GOS updates: patient address, electronic claims and claim window

NHS England has updated General Ophthalmic Services contractors on key changes to regulations and service provision

A hand holding a pen writes a signature on an official document.
NHS England has confirmed that there is no need to provide a permanent home address on General Ophthalmic Services (GOS) forms as part of an update on service provision.

In a letter to GOS contractors, NHS England highlighted that in the past, having no fixed abode could be a barrier to accessing services.

“To help ensure access is available for all we are writing to confirm that an alternative address may be used,” the letter stated.

This alternative address could include the address of the practice, the patient’s GP, a temporary accommodation provider or family and friends of the patient.

“To summarise, there is no legal requirement to provide a permanent home address in order that a patient can receive GOS services,” NHS England confirmed.

Specsavers clinical director, Giles Edmonds, welcomed the statement by NHS England.

“Having an address on all GOS forms is mandatory, so in the past it has proved to be a barrier to accessing eye care for homeless people,” he said.

“We welcome this important move by NHS England because it will help change lives and has the potential to save people’s vision,” Edmonds shared.

Adam Sampson, AOP chief executive, who previously ran housing charity Shelter, said: “This important change will address a major health inequality issue for those people who are homeless or rough sleeping. We have been pushing for this amendment for some time and it marks a real turning point in ensuring the patients who are already struggling receive the help they deserve.”

Karen Gennard, clinic development manager for Vision Care for Homeless People, and AOP Councillor, said the change offers clarification after many years.

“We have often used a day centre for an address for people who are homeless. Clarifying this issue for all optometrists and practices will hopefully lead to more practices offering services to this vulnerable group,” she emphasised.

Mandatory electronic claims

NHS England outlined a number of proposals for regulatory reform that have been granted ministerial approval. The changes will come before parliament on 20 July.

The proposals include that from 1 January 2024 it will be a contractual requirement that all GOS claims are submitted electronically through the Primary Care Support England (PCSE) electronic payment claims system.

NHS England acknowledged the potential for disruption created by unplanned system outages and domiciliary contractors who operate in areas with low signal.

“To mitigate against these instances, we will be introducing a new paper slip in order that a patient’s signature can be collected. Once the system is accessible, the performer should complete the claim electronically, leaving the patient signature blank, and retain this slip either in the form of hard or scanned copy within the practice,” NHS England stated.

Reduction in claim window

From 1 January 2024, the claim window for submitting GOS 1, 5 and 6 forms will reduce from six months to three months.

NHS England highlighted that this was to enable more timely data and prompt payments for contractors.

“We recognise that there may be exceptional circumstances where it may not been possible for contractors to submit claims within any regulated timescale,” NHS England acknowledged.

In these cases, integrated care boards can review the circumstances and, where appropriate, arrange with PCSE for the claim to be paid.

Death of a contractor

From 1 November, 2023 it is anticipated that a regulatory change will be implemented extending the timeframe that a contract continues following the death of a GOS contractor.

At present, a contract terminates seven days after the death of a contractor unless arrangements have been made to extend the contract by up to three months.

“We recognise that in these circumstances families and next of kin may not always have adequate time to make any alternative arrangements,” NHS England highlighted.

Under the changes, the contract would continue for 28 days during which time an extension can be arranged.

Removing the requirement to collect data on contract applicant’s sex

Currently there is a requirement for GOS contract applicants to declare their sex.

This would be removed from 1 November 2023 under planned regulatory changes.

“The award of the contract is not dependant on the sex of a contractor and therefore we propose to remove this requirement from the regulations,” NHS England shared.