Health and Social Care Bill

Health and Social Care Bill

Written evidence to the Public Bill Committee

1 About us

1.1 The Optical Confederation represents the 12,000 optometrists, 6,000 dispensing opticians and 7,000 optical businesses in the UK who provide high quality and accessible eye care services to the whole population. The Confederation is a coalition of five optical bodies; the Association of British Dispensing Opticians, the Association of Contact Lens Manufacturers, the Association of Optometrists, the Federation of Manufacturing Opticians and the Federation of Ophthalmic and Dispensing Opticians.

2 Overview

2.1 The Confederation welcomes the principles of the Bill to abolish PCTs and SHAs and to reinvest the savings in frontline care. Bureaucracy has escalated significantly in our areas of the health service over recent years, with no demonstrable benefits to patients. We therefore welcome the measures to reduce the administrative and unnecessary regulatory burdens on frontline care.

2.2 We also support the measures to give greater choice and control to patients. This is an area where we excel, where patients are able to choose where they go for a sight test (close to where they live or work) at a time and location that is convenient to them. The highly competitive, open market in which community optical practices already operate delivers high levels of quality, access and choice to all patients, including those that are confined to their homes. Being a national service, set out in regulations, regulated by the General Optical Council and market-led, the funding genuinely follows the patient and the system delivers accessible care without waiting, wherever patients want it, the length and breadth of the country. Almost uniquely in the NHS, in eye care money directly follows the patient and practices compete for each and every patient. If not, they go out of business and others move in to take their place.

2.3 We very much welcome the proposal to keep this efficient and high quality service as a national service commissioned by the NHS Commissioning Board. We also welcome the measures to improve health outcomes and the new public health role for Local Authorities.

2.4 We do however have some concerns regarding the detail of certain clauses in the Bill and we ask Committee Members to consider these points in more detail.

3 Performers’ Lists held by the Board

3.1 Schedule 4, part 6, paragraph 58 makes provision for the power to establish Ophthalmic Performer Lists to be transferred from Primary Care Trusts to the NHS Commissioning Board, and we understand that the intention is for the NHS Commissioning Board to establish a national list of those ‘persons performing primary ophthalmic services’.

3.2 However our regulator, the General Optical Council, already keeps a Register which provides the same information, is publicly available online, and in our view is fit for purpose. If it is deemed not fit for the NHS Commissioning Board’s purposes, then the solution is to make it so, not to establish a duplicate system.

3.3 One argument often raised in support of a separate list is that the old listing arrangements include an additional parallel set of disciplinary functions which PCTs felt they needed in the old world. However if the NHS Commissioning Board has a problem with a contractor’s staff, it should raise the issue under ‘contractual terms’ and, if there is an issue with a professional as now the options would be;

· to send in a professional optometric adviser to review and support them

· or, if serious enough, to refer them to the General Optical Council (GOC) or the General Medical Council (GMC), according to the individual case.

3.4 We strongly believe it is the Regulator who should control and discipline practitioners and the GOC is modernising and streamlining its functions to be able to separate out more easily important issues from those that can be dealt with by administrative means.

3.5 In our view therefore, this is duplication of the regulatory bodies’ functions through an additional professional list which adds an additional tier of unnecessary bureaucracy, which is a throwback to the old days of PCT bureaucracy. Moreover, this adds costs both for the NHS Commissioning Board and the primary care professions. We would therefore ask the Government to seriously reconsider if these duplicatory arrangements are necessary in the Liberated NHS and to clarify the cost effectiveness of this move.

3.6. The explanatory notes to the Bill also refer to Clause 41 which inserts new section 125A in the NHS Act 2006, which allows the Board to consider matters such as those relating "to a contractor’s performance under its contract." This would suggest that there are adequate measures within the Primary Ophthalmic Services contracts to address any concerns regarding a contractor’s performance. In addition, as noted above, if there are concerns about practitioners locally, the NHS Commissioning Board can deal with this under its contractual powers possibly through a visit and recommendations by an optometric advisor or by referral to the GOC.

3.7 In our view, the solution to any problems under the Primary Ophthalmic Services contracts should be through the contracts themselves not through a separate and costly set of administrative and duplicatory arrangements.

4 Optometric Advice to GP Commissioning Consortia

4.1 Under Clause 22, "Commissioning consortia: general duties," new section 140 requires consortia to obtain appropriate advice from healthcare professionals which could include obtaining advice on commissioning decisions in relation to particular services or allow for healthcare professionals to be appointed to any committees the consortia wishes to set up to provide support on commissioning decisions.

4.2 At national level the four contractor professions – medical, dental, pharmacy and optometry – have made clear their united view that local representative committees [1] embrace the whole range of professions and modalities of care locally and are ideally placed to advise GP Commissioning Consortia on the commissioning of wider services in their professional areas.

4.3 It follows therefore that it would be sensible for GP Commissioning Consortia to consult for example Local Optical Committees, when considering the commissioning of optical and ophthalmology services (as well of course as the local hospital service and social care).

