Terms and Conditions for Ophthalmologists

1. Basis of recognition

Your relationship with OcuPlan is important to us and we agree to recognise you as an "OcuPlan Partner” on the terms set out in this agreement and (where relevant) on the basis of your application form which forms a part of your agreement with us. In return, you agree that any agreements or arrangements you may have with a Member are subject to your agreement with us.

In order to be eligible to join OcuPlan you need to be registered with the General Medical Council as a consultant ophthalmologist and be on the specialist register for ophthalmology. It is important that your ‘scope of practice’ also includes the care of patients with general ophthalmic disease and that you are familiar with interpretation of Optical Coherence Tomography (OCT) scans of both the retina and optic nerve glaucoma (OCT) scans, as well as visual field tests.

You also must agree to let us know immediately if there is:

any change to your registration with the General Medical Council (including conditional registration or investigation);

any legal or threatened action against you in connection with your profession;

a new criminal conviction;

a new suspension or dismissal from General Medical Council;

any change to your practising privileges at your registered private medical site.

Every 12 months we will ask you to verify that your personal details are up to date and whether there has been any change to your GMC registration.

Under OcuPlan’s scheme rules, we will only reimburse you if you have an agreement in place for the provision of consultations for OcuPlan patients, and by a financial amount defined in Schedule 1 of this document.

Charges to OcuPlan for consultations without use of scanning a valid patient membership card QR code, or any charges outside our contract with you, will not be paid. We can authorise payment over the phone if the patient forgets their membership card and ask us that you call at the soonest available opportunity ti rectify this please.

You acknowledge that you will comply with the service standards set out in Schedule 2.

You agree to comply with competition law and decide your consultation fees independently without discussion or collusion with your peers and colleagues.

You have signed this document to say you will abide by these terms and conditions.

2. Clinical Standards

We trust that the clinical quality of the consultations that you perform for our Members will be acceptable. In support of this, you agree to provide all consultations in accordance with the Clinical Standards published in our terms and conditions. We may on occasion receive a complaint that is clinical in nature. If we contact you about such a case, it will usually follow a complaint made to us by one of our Members. We wish to ensure that all our Members have received high quality medical care and treatment. We ask that you fully review any such complaint and, in line with the guidance set out by the General Medical Council, provide us information, to the extent permitted by applicable data protection legislation, which will help us to address any Member concerns.

3. Services

This section relates to the expectations of our Members in relation to the services provided, and we are asking you to sign up to the minimum as described below:

Clinical consultations should allow for a minimum of 20-minute duration to ensure adequate time to fully clinically assess the patient without the feeling of time-pressure or rushing;

Additional time required by you to review the patient’s ocular investigations provided by the Member’s recognised optometrist should not be charged for;

Additional follow-up consultations, if required, should be clearly explained as to their necessity to the Member so they can decide whether to fund these using their OcuPlan package or independently from OcuPlan;

A copy of the clinical letter that you would normally send to the patient’s GP should also be copied to the patient and their optometrist within 10 days of the consultation date.

You are required to provide a NHS.net or Egress password protected email address and give us permission to share this with OcuPlan registered optometrists, so that they can send you the results of the Members investigations directly. If you do not have a valid NHS.net email account then you are required to purchase an Egress secure email account, which can then be used to transfer the investigation data securely.In addition, you agree where practically possible, to provide consultations to Members within a maximum of 14 working days from request by the Member. You agree to ensure that someone can be contacted to arrange appointments for you within the normal working hours of 9 AM to 5.30 PM and to ensure that an ‘out of hours’ answer phone service is provided for Members calling at a time when no one is available to take appointment calls in person. You further agree that Members leaving a message on this service will receive a call back within 48 hours Monday to Friday.

4. Charging Members

Charging Members personally unexpected bills are a major cause of customer complaint and so we have set out below how charging needs to operate. It is a condition of this agreement that you will not invoice or bill Members personally for consultations if they are being performed as part of their OcuPlan scheme. It is straight forward to know if a Member has pre-authorisation for their planned consultation because they will have a valid OcuPlan membership card. This will need to be scanned by you or your team using either a smart phone or tablet device logged in to the OcuPlan kiosk. The kiosk function can be found on the OcuPlan website and is a useful tool for the reception area and administration team. This enables them to scan membership cards for you when patients arrive to your practice. Scanning the membership card automatically starts the payment processes to you and registers the patient on your OcuPlan account. OcuPlan will reimburse you by an amount set out in Schedule 1 of this document.

If a Member requires any additional ocular investigations that fall outside of their OcuPlan scheme, or any other treatments, it is important you make it clear to the patient that these are not included in their OcuPlan scheme. Patients will have to decide how to fund additional works independently of OcuPlan, such as using a medical insurance policy if they have one, or by self-funding these services and treatments with you, or by asking to be referred to the NHS.

