How the PCT can help you

Bill Millar, WK PCT Richard Woolterton, Medway PCT John Jones, ECK PCT

• Named PCT contacts for contract enquiries • KPCA for OPL enquiries – will deal promptly with enquiries as to listing for K&M practitioners • Optometric Adviser to answer clinical queries • KPCA to answer payment queries • Meetings with LOC to discuss contractual issues • Dissemination of shared learning

Contract Type

• Mandatory Services • Additional Services (Domiciliary) • Individual • Partnership (General or Limited) • Corporate Body Model contract available at www.primarycarecontracting.nhs.uk/298

Clinical obligations

• Contractor has responsibilities under the new Contract. These are in addition to the professional responsibilities imposed on the OP by virtue of their registration.

• Failure to comply with those responsibilities can lead to termination of the Contract

Clinical Audit

• Kent LOC’s sight test framework lists the procedures that would normally be included in a sight test.

• Record audits have shown that this is often not complied with.

• Contractual duty to keep ‘full accurate and contemporaneous record’ of sight testing.

• Clinical Audit advice available from the PCT • Other areas for audit include – Are all NHS forms correctly filled in?

– Is the basic stock of drugs always available and in date?

Payment analysis

• National figures for prism and tint prescribing available on DH website.

• Practices can compare themselves with these figures as part of Peer Review.

• Reasons for outliers should be investigated, as may indicate performance issues.

Performance review

• Contractual obligations to ensure that terms of the contract are met.

• Systematic failings (‘what you do’) likely to be be considered as part of the contract and the responsibility of the Contractor.

• Clinical failings (‘how you do it’) more likely to be considered as performance review, although it may also show up contractual failings (e.g. record keeping).

Contractual issues

• Records – Need to be full and complete, stored securely – Contractor’s responsibility • Systems – Admin (NHS forms etc) – Infection control – H&S

Performance issues

• Quality of records – is what is written on them correct (rather than complete)?

• Quality of sight test – non tols?

• Px complaints • May overlap with contractual issues

Examples 1

• On analysis of a sample of records, the contractor notices that performer A consistently omits a record of the patient’s ocular muscle status. The contractor is not sure whether this is because the performer does not measure the patient’s OMB, or forgets to write it down.

• Is this contractual or performance?

Examples 2

• It is noticed that a performer sometimes prescribes prescriptions that are clinically insignificant. • Contractual or performance?

Examples 3

• Feedback from the hospital reveals that patients are being inappropriately referred as glaucoma suspects. The hospital finds that the IOP readings written on the referral letter are considerably higher than found at the hospital • Contractual or performance?

Examples 4

• It is noticed that patients are being referred with field defects that are not confirmed by the hospital • Contractual or performance?

Performance review: contractors

• Contractors should monitor the performance of their performers • Have procedures in place to support performers • Appraisals, PDPs… • Constructive, not disciplinary • Can ask for support from PCT

Performance review: PCT

• Aim is constructive and remedial rather than disciplinary • Action plan developed by practitioner to address issues raised – often jointly monitored by PCT and Contractor • If no progress made, case may be referred to GOC/GMC as last resort

Overview of Process in Medway

* QOF * Complaints/SUI * Prescribing * Contractual Issues * Commissioning Issues

Quality Development Group (QDG)

PCT Board

report Decision Making Group (DMG) trends

Patient Safety Group Assessment

Performance Advisory Groups (PAGs)

Other Health Economy PAGs

• John Jones, ECK PCT (until 31 July 08) – 01304 222227 [email protected]

– Jayne MacDonald [email protected]

– 01304 222234 • Bill Millar, WK PCT – 01474 360575 [email protected]

• Richard Woolterton, Medway PCT – 01634 382746 [email protected]

• Samantha Harris, KPCA – 01622 655126 [email protected]

• Christine Pearson, KPCA – 01622 655061 [email protected]

• Susan Blakeney, Optometric Adviser – 020 8308 1770 [email protected]

LOC Contact Details

• Chairman, Dr Huw Pinney • Admin Secretary, David Lacey – 01322 660388 [email protected]