Legalize / United Kingdom / Wales / Welsh-Statutory-Instrument

The National Health Service (Ophthalmic Services) (Wales) Regulations 2023

Type Welsh-Statutory-Instrument

Publication 2023-09-27

Last updated 2025-04-01

State In force

Jurisdiction Wales

Department King's Printer of Acts of Parliament

Source legislation.gov.uk

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(ii) the single claimant or, as the case may be, both joint claimants, did not have limited capability for work, and

(iii) the single claimant had earned income or, as the case may be, the joint claimants had combined earned income, of £435.00 or less;

(b) had an award of universal credit, either as a single claimant or as one of joint claimants, where—

(i) the award included the child element, and

(ii) the single claimant had earned income or, as the case may be, the joint claimants had combined earned income, of £935.00 or less;

(i) the single claimant or, as the case may be, one or both joint claimants, had limited capability for work, and

(ii) the single claimant had earned income or, as the case may be, the joint claimants had combined earned income, of £935.00 or less;

(d) was a qualifying young person for whom a recipient referred to in paragraph (b) or (c) is responsible (within the meaning of Part 1 of the 2012 Act[^f00036] (universal credit) and regulations made thereunder).

(5) Where sub-paragraph (6) applies, a person must be treated as falling within the description of a relevant universal credit recipient in sub-paragraph (2)(n).

(6) This sub-paragraph applies where the conditions in paragraph (a), (b), (c) or (d) of sub-paragraph (4) are satisfied in the assessment period in which the sight test takes place and—

(a) there is no relevant assessment period, or

(b) none of those conditions were satisfied in the relevant assessment period.

(7) In sub-paragraph (2), “family” has the meaning assigned to it by section 137(1) of the Social Security Contributions and Benefits Act 1992[^f00037] (interpretation of Part VII and supplementary provisions) as it applies to income support except that—

(a) in paragraphs (b), (d) and (k), it has the meaning assigned to it by section 35 of the Jobseekers Act 1995[^f00038] (interpretation);

(b) in paragraph (g), it has the meaning assigned to it by regulation 2(2) of the Tax Credits (Definition and Calculation of Income) Regulations 2002[^f00039] (interpretation);

(c) in paragraph (m), it has the meaning assigned to it by regulation 2 of the Employment and Support Allowance Regulations 2008[^f00040] (interpretation).

(8) In this paragraph—

“the 2012 Act” (“Deddf 2012”) means the Welfare Reform Act 2012;

“assessment period” (“cyfnod asesu”) means the assessment period for the purposes of universal credit as specified in regulation 21 of the Universal Credit Regulations 2013[^f00041] (assessment periods);

“capital limit” (“terfyn cyfalaf”) means the amount prescribed for the purposes of section 134(1) of the Social Security Contributions and Benefits Act 1992 (exclusions from benefit) as it applies to income support;

“child element” (“elfen plentyn”) means the child element of universal credit as specified in regulation 24(1) of the Universal Credit Regulations 2013[^f00042] (the child element);

“child tax credit” (“credyd treth plant”) means child tax credit under section 8 of the Tax Credits Act 2002 (entitlement);

“disability element” (“elfen anabledd”) means the disability element of working tax credit as specified in section 11(3) of the Tax Credits Act 2002 (maximum rate);

“earned income” (“incwm a enillir”) means a person’s earned income as defined by Chapter 2 of Part 6 of the Universal Credit Regulations 2013 (calculation of capital and income – earned income);

“gross annual income” (“incwm blynyddol gros”) means income that is calculated for a tax year for the purposes of Part 1 of the Tax Credits Act 2002 in accordance with regulations made under section 7 of that Act (income test);

“an income-based jobseeker’s allowance” (“lwfans ceisio gwaith yn seiliedig ar incwm”) has the meaning given to it by section 1(4) of the Jobseekers Act 1995[^f00043] (the jobseeker’s allowance);

“income support” (“cymhorthdal incwm”) means income support under Part VII of the Social Security Contributions and Benefits Act 1992 and includes personal expenses addition, special transitional addition and transitional addition as defined in regulation 2(1) of the Income Support (Transitional) Regulations 1987[^f00044] (interpretation);