5. Charges

We will only pay for pre-authorised consultations to a financial amount as set out in Schedule 1 of this agreement. The OcuPlan fees you choose are all inclusive (including VAT) and represent full payment from us to you. A consultation is defined as ‘pre-authorised’ if you are able to scan a valid OcuPlan Member’s membership card for that service. If the membership card is not valid then an error message will appear, and you should advise the patient to check their account validity online or call OcuPlan.

New patients are defined as being new to the OcuPlan scheme and you will be reimbursed as a new OcuPlan patient consultation.

Follow-up patients are defined as being seen within the OcuPlan scheme previously within the last 3 years. These consultations will be reimbursed as a follow-up OcuPlan patient consultation.

6. Invoicing

It is not necessary to submit an invoice to receive payment for OcuPlan consultations because the payment process is automatically triggered by scanning a valid OcuPlan membership card. These can be scanned using a smart phone or tablet device connected to the internet and logged in to your OcuPlan account. Alternatively, there is a kiosk function found on the OcuPlan website that can be used by your administration team in the reception area or at the front desk. This allows your team to scan membership cards for you when patients arrive at your practice. Scanning the QR code on the card automatically starts the payment processes to you and registers the patient on your OcuPlan account. If a Member does not have a valid membership card then you might not be paid for the consultation, so it is important you advise the patient to check this or give us a call to investigate.

We advise that you keep a minimum data record of consultations for OcuPlan patients to consist of the Member’s name, date of birth, and date of consultation as this information may be required for internal audit processes or if any payment discrepancies arise.

7. Payment for services

Payment to the consultant from OcuPlan will only be authorised if the Member presents a valid OcuPlan membership card at the consultation.

OcuPlan will pay directly by BACs to the bank account provided by the consultant, in a time frame set out below.

For Members who pay for their OcuPlan package in full in advance, the consultant will be reimbursed in full within 30 days of the consultation being performed;

For Members who pay for their OcuPlan package in instalments, the consultant will be paid in equal instalments for the consultation over the relevant time frame as set out below:

For once per year consultations, these will be paid over 12 monthly instalments.

For twice per year consultations, each consultation will be paid over 6 monthly instalments.

For three times per year consultations, each consultation will be paid over 4 monthly instalments.

For Members who pay for their OcuPlan packages using instalments, sometimes they will be ahead with their payments. In these circumstances the equivalent number of monthly instalments will also be advanced to the consultant in one lump sum at the same time as the consultation, as long as the Member has a valid OcuPlan QR code token. In this way OcuPlan will pass on payments in the fastest possible way to the consultant to keep them in line with the Member’s annual contract. For example, if a patient is in month 2 of their 12-month scheme and they attend for a consultation, then 2/12th of the reimbursement will be paid immediately to consultant within the time frame set out in section 7, with the remaining 10/12th being paid in equal instalments over the subsequent 10 months. Similarly, if the patient is on a twice per year scheme and attends for their first consultation at month 3, then 3/6th of their consultation remuneration will be paid to the consultant at that time, with the remaining 3/6th being paid in equal amounts over the next 3 months.

For Members who pay for their OcuPlan package in instalments, the first payment made to the consultant will be within 30 days of the relevant valid QR token being scanned.

In the unlikely event that you perform a consultation on a Member who is paying by instalments, and then shortly afterwards they cancel their OcuPlan membership before completing their full payment cycle, then OcuPlan will seek to recover any outstanding monies owed by the Member and pass any payments owed on to you within 90 days of the first missed instalment.

Occasionally we may overpay an invoice in error. Where you are overpaid, we will ask for this to be refunded to us if required. We will occasionally conduct an audit of your underlying payment procedures and history to confirm compliance with these terms. You must agree to assist us on any reasonable request in these audit activities.

8. Ending Your Agreement

This section of the document addresses the processes and rights where either you or OcuPlan may end this agreement at any time by notifying the other party in writing on 30 days’ notice and sent to OcuPlan Limited, Kingsway House, 40 Foregate Street, Worcester, WR1 1EE. You may also end this agreement through your account, in the settings section.

Where we feel that there are issues of safety regarding the performance of consultations for Members, or indications of fraud, we may end or suspend this agreement and/or your OcuPlan Recognition immediately on the provision of notice, if we feel that this is appropriate.

We do expect that, in return for the support of your practise and referrals to our Members, you maintain a professional relationship with our Members and do not disparage OcuPlan. If a Member is receiving a consultation on the date your recognition ends or is suspended, you will have to inform the Member that you are no longer in the OcuPlan scheme. At that time, you can ask the patient to either self-fund the consultation with you in the traditional way independently from OcuPlan, or we can arrange for them to see another OcuPlan approved consultant.

9. Insurance

It is essential that you hold professional medical indemnity insurance to protect our Members and that this is from a recognised UK organisation and covers at least a minimum of £5 million UK pounds per claim.

It is important that you care for our Members in the same way you would care for private patients normally.

The medico legal responsibility for monitoring, the frequency of consultations and investigations, and interpretation of investigations rests with the consultant ophthalmologist for whom the patient is under their care, not with the optometrist.