4.4 We would ask that Ministers ensure that a reminder about consulting the appropriate local representative committee is included in commissioning guidance to GP consortia.

5 NHS Commissioning Board

5.1 The Optical Confederation fully supports the Government’s decision to retain a national sight testing service commissioned by the NHS Commissioning Board. This will minimise transaction costs for the NHS and on front line care. It is not only very cost-effective but, as we have outlined above, already offers an efficient and high quality service to all patients.

5.2 However subsection (3) of clause 41, ‘Primary care services: directions as to exercise of functions’, inserts new section 125A into the NHS Act and provides a power of direction in relation to Primary Ophthalmic Services. This section allows for the Board to direct to a commissioning consortium to exercise any of the Boards functions relating to the provision of Primary Ophthalmic Services. We understand that will allow for commissioning consortium to commission enhanced eye care services – essentially those services outside the sight testing service.

5.3 We fully understand why enhanced eye care services, for example, shared care with hospitals and GPs, such as pre- and post-operation cataracts and stable glaucoma management need to be commissioned locally.

5.4 However, there are also identified single defined services - such as glaucoma referral refinement as recommended by NICE, and minor optical emergencies – which, on the same basis as the NHS sight test, should ideally be commissioned nationally against a national tariff in order to save transaction costs for GP Commissioning Consortia and front line providers.

5.5 If such standard national services were nationally commissioned, any optical practice which carried out such an item of service and would then simply submit a claim to the NHS Commissioning Board. If they did not, of course, no payment would be made. This would again save money and transaction costs throughout the system for standard nationally necessary services.

5.6 We ask Committee Members to ask the Minister what steps he is taking to ensure the NHS Commissioning Board give early consideration to this possibility. If, for whatever reason, it were not deemed possible, a nationally commended pathway to GP Commissioning Consortia could possibly go at least some way to achieving similar ends of efficiency and high quality without added bureaucracy.

6 Working with the Professions nationally

6.1. As the Bill itself recognises some services are best commissioned locally and some nationally and, in the case of nationally commissioned primary care services, we believe that the Bill should be strengthened to ensure that the NHS Commissioning Board has a duty to consult the relevant national representative and professional bodies within primary care. There are currently no requirements on the Board to consult these bodies such as the BMA, the PSNC, the Optical Confederation and the BDA and we believe the Bill should be amended to rectify this oversight.

7 Monitor

7.1 The Optical Confederation has welcomed the commitments given by the Department of Health that Primary Ophthalmic Services (in common with other primary care providers) do not need to be brought within the Monitor licensing regime. This is sensible and proportionate.

7.2 However we would urge the Government to ensure that commissioning guidance and model contracts produced by the NHS Commissioning Board, are explicit in recognising that, although not ‘Monitor licensed’;

· all appropriate tendering exercises should be open to primary care providers – in our case optical practices or consortia of optical practices

· "any willing provider" or "preferred willing provider" regimes should similarly be open to non-Monitor licensed primary care providers.

7.3 Otherwise, there is a risk that the paperwork will simply require all NHS providers bidding for work to be ‘Monitor-licensed’ as a matter of course which would rule out the optical and pharmacy sectors bidding for work, stifle innovation, and potentially seriously impair the development of local services for patients. (Clauses 76 & 77)

8 Duty on Local Authorities to consult Local Representative Committees

8.1 We are concerned that there is currently no duty on Local Authorities nor Health and Wellbeing Boards to consult their local representative committees when preparing strategic plans and strategies. Clause 176 (6) makes provision for the Local Authority to consult any ‘person it thinks appropriate’ when preparing the local Joint Strategic Needs Assessment. We are seeking an assurance that the Local Authority will have a duty to consult with the local representative committees.

8.2 Ensuring that Local Optical Committees are able to provide their expertise and advice in relation to eye health services, will be vital to improve the eye health of the local population. With rising levels of avoidable sight loss, placing a huge burden not only on the individual but on NHS and social care services, this major public health challenge must be part of the Joint Strategic Needs Assessment. Utilising the expertise of the Local Optical Committee in a collaborative nature, will ensure the local eye health needs are met.

8.3 Clause 177 makes provision for the Local Authority and GP Commissioning Consortia to produce a joint health and wellbeing strategy. Given the reasons outlined above the local representative committees must be consulted when devising these strategies.

8.4 Clause 179 places a duty on Health and Wellbeing Boards to encourage integrated working and to work closely with commissioners of health and social care services. As the local voice of expertise in primary care, the local representative committees, who represent providers of primary dental, pharmacy, optical and medical services, should be consulted. We believe that the Bill should be strengthened to ensure that Health and Wellbeing Boards consult these committees in respect of relevant services.

For further information please contact;

Heather Marshall
Head of Public Affairs, Optical Confederation
Email: heathermarshall@aop.org.uk
Telephone: 020 7202 8157

February 2011


[1] i.e. Local Medical, Dental, Pharmaceutical and Optical Committees