The Primary Ophthalmic Services Amendment, Transitional and Consequential Provisions Regulations 2008

PART 2 TRANSITIONAL PROVISIONS IN RESPECT OF GENERAL OPHTHALMIC SERVICES PROVIDED BEFORE 1ST AUGUST 2008

Interpretation of Part 2

3.  For the purposes of this Part “relevant contractor” means an ophthalmic practitioner included in an ophthalmic list on 31^st July 2008 which enters into a general ophthalmic services contract and includes any contractor which is a partnership, one of whose partners was such an ophthalmic practitioner.

Investigation of outstanding complaints

4.—(1) Subject to paragraph (2), where before 1st August 2008—

(a) a complaint had been made under paragraphs 8A to 8C of Schedule 1 (terms of service) to the 1986 Regulations(1) by or on behalf of a patient or former patient of an ophthalmic practitioner; and

(b) the investigation of that complaint under the procedure required to be established under those paragraphs had not concluded,

that complaint must, on or after 1st August 2008, be investigated, or continue to be investigated, by the relevant contractor, as if those paragraphs had not been revoked and continued to have effect as in force on 31st July 2008.

(2) In a case where there is no relevant contractor the complaint must be investigated or continue to be investigated by the PCT on whose ophthalmic list the ophthalmic practitioner was included.

(3) Where a complaint falls to be investigated by a PCT under paragraph (2), the investigation shall be carried out in accordance with the Complaints Regulations.

Complaints relating to general ophthalmic services made after 31st July 2008

5.—(1) Subject to paragraph (2), the complaints procedure established and operated by a relevant contractor under the terms of its general ophthalmic services contract which gives effect to paragraph 22 of Schedule 1 (other contractual terms) to the Contracts Regulations shall apply to any complaint which a patient or former patient of the relevant contractor could have made (but did not make) on or before 31st July 2008 under paragraphs 8A to 8C of Schedule 1 to the 1986 Regulations, as it applies to complaints made by a patient or former patient of the relevant contractor in relation to any matter reasonably connected with the provision of services under the contract.

(2) In a case where there is no relevant contractor, the complaint must be investigated by the PCT in whose area the general ophthalmic services were provided.

(3) Where a complaint falls to be investigated by a PCT under paragraph (2), the investigation shall be carried out in accordance with the Complaints Regulations.

Recovery of Overpayments

6.—(1) Where, before 1st August 2008, an ophthalmic practitioner had admitted an overpayment drawn to its attention by a PCT under regulation 12(2) (payment for services) of the 1986 Regulations(2), but the overpayment, or any part of it, had not been recovered before that date, the amount overpaid, or the part of it not recovered, shall continue to be recoverable by that PCT and be treated as a debt owed by that ophthalmic practitioner to that PCT, notwithstanding the revocation of the 1986 Regulations.

(2) Notwithstanding the revocation of the 1986 Regulations, where a PCT considers that a payment has been made to an ophthalmic practitioner under the Statement when it was not due and that alleged overpayment has not been drawn to the ophthalmic practitioner’s attention by the PCT before 1st August 2008, that PCT may draw that overpayment to the attention of the ophthalmic practitioner and—

(a) where the overpayment is admitted by the ophthalmic practitioner, the PCT may recover the amount overpaid from the ophthalmic practitioner as a civil debt; and

(b) where the overpayment is not admitted by the ophthalmic practitioner —

(i) the arrangements for appeals referred to in regulation 12(2)(b) of the 1986 Regulations as in force on 31st July 2008, as those arrangements had effect on 31st July 2008, shall apply,

(ii) if the ophthalmic practitioner does not appeal or appeals unsuccessfully, the PCT may recover the amount of the civil debt.

(3) Where, before 1st August 2008, a PCT has drawn a possible overpayment under the Statement to the attention of an ophthalmic practitioner, and the overpayment has not been admitted by the ophthalmic practitioner, then notwithstanding the revocation of the 1986 Regulations—

(a) the arrangements for appeals referred to in regulation 12(2)(b) of the 1986 Regulations, as in force on 31st July 2008, as those arrangements had effect on 31st July 2008, shall apply; and

(b) if the ophthalmic practitioner has not appealed or does not appeal, or is unsuccessful in an appeal, the PCT may recover the amount as a civil debt.

Remuneration of Ophthalmic Practitioners

7.—(1) Notwithstanding the revocation of the 1986 Regulations, claims may still be made for payments under the Statement by an ophthalmic practitioner in relation to general ophthalmic services provided before 1st August 2008, who may be entitled to such a payment, provided that the claim is made within any period stipulated in the Statement as being the period during which a claim for the payment is to be made.

(2) Notwithstanding the revocation of the 1986 Regulations, as regards any claim for payment under the Statement which is made within the period stipulated in the Statement (whether before 1st August 2008 or by virtue of paragraph (1)), the 1986 Regulations shall continue to have effect as they were in force on 31st July 2008 in respect of—

(a) the approval and making of the payments;

(b) the recovery of payments and overpayments; and

(c) the payments in consequence of suspension or successful appeal.

Service of documents

8.  Where any notice or other document is required to be given or sent as a consequence of regulation 16 (service of documents on contractors) of the 1986 Regulations(3) and has not be given or sent before 1st August 2008, notwithstanding the revocation of the 1986 Regulations, regulation 16 of those Regulations shall continue to have effect as in force on 31st July 2008 in respect of such a notice or document.

Records

9.  Notwithstanding the revocation of the 1986 Regulations, an ophthalmic practitioner shall continue to keep a record in respect of the matters referred to in paragraph 6(1) (records)(4) of Schedule 1 to the 1986 Regulations and paragraph 6 of that Schedule shall continue to have effect as in force on 31st July 2008 to such a record until 1st August 2015.

(1)

Paragraphs 8A to 8C were inserted by S.I. 1996/705 and amended by S.I. 2002/2469, 2004/865 and 2006/1550.

(2)

Regulation 12(2) was amended by S.I. 1996/705, 2001/3739 and 2002/2469.

(3)

Regulation 16 was amended by S.I. 1996/705, 2001/414 and 3739 and 2002/2469.

(4)

Paragraph 6 was substituted by S.I. 2001/414 and amended by S.I. 2002/2469 and 2005/480.