“income-related employment and support allowance” (“lwfans cyflogaeth a chymorth yn seiliedig ar incwm”) means an employment and support allowance, entitlement to which is based on section 1(2)(b) of the Welfare Reform Act 2007[^f00045] (income-related employment and support allowance);

“joint claimants” (“hawlwyr ar y cyd”) has the meaning given in section 40 of the 2012 Act (interpretation of Part 1);

“limited capability for work” (“gallu cyfyngedig i weithio”) means limited capability for work or limited capability for work and work-related activity as interpreted in accordance with regulations 39 and 40 respectively of the Universal Credit Regulations 2013[^f00046] (limited capability for work; limited capability for work and work-related activity);

“pension credit guarantee credit” (“credyd gwarant y credyd pensiwn”) must be interpreted in accordance with sections 1 and 2 of the State Pension Credit Act 2002[^f00047] (entitlement; guarantee credit);

“prisoner” (“carcharor”) means a person who is detained in a prison, including a young offender institution, a secure training centre, and a naval, military or air force prison, but is, at the time of receiving any general ophthalmic service, on leave from that prison, and for the purposes of this definition— “secure training centre” means a place in which offenders subject to detention and training orders within the meaning given by section 233 of the Sentencing Code[^f00048] (detention and training order) may be detained and given training and education and prepared for their release, and “young offender institution” means a place for the detention of offenders sentenced to detention in a young offender institution or to custody for life;

“qualifying young person” (“person ifanc cymhwysol”) has the meaning given in section 10(5) of the 2012 Act (responsibility for children and young persons);

“relevant assessment period” (“cyfnod asesu perthnasol”) means the assessment period immediately preceding that in which the sight test take place;

“severe disability element” (“elfen anabledd difrifol”) means the severe disability element of working tax credit as specified in section 11(6)(d) of the Tax Credits Act 2002 (maximum rate);

“single claimant” (“hawlydd unigol”) has the meaning given in section 40 of the 2012 Act (interpretation of Part 1);

“universal credit” (“credyd cynhwysol”) means universal credit under Part 1 of the 2012 Act;

“working tax credit” (“credyd treth gwaith”) means working tax credit under section 10 of the Tax Credits Act 2002 (entitlement).

(9) In this paragraph and paragraph 2—

“complex appliance” (“teclyn cymhleth”) means an optical appliance at least one lens of which— has a power in any one meridian of plus or minus 10 or more dioptres, or is a prism-controlled multifocal lens;

“notice of entitlement” (“hysbysiad o hawlogaeth”) means a notice issued under regulation 8 of the National Health Service (Travelling Expenses and Remission of Charges) (Wales) Regulations 2007 (notices of entitlement).

Specific evidence of eligibility for certain persons

2

(1) Subject to sub-paragraph (2), the specific evidence mentioned in regulation 6(5) is—

(a) for a person who is eligible only by virtue of paragraph 1(1)(d) and (2)(c) or (d), a current notice of entitlement;

(b) for a person who is eligible only by virtue of paragraph 1(1)(e), the prescription for a complex appliance issued to that person on the occasion when the person’s sight was last tested;

(c) for a person who is eligible only by virtue of paragraph 1(1)(g), the name and address of that person’s medical practitioner and consent to the Local Health Board seeking confirmation of the person’s diabetes or glaucoma from that person’s medical practitioner, set out on a form provided for that purpose to contractors by the Local Health Board.

(2) Where an eligible person to whom sub-paragraph (1)(b) applies is unable to meet its requirements, the contractor may instead of satisfying themselves that those requirements are met, satisfy themselves that the person is an eligible person by referring to the contractor’s own records or by measuring the power of the lenses of the person’s existing optical appliance by means of a focimeter or other suitable means.

