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AOP success in legal case to protect the profession

The AOP wins case to protect members over General Ophthalmic Services (GOS) claims

04 May 2016

The Association of Optometrists (AOP) has intervened and championed practitioners in an unprecedented legal battle based on unfounded NHS England claims. The success of the AOP’s in-house legal team protecting members, working as employees or locums, represents a significant win for the profession.

The case – which lasted over two years – arose when NHS England decided in 2014 to pursue performers for General Ophthalmic Services (GOS) claims. Commenting on the background to the case, Gerda Goldinger, AOP Legal and Regulatory Services Director, said: “The NHS has always had the remit to audit records produced by contractors. However in 2013, NHS England adopted a different approach to the auditing and recovery of GOS claims that they thought had been inappropriately claimed.” 

“The change in approach was an aggressive one. The company brought in by NHS England started to work with a firm of solicitors to threaten members. And not just with the recovery of sums that they considered to be due, but with taking away their livelihoods and their homes if they did not respond urgently and positively to the claim letters.”

Described as a “frightening and intimidating” tactic, this practice was then extended to performers, who were working as employees or locums of contractors. Commenting on this experience, one of the AOP members involved in the case, who requested to remain anonymous, said: “Completely out of the blue I received a letter from a firm of solicitors. The letter informed me that, following an audit of a number of patient records and NHS claims from a three-year period, some claims were incorrect, and I was to personally pay back what they deemed to have been incorrect GOS1 and GOS3 claims. The aggressive, uncompromising tone of the letter - along with the implied allegations and implications, both professional and financial - made it extremely distressing.”

At this point, the AOP was compelled to intervene to protect its members. Ms Goldinger explained: “We knew that if NHS England directly pursued the performer, the move was going to change the landscape forever and we needed to act.” Ms Goldinger continued: “This case would have meant a much more defensive mode of practice would have been adopted. And it would have pushed a lot of performers out of the profession because it would have become a stressful way to work.”

For the two AOP members involved in this case, the matter has now been resolved in their favour. However, this decision does not bind the NHS to any other cases, as every case is considered individually. Ms Goldinger added: “I think NHS England will think long and hard now before they pursue any other performer members, certainly in cases where the facts are very similar to this one. As it stands, we are aware of ten cases of individual members being targeted, but we are hoping that we are going to get some closure on those cases in the coming months.”

One of the AOP members involved in the case added: “Thankfully, because of the AOP's robust stance, after nearly two years, the allegations were finally dropped. The AOP was excellent from beginning to end, and I am extremely grateful to the team. You never want to have to use a safety net – but if you do, it is good to know it works.” Commenting on the AOP’s legal support for members, Ms Goldinger said: “Defending litigation is a very expensive business, and for most people it is quite out of reach. I think a number of our members would have felt that they had nowhere to go if we had not stepped in.”

Following the case, Ms Goldinger highlighted the importance of keeping up to speed with changes in the profession. “Our advice to any AOP member who is under investigation is to contact us immediately. The Optical Confederation’s guide to Making Accurate Claims, authored by the AOP, is a resource worth repeat reading,” she added.

For more information on this case, read Protecting the performer, Optometry Today.

Ends

For more information, please contact Anne Grenyer, PR and Media Manager at the Association of Optometrists, at [email protected] or telephone 020 7549 2063.

Notes to Editors

Association of Optometrists 

The Association of Optometrists (AOP) is the leading professional membership organisation for optometrists and other optical professionals in the UK. We support our community of 16,000 plus members to fulfil their professional roles to protect the nation’s eye health. As a founding member of the Optical Confederation (OC) we work with others to improve eye health for the public good.

AOP in-house legal and regulatory support

The AOP is the leading provider of medical malpractice insurance for optometrists in the UK. Our in-house legal team vigorously defends the reputation and livelihood of our members. We support our members in all four nations on a wide range of issues, including the defence of insurance claims, representation before the GOC and at NHS panel meetings and employment issues. Find out more about our legal department.

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