10. Data protection

You must comply with Data Protection Law and the Data Protection Act 2018. Situations may arise where we ask you to disclose Member Data to allow us to effectively provide our Members the services they are entitled to. If you feel that sharing this information is in breach of Data Protection Law, then please notify us via email.

We advise that you familiarise yourself with our Privacy Notice, which is available on our website.

11. Anti-bribery and corruption

You agree to comply with all applicable laws relating to the detection and prevention of financial crime.

12. Disputes

Rarely dispute between us and you may occur, if this happens it is important you let us know your concerns at the soonest possible time and give us a call so we can try and solve the problem quickly over the phone or contact us via the website. If you are not satisfied with the response you can put your complaint in writing, and we will arrange an opportunity to sit down together and talk through the dispute. Written complaints regarding a dispute should be sent to OcuPlan Limited, Kingsway House, 40 Foregate Street, Worcester, WR1 1EE. Sometimes the dispute can be resolved in writing and where possible we will try to do this promptly within 30 days.

OcuPlan operates under the legal framework provided by the Consumer Rights Act 2015. Under the terms of this Act, if services are provided in a way that is deemed to be inadequate or falling short of the standards set out in this Terms and Conditions document, then OcuPlan has the right to ask you to repeat the consultation for our member free of charge to address these shortcomings. If services have been performed and you have been reimbursed by OcuPlan for these services, and they are then deemed to have fallen short of the standards set out in the Terms and Conditions, or by the standards deemed fair and sensible by either the Member involved or OcuPlan, then OcuPlan has the right to either ask for a refund from yourself of the total amount paid, or a proportion of this amount deemed to be fair.

13. General

Please note that these terms are governed by English law and represent the whole and only agreement between us relating to the subject matter of these terms.

14. Definitions

- “Member (Member’s)” – an individual who has signed a contract with OcuPlan to purchase a fixed-term package of care and has approved the Terms and Conditions of this package of care in their OcuPlan agreement.

- “OcuPlan Partner” – any consultant who has an agreement with OcuPlan to provide services to Members on the terms of this agreement.

- “OcuPlan Account” – your individual OcuPlan account, which is available online and can be accessed with a username and password

- “we”, “our”, or “us” – OcuPlan Limited.- **“you” or “your”** – the consultant named in Schedule 1 below.

Schedule 1

Consultant consultation fees

At OcuPlan we offer flexible ways for you to select your own OcuPlan consultation fees. You can choose to either use our standard OcuPlan consultation fees or choose your own OcuPlan consultation fees in a flexible way.

Our standard OcuPlan consultation fees are socially aware and aim to make private eye care more affordable for patients who may not otherwise be able to afford it.

Our standard OcuPlan consultation fees are as follows:

Clinical consultation for a new OcuPlan patient £150

Clinical consultation for a follow-up OcuPlan patient £110

Alternatively, if you prefer, you can decide your own OcuPlan consultation fees in a flexible way, different to our standard fees.

Please be aware that if you set your OcuPlan fees higher, this will make your OcuPlan package prices more expensive for patients. In a similar way, setting them lower will make your OcuPlan packages less expensive and more affordable for patients. When you decide how to set your OcuPlan fees it is important that you do this independently from your competitors.

If you would like to set your OcuPlan fees flexibly, differently from our standard fees, please call us so we can make the necessary adjustments to your account. We take steps to keep information about your fees confidential and limit access to this data internally as part of our competition compliance policy and data protection policy.

The fees we pay you for patient consultations will be determined by the fee registered to your account at the time the patient initially purchased their OcuPlan care package, or at the start of their renewal year. This means if you change your fees during the year, the patient will be quoted a new package price based on this change when they come to renew. You can change your fees at any time and can do this by giving us a call.

The OcuPlan package prices for patients are calculated by adding together either the new or follow-up consultant consultation fees as relevant, the optometry fees for providing OcuPlan investigations, and our standard administration fees for providing this service.

In addition, payment will only be made by OcuPlan to the consultant for consultations that meet our criteria set out in Schedule 2 below and for which you are recognised under this agreement.

Schedule 2

Clinical Quality

Consultations are performed in a safe and appropriate clinical setting that reflects the standards that OcuPlan would expect of all of its providers.

You agree to:

(a) provide to Members services that you have the capability to do so in a safe and professional manner;

(b) comply with all legal requirements for clinical practice, including working in clinics that are regulated and approved by the Care Quality Commission;

(c) stop performing consultations where they cannot be provided safely and write to let us know immediately why this has happened;

(d) have an up to date infection control policy and keep up to date with infection control mandatory training;

(e) have a process for the investigation of adverse incidents and/or complaints;

(f) ensure that each health care professional employed or engaged by you to perform the running of your clinical services for a Member has the appropriate qualifications and is registered with the relevant professional body;

(g) ensure all staff employed or engaged by you undertake professional development requirements for their designated roles and professional registration.

Ophthalmology