SCHEDULE 2 — Recognition of ophthalmic medical practitioners

Qualifications of ophthalmic medical practitioners

1

(1) The prescribed qualifications which a medical practitioner must possess for the purposes of section 71 of the Act (arrangements for general ophthalmic services) are that the medical practitioner has (at the date of consideration of this application under paragraph 2) recent and adequate experience and either—

(a) has held—

(i) an appointment in the health service, otherwise than under Part 4 of the National Health Service Act 1946[^f00049], Part 2 of the National Health Service Act 1977[^f00050], or Part 6 of the Act, with the status of consultant ophthalmologist, or

(ii) an appointment for a period of 2 years or more of equivalent status as ophthalmic surgeon or assistant ophthalmic surgeon on the staff of an approved ophthalmic hospital, or

(b) has—

(i) obtained the Membership of the Royal College of Ophthalmologists, or any approved higher degree or qualification, and

(ii) held one or more ophthalmic appointments in an approved ophthalmic hospital for a period totalling 2 years or more, which must include tenure for at least 6 months of a residential appointment or an appointment with duties comparable with those of a residential appointment.

(2) The tenure for 6 months of a residential or comparable appointment referred to in sub-paragraph (1)(b)(ii) is not required in the case of a medical practitioner who has been fully registered for at least 7 years and whose experience is such as to make that requirement unnecessary.

(3) In this paragraph, “approved” means approved by the Ophthalmic Qualifications Committee or by an appeal committee under paragraph 3.

Approval of qualifications of ophthalmic medical practitioners

2

(1) A medical practitioner who wishes to be recognised as an ophthalmic medical practitioner must apply to the Ophthalmic Qualifications Committee for its approval of that person’s qualifications and must give to the Ophthalmic Qualifications Committee such particulars of those qualifications as the Committee may require.

(2) The Ophthalmic Qualifications Committee must consider and determine that applicant’s application and within 2 months beginning with the date of the application must inform that applicant of its determination.

(3) If the Ophthalmic Qualifications Committee is satisfied that the applicant possesses the qualifications prescribed by paragraph 1, the applicant must be considered an ophthalmic medical practitioner.

(4) Despite paragraph 1 and sub-paragraph (1), a medical practitioner who has the prescribed qualifications for the purposes of providing general ophthalmic services in Northern Ireland under the Health and Personal Social Services (Northern Ireland) Order 1972, in Scotland under the National Health Service (Scotland) Act 1978, or in England under the National Health Service Act 2006, must be considered an ophthalmic medical practitioner.

(5) For the purposes of sub-paragraph (2), the date of the application is the later of—

(a) the date on which a completed application with all necessary supporting information is received by the Ophthalmic Qualifications Committee, or

(b) if the Ophthalmic Qualifications Committee requires any further supporting particulars from the applicant, the date on which the Committee receives all the particulars that it requires.

Appeals from Ophthalmic Qualifications Committee

3

(1) Any person (“an appellant”) dissatisfied with a determination of the Ophthalmic Qualifications Committee that the appellant is not qualified to be an ophthalmic medical practitioner may, within 1 month beginning with the date on which the appellant received notice of that determination, or such longer period as the Welsh Ministers may at any time allow, appeal against the determination by sending to the Welsh Ministers a notice of appeal stating the facts and contentions on which the appellant relies.

(2) The Welsh Ministers must—

(a) appoint to determine the appeal an appeal committee of 5 persons of whom at least 3 must be appointed after consultation with such bodies or organisations representing medical practitioners as appear to the Welsh Ministers to be concerned with the issues relating to qualification as an ophthalmic medical practitioner,

(b) refer the appeal to that appeal committee,

(c) send a copy of the notice of appeal to the Ophthalmic Qualifications Committee and to such other persons as appear to the Welsh Ministers to be interested in the appeal, and

(d) inform the appellant, the Ophthalmic Qualifications Committee and any such other persons that the appeal has been referred to an appeal committee and of the address to which communications to the appeal committee must be sent.

(3) The appeal committee may, and if requested to do so by the appellant or the Ophthalmic Qualifications Committee must, hold a hearing in connection with an appeal at such time and place as it may direct.

(4) Notice of the hearing must, at least 14 clear days before the date of the hearing, be sent by recorded delivery service to the appellant, the Ophthalmic Qualifications Committee and any other person to whom the Welsh Ministers have under sub-paragraph (2) sent notice of the appeal.

(5) Either the appellant or the Ophthalmic Qualifications Committee may within 1 month of being informed that the appeal has been referred to an appeal committee, or of being informed that a hearing of the appeal will be held, give notice that they wish to appear before the appeal committee.

