Which patients can access the OcuPlan scheme?
The OcuPlan care packages are only suitable for patients with a known ophthalmic diagnosis where regular monitoring is required. It is not suitable for new referrals of patients with new eye symptoms with an unknown diagnosis that requires investigation or for complex eye conditions that require more intensive eye hospital management. If patients have a known diagnosis either made in the NHS or private sector that requires long term monitoring, then they can access the OcuPlan scheme directly. Patients who enter the OcuPlan scheme are usually already under the care of the local NHS or private hospital, and so they should be aware of their pre-existing diagnosis, such as glaucoma or age-related macular degeneration. Figure 1 (see below) explains the various routes of access for patients in to the OcuPlan scheme.
Figure 1: Flow chart showing routes of access for patients in to OcuPlan
What if a patient develops a new problem that requires additional hospital investigations of treatment?
Occasionally patients who are enrolled with the OcuPlan scheme will develop new problems that need additional investigations or treatments. Where possible we advise you to help the patient utilise their full eligible optometry support as part of their care package; for example, if a visual field test or OCT scan is required and is already part of their care package you should obtain these investigations from their recognised optometrist. Additional investigations outside the OcuPlan scheme such as corneal topography, fundus fluorescein angiography, orthoptic assessment, or electrodiagostic studies should be justified to the patient if required and they then have the option of either pursuing these in the private sector independently from OcuPlan or via the NHS.
If the patient would like to be referred to the NHS, then you are obliged to do this with a letter to the GP advising them to refer the patient to the local NHS eye department. If they choose to have them performed privately then it is very important you explain to the patient beforehand that these tests would need to be paid for separately by the patient. This would either be as a self-funding patient or if they have private medical insurance, it may be possible for them to claim the cost of these investigations with their medical insurance policy. If the new eye problem is outside of your subspecialty then a referral to a colleague who specialises in the area of their new problem may be required in a timely manner, either urgent or routine depending on your clinical judgement. This referral would be outside the scope of the OcuPlan scheme and so they would have to self-fund this appointment if they choose to pursue it in the private sector. If at a later date the patient becomes suitable again to an ongoing OcuPlan care package, then they can resume these services.
If a patient develops a new problem that requires treatment, they can either seek to have this treatment in the NHS or you can offer to provide it for them privately. If they choose to have their treatment privately this would be separate to the OcuPlan scheme and they are liable for the self-funding private fees you and your hospital charge for the treatment in question. If they have pre-existing medical health insurance, then they can also seek to obtain funding from their health insurance provider for this treatment if they are eligible. If they would like to have the treatment in the NHS, then you are obliged to refer them to their GP who will be able to refer them into the NHS hospital eye service.
Can you recommend OcuPlan to patients?
The OcuPlan scheme is particularly suitable for any pre-existing patients who currently see you in clinic at regular intervals and who have an ophthalmic problem that you can predict how many times you need to see them per year. For example, if you have a patient with ocular hypertension that you see once a year with a visual field test and OCT scan, then they would be well suited to the basic OcuPlan Care scheme. If you have a patient who is seen twice or three times per year, then they may be more suited to the OcuPlan CarePlus or Premium scheme.
If you think your patient would benefit from the service OcuPlan facilitates, then you are allowed to offer OcuPlan to patients as one of the options available for accessing care. It is important that patients do not feel it is their 'only' choice, as they can of course alternatively continue to self-fund their care in the traditional way, or access care services through health insurance if relevant or in the NHS. It is good practice to provide patients with choices, so they can decide independently and in their own time. We do, however, suggest you use your medical knowledge to advise them which package level would be best suited to their needs for clinical monitoring reasons as stated in the above paragraph.
How do you check if a patient is authorised by OcuPlan for your consultation
As part of their care package OcuPlan Members have tokens on their account that can be used to pay for your services. When the Member arrives to your clinic, someone will need to scan their OcuPlan membership card using a smart phone or tablet device connected to the internet. This automatically authorises and registers the consultation and activates the relevant token to start the payment process to you. Scanning can be done either by you or your administration team logged in to your OcuPlan account. Alternatively, there is a kiosk function on the OcuPlan website designed to be used by the administration team in your reception area or at the front desk. The kiosk function allows your team to scan Member’s membership cards or tokens, which automatically registers the visit on your account. There is a guide on the website, which explains how to set up a kiosk function.
We will only pay for consultations that are authorised by the process of scanning a valid OcuPlan membership card. If you need to see a patient more frequently than their current care package allows, you can either advise the patient to ‘self-fund’ a further appointment with you independently of OcuPlan, or they may choose to be referred to the NHS to access any extra care.
How many times and how frequently can I see an OcuPlan patient?
If your patient is on a ‘once per year package’ (OcuPlan Care), this includes one consultation with you and one set of ocular investigations with their optometrist, at any time during the year.
If they are on the ‘twice per year package’ (OcuPlan Care Plus), this includes one consultation with you and one set of ocular investigations with their optometrist in the first 6 months after joining, and a second of each in the second 6 months after joining. The only exception to this is that if the patient has not used any services until they reach the second 6 months after joining, then they can access both consultations and both sets of investigations in the second half of the year.
If they are on the ‘three times per year package’ (OcuPlan Premium), this includes one consultation with you and one set of ocular investigations with their optometrists in the first 4 months after joining, and a second of each in the 5-8th months after joining, and the third of each in the last 4 months after joining. The only exception to this is that if the patient has reached month 5 after joining and has not yet accessed any services, then they can use 2 consultations and 2 sets of investigations during the 5-8th month. Similarly from month 9, if they have not accessed any services they can use 3 consultations and 3 sets of investigations before the end of the year. If they have any unused services at the end of the year, they may choose to cancel their membership and we will reimburse them as per our patient terms and conditions.
The OcuPlan scheme has been specifically set up to save patients money for known care needs and also provides them with the highest quality of consultant delivered eye care possible. The scheme is designed for patients in the monitoring phase, and therefore the structure of regularly spaced follow-up appointments as explained in the various package options above, reflects this. It helps them afford the predictable eye care that they need as a basic minimum each year. Occasionally additional consultations will be needed for problems that may arise in an unpredictable way with their eye health or treatment. These would fall outside the scope of OcuPlan and would need to be funded either independently from OcuPlan in the traditional private practice way, or by being seen within the NHS or through a private medical insurance policy if available.