Alan Donnelly (Letters, August 22) raises a number of interesting points. With regards to the negotiation of the contract, I fully agree that it was a missed opportunity. My opinion is that the negotiators were led a merry dance by the DoH threatening to scrap the national pot for GOS and pretty much accepted all the other things thrown at them.
The terms of a contract are in no way a substitute for common sense. You already had to give opening hours under GOS terms of service, so there is no change there. The hours you specify are your usual opening hours and holidays and ad hoc changes due to illness are catered for in that. PCTs take a sensible line on that.
Our referral requirements have not changed. You do not have to refer to an ophthalmic hospital as DoH guidance makes clear (www.primarycarecontracting.nhs.uk/uploads/Optometry/May%2008/contract_regs_guidance_final.pdf Page 15).
The DoH issued specific guidance to PCTs that they were not to alter the contract from that agreed nationally (www.primarycarecontracting.nhs.uk/298) my main involvement in this has been picking up minor issues which local PCTs have tried to insert (through ignorance rather than malice).
Again it is worth pointing out that the College's remit is to uphold professional standards for the public, not to negotiate a better deal for the profession so it is unfair to blame them for the negotiated contract. This new contract really is very little different to the old arrangements (unfortunately).
Darren Kirton, Bath
I have followed with interest the continuing correspondence in your letters column over the last few weeks on the subject of the new NHS/PCT contracts and noted the apprehension bordering on despair of those colleagues taking the trouble to write. I have also had the opportunity to read one of these needlessly lengthy and complicated documents and to discuss its content with optometric colleagues.
Although I am not (or ever likely to be) an NHS/PCT contractor, I must say that I agree with the sentiment expressed by all of those participating in the discussion, that the best advice is to completely ignore it all as has always been the case and continue to do the job in the way that it has always been done, ie in the best interest of the patient as this is in fact the only way the NHS works, and keep in mind that famous and often quoted saying that: ‘Rules are for the guidance of wise men (or women) and the obedience of fools’.
The same would appear to be the case as far as section 6 of the rules on the sale/supply of contact lenses is concerned (quite what the difference is between sale and supply also seems open to interpretation). Your correspondent Mr Hamilton of daysoft is quite correct, all multiple companies using systems of supply direct from manufacturer to patient are in breach of this regulation every day, but then so are all practices whatever size as it just isn’t practical for a professional to be ‘In a position to intervene’ every time a patient collects their lenses.
So I would have to say that most of these regulations would be totally unenforceable should anyone charged with a breach of these rules use a competent litigation lawyer to defend them.
A much bigger problem is those manufacturers of contact lenses who, when receiving an order from a patient/customer for contact lenses of a different specification to that in their range, willingly supply their nearest alternative without regard for the patient’s well being (It has happened).
It makes me question why I should go to all the trouble of establishing exactly which lenses, in material, back surface radius, diameter and prescription are best suited to the patient’s clinical needs, together with the most compatible care regime, then hand a copy to the patient for it to be completely ignored by the lens supplier when the patient enters this information into the manufacturer’s website order form?
Finally, on what I would suggest is another serious issue, how can an optometrist serve as an optometric advisor to a PCT in whose area he/she has a practice, without being open to a charge of serious conflict of interest?
Richard S Morris
Great Sutton, South Wirral
Given the farce of the new contract, has any optometrist taken their PCT to court yet? Unfair contract forced at unfair speed on a minor party by a major party?
How much valuable practice goodwill have optometrists who have signed the contract given away for free? Is it all their GOS patients or only those GOS patients tested from now on? Given the perfidy of NHS in matters optometric, does anyone believe NHS assurances it will only be used as a last resort?
It is important that optometrists do not give anything away free. They should not let NHS have what it wants by word of mouth agreements outside the contract. They should strictly follow the contract and refer all patients to eye clinics and only agree to changing the contract to alter that when the NHS change the contract to make sure an optometrist’s records belong to the optometrist and the optometrist can change his opening hours or see clients outside opening hours whenever he wishes as long as he notifies the NHS.
By all means report on every diabetic/glaucoma/cataract etc by means of a small printed slip which you send with your forms for the PCT to sort and send on to GPs with the NHS internal mail. Get everyone to sign a slip to say they have received their test form and charge the NHS for the cost of designing and printing it (Design and print is not part of the GOS contract, hence a separate reasonable fee can be charged. I charge receptionist time out at £30 per hour). You can take the NHS to court if they don’t pay up. The small claims court is cheap and simple, with each side being responsible for its own costs.
I have a court date in November for my claim against my LHB for £11.15p. I’ll keep you posted.
Peter Harrop, Caernarfon
Maybe I’m biased, but surely everyone knows that it’s men who are not keen to wear their driving glasses! My colleagues (four female optoms) are all in agreement.
Has there been any other research done by insurance companies? Perhaps men would not be so honest with their answers.
I must congratulate ‘Sheilas’ Wheels’ for doing this research (News, August 22) because once again it highlights the fact that people drive with inadequate levels of vision (especially men).
Gill Syme, Glasgow
When a patient reports wavy lines or when an Amsler Chart test detects abnormalities the clock is already ticking. In my own case wavy lines were noticed on day two of my wet AMD. Day one was when I felt slightly nauseous.
How I wish that my pigment density could have been measured and interpreted before the clock had been wound up.
I look forward to the day when measuring macular protective pigment density is routine in all adults.
Harry H Marsland, Oundle