(6) Any party to an appeal is entitled to appear and be heard by counsel or a solicitor and—

(a) the Ophthalmic Qualifications Committee is entitled to appear by a member or by their clerk or other officer duly appointed for the purpose;

(b) the appellant is entitled to appear in person, by any member of the appellant’s family, by any friend, or by any officer or member of any organisation of which the appellant is a member.

(7) An appeal committee is to have all the powers of the Ophthalmic Qualifications Committee, including in particular the power of approval, and if satisfied that an appellant possesses the qualifications and experience prescribed by paragraph 1, it must give that approval.

(8) The appeal committee must as soon as practicable notify its determination to the appellant, the Ophthalmic Qualifications Committee, the Welsh Ministers and any other person to whom the Welsh Ministers have sent notice of the appeal under paragraph (2).

(9) Subject to the other provisions in this paragraph, the appeal committee may set the procedure of the appeal as it considers proper.

Interpretation

4

In this Schedule—

“the health service” (“y gwasanaeth iechyd”) has the meaning given in section 206 of the Act;

“qualifications” (“cymwysterau”) includes qualifications as to experience.

SCHEDULE 3 — Combined lists

PART 1 — Information in the combined list

Information in the ophthalmic list

1

A Local Health Board’s ophthalmic list must contain the following information—

(a) the full names of the persons the Local Health Board has included in it;

(b) each such person’s professional registration number, with—

(i) suffixed to that number, the organisational code given by the Welsh Ministers to the Local Health Board, and

(ii) prefixed to that number, the initials OL;

(c) in the case of an individual, where consent is given, that person’s date of birth or where consent is not given or in the case of a corporate optician, the date of their first registration in the register;

(d) the date that the person’s name was first included in the ophthalmic list;

(e) if the qualified practitioner has made arrangements with the Local Health Board to provide mobile services, that fact;

(f) if the qualified practitioner is a mobile practice, that fact;

(g) the addresses of any places in the locality of the Local Health Board at which the qualified practitioner has undertaken to provide primary ophthalmic services other than mobile services, or in the case of a mobile practice, the address to which correspondence in connection with such provision may be sent and the addresses of any day or residential centres visited regularly;

(h) particulars of the days on which and hours between which the qualified practitioner has agreed to provide primary ophthalmic services at those addresses, or in the case of visits to day or residential centres by a mobile practice, the months in which visits are intended to take place and the planned interval between such visits, as agreed with the Local Health Board;

(i) the names of every other qualified practitioner who is regularly engaged as a deputy, director or employee in assisting in the provision of primary ophthalmic services at any of those addresses or in the provision of mobile services.

Information in the supplementary list

2

A Local Health Board’s supplementary list must contain the following information—

(a) the full names of the persons the Local Health Board has included in it;

(b) each such person’s professional registration number, with—

(i) suffixed to that number, the organisational code given by the Welsh Ministers to the Local Health Board, and

(ii) prefixed to that number, the initials SOL;

(c) date of birth, where the qualified practitioner has given consent, or if consent is not given, the date of the qualified practitioner’s first registration in the register;

(d) the date on which that person’s name was included in the supplementary list.

PART 2 — Information and undertakings to be provided in applications

Ophthalmic lists: information to be included in an application

3

A qualified practitioner applying to be included in a Local Health Board’s ophthalmic list must provide the following information—

(a) the qualified practitioner’s full name;

(b) the qualified practitioner’s professional registration number, with—

(i) suffixed to that number, the organisational code given by the Welsh Ministers to the Local Health Board, and

(ii) prefixed to that number, the initials OL;

(c) in the case of an individual, where consent is given, that person’s date of birth or where consent is not given or in the case of a corporate optician, the date of their first registration in the register;

(d) details of the addresses of any places in the Local Health Board’s locality at which the qualified practitioner undertakes to provide primary ophthalmic services;

(e) the names of every other ophthalmic medical practitioner or optometrist who is regularly engaged as a deputy, director or employee in assisting in the provision of primary ophthalmic services at any of those addresses or in the provision of mobile services;

(f) if the qualified practitioner wishes to provide mobile services, the addresses to which correspondence in connection with such provision may be sent;

(g) particulars of the days on which and hours between which the qualified practitioner agrees to provide primary ophthalmic services;

