Classification: Official
Publication reference: PRN00660
To:
- General Ophthalmic Services (GOS) contract holders
cc.
- Commissioners of GOS
- Representative membership bodies for optometry
Dear Colleagues,
Changes to General Ophthalmic Services (GOS) regulations
Further to our letter on 3 July 2023 which set out proposed regulatory changes, I am writing to confirm that all regulatory changes were laid in parliament on 20 July 2023. If you have not yet received a copy of the previous letter, please contact your commissioning team.
Mandating electronic claims
The first change, effective from 1 January 2024, is that all GOS claims must be submitted electronically through Primary Care Support England (PCSE) Online or a practice management system’s eGOS functionality. If you have not yet switched to an electronic system, you are encouraged to start planning the transition as soon as possible.
PCSE has produced a range of support materials for contractors who are considering the use of PCSE Online, which includes a welcome pack, helpful user guides and several videos. They have also commenced a series of communications to contractors submitting paper claims.
Continuity arrangements and system changes
To support these regulatory changes a revised business continuity plan is currently being produced. This will outline the processes to follow in the event of unplanned system outages, domiciliary visits in areas with low or poor mobile signal or disruption to practices’ internet connections. We will disseminate the revised business continuity plan shortly which will also be published on the PCSE website.
In addition to the above changes, the regulations providing for the issue of GOS 3 vouchers have also been amended. As of 1 January 2024, the default position is that, wherever possible, the vouchers should be issued at the time of a sight test. However, should a contractor be unable to do so due to systems not being available, as detailed above, these vouchers may be issued to patients once the system is available.
A number of PCSE Online system changes will be introduced before 1 January 2024 to enable all claims to be submitted electronically. PCSE will share more updated user guides, incorporating these changes by December 2023.
Reduction to the claim window for sight test claims
Regulations have also been amended to reduce the claim period for submission of GOS 1, 5 and 6 forms from six months to three months. This will enable more timely data for NHS-funded sight tests and avoid lengthy delays between activity and payment. The reduced claim window will apply to claims with a completion date on or after 1 January 2024. Claims with a completion date prior to the 1 January 2024 will be processed under existing arrangements.
We recognise that there may be exceptional circumstances where contractors have been unable to submit claims within any regulated timescale. This should be flagged with your commissioner so they can review the circumstances and where it is appropriate to do so, arrange with PCSE for the claim to be paid.
We would also like to notify you that further two contractual changes will become effective on 1 November 2023.
Death of contractor arrangements
Current contractual arrangements require the GOS contract to terminate after 7 days unless agreement is reached between interested parties and the responsible commissioner. We recognise that in these circumstances this time frame have not always provided adequate time for families and next of kin to make alternative arrangements.
We are therefore extending the period of termination from 7 to 28 days. This allows more time for making any necessary business arrangements which could include extending the contract by up to three months.
Removing the need to collect data on GOS contract applicants’ sex
The requirement for declaring the sex of a contract applicant during the GOS contract application process will be removed from 1 November 2023 and all relevant application paperwork will be updated in readiness for this change.
Finally, for patients with no fixed abode I would like to confirm that you can use an alternative address. This can include your practice address, the address of the patient’s GP should they have one, a friend/relative’s address or a temporary accommodation provider.
I hope this letter has provided further clarity on the changes to the regulations and the forthcoming system and process changes. We are in the process of updating the policy book for GOS, which will incorporate specific guidance for the regulatory changes. If there are any questions, please contact your integrated care board (ICB) commissioning team or Optical Fees Negotiating Committee (OFNC) representative membership organisation.
Yours sincerely,
Ali Sparke, Director of Optometry, Dental and Pharmacy, NHS England.