Published: 25/11/2004, Volume II4, No. 5933 Page 7
Eleventh-hour guidance has been issued to avert a row which risks derailing the government's flagship patient choice initiative.
The policy, which will offer patients choice of treatment provider at the point of GP referral, is due to be rolled out across the NHS by December 2005 as part of the 'choose and book' agenda. But it starts in January for all new patients awaiting cataract operations.
Primary care trusts will be expected to ensure that at the point of referral new cataract patients are offered a choice of at least two surgery venues, with surgery to be carried out within three months of first outpatient appointment.
But there are fears that the policy has failed to engage and incentivise the optometrists who are key to its implementation. Optometrists are alarmed at the assumption of some PCTs that they will be required to refer patients directly for surgery and offer them a choice of venues, as they say the existing general optical services (GOS) contract with the NHS only pays them to perform a sight test.
'PCTs presumed it was part of optometrists' duty under GOS to directly refer [cataract patients], ' said Association of Optometrists head of professional services Patricia O'Sullivan. 'But that is not the case, which is why before choose and book a lot of cataract referral schemes were put in place where PCTs negotiated a fee for assessing and counselling a cataract patient.' 'Choose and book adds another dimension to a service that is additional, that has to be paid for, and this is where the confusion lies.' However, the guidance from DoH head of capacity, plurality and choice Bob Ricketts says the DoH is still 'seeking advice' from strategic health authorities on whether to issue central guidance on a range of fees that should be paid to optometrists for 'work outside their GOS work'. In the meantime, Mr Ricketts is advising PCTs to negotiate locally with optometrists on remuneration for their 'clinical role' in choice.
Some pilot PCTs have set up referral centres that will also make the choice offer - a move endorsed by the DoH. However, Ms O'Sullivan said this would be unacceptable to older patients and dilutes the original intention of the policy: 'Elderly people...can find the taking in of information over the phone difficult, and it would be equally difficult for them to make an informed choice under the circumstances.' She added: 'Referring a patient to a central clearing centre for onward distribution is not choice at the point of referral.' But the guidance accepts the possibility that the 'referral, choice offer and appointment booking will all be handled separately' and only requires PCTs to ensure the 'process is clear to everyone involved'.
The guidance also states that PCTs must ensure provider organisations on the choice menu can deliver treatment within the 'maximum three-month waiting time'.
SHAs have been told they must report that 100 per cent of providers in their patch are within the three-month target by the end of this year.
No comments yet