(h) company number, if appropriate;

(i) the qualified practitioner’s private address, or in the case of a corporate optician, the address of its registered office, and, in either case, a telephone number;

(j) qualifications and where they were obtained;

(k) chronological details of the qualified practitioner’s professional experience (including starting and finishing dates of each appointment together with an explanation of any gaps between appointments), with any supporting particulars, and an explanation of why the qualified practitioner was dismissed from any post;

(l) names and addresses of two referees who are willing to provide references in respect of two recent posts (which may include any current post) as a qualified practitioner, which lasted for at least 3 months without a significant break, and where this is not possible, a full explanation and the names and addresses of alternative referees;

(m) any information that the qualified practitioner has undertaken to provide under this Schedule;

(n) particulars of any outstanding or deferred application for inclusion in the ophthalmic list, or any other list of a Local Health Board or equivalent body, with the name of the Local Health Board or equivalent body in question;

(o) particulars of any Local Health Board or equivalent body in whose lists the qualified practitioner is included, or from which the qualified practitioner has been removed or contingently removed, or is suspended, or to which they have been refused admission or in which they have been conditionally included, with an explanation as to why;

(p) if the applicant is a director of a body corporate that is included in any list or equivalent list, or which has an outstanding application (including a deferred application) for inclusion in such a list, the name and address of the registered office of that body and details of the Local Health Board or equivalent body concerned;

(q) if the applicant is, or was in the preceding 6 months, or was at the time of the originating events, a director of a body corporate, details of any list or equivalent list to which that body has been refused admission, in which it has been conditionally included, from which it has been removed, contingently removed or from which it is currently suspended, with an explanation as to why and details of the Local Health Board or equivalent body concerned;

(r) all necessary authority to enable a request to be made by the Local Health Board to any employer (or former employer), licensing, regulatory or other body in the United Kingdom or elsewhere, for information relating to a current investigation, or an investigation where the outcome was adverse, by them into the qualified practitioner;

(s) any other information the Local Health Board may reasonably require.

4

A qualified practitioner applying to be included in a Local Health Board’s ophthalmic list must provide the following undertakings and consent—

(a) an undertaking to provide the information required by this Schedule and any further information requested by the Local Health Board;

(b) an undertaking to notify the Local Health Board within 7 days of any material changes to the information provided in the application until the application is finally determined;

(c) an undertaking to neither provide nor assist in the provision of primary ophthalmic services in the area of another Local Health Board or equivalent body from whose combined list or equivalent list the qualified practitioner has been removed, except where that removal was at the qualified practitioner’s request or in accordance with regulation 17(3)(e), without the consent, in writing of that Local Health Board or equivalent body;

(d) consent to the disclosure of information in accordance with these Regulations.

Supplementary lists: information to be provided in an application

5

A qualified practitioner applying to be included in a Local Health Board’s supplementary list must provide the following information—

(a) the qualified practitioner’s full name;

(b) the qualified practitioner’s date of birth;

(d) details of the qualified practitioner’s qualifications and where they were obtained;

(e) a declaration that the qualified practitioner is a fully registered ophthalmic medical practitioner or optometrist, or student optometrist, included in the register;

(f) the qualified practitioner’s professional registration number and their date of first registration in the register;

(g) chronological details of the qualified practitioner’s professional experience (including starting and finishing dates of each appointment together with an explanation of any gaps between appointments), with any supporting particulars, and an explanation of why the qualified practitioner was dismissed from any post;

(h) except where the applicant is a student optometrist, names and addresses of two referees who are willing to provide references in respect of two recent posts (which may include any current post) as a qualified practitioner, which lasted for at least 3 months without a significant break, and where this is not possible, a full explanation and the names and addresses of alternative referees;

(i) whether the qualified practitioner has any outstanding application, including a deferred application, to be included in a combined list or an equivalent list and, if so, particulars of that application;

(j) details of any Local Health Board or equivalent list from which the qualified practitioner has been removed or contingently removed, or to which they have been refused admission or in which they have been conditionally included, with an explanation as to why;

(k) if the qualified practitioner is the director of a body corporate that is included in any combined list or equivalent list, or which has an outstanding application (including a deferred application) for inclusion in such