCCG. The Interim/Intermediate Community Ophthalmology Service (ICOS) pilot scheme service was supposed to finish in October 2015, but appears to have been extended. Irfan reports that this is often the case with ‘pilot scheme’ where there are difficulties in tendering for these services. Irfan suggests that it may be worth getting LOCSU involved in this if we want to become more involved in glaucoma pathways in the future. Bruce feels that there is more desire for locally commissioned services now.
iii) Clinical Governance
There have only been a few issues discussed amongst the group since the last meeting. This included discussions on waste disposal, and GOS reclaims.
5) LOC Vision and Objectives
Discussed above; the committee felt this was a useful document and were happy with the proposed draft.
6) AOB
Irfan stresses that practice must include GOC numbers when submitting HES vouchers for payment.
7) Date of next meeting
Tuesday 12 April
Meeting closed 10pm (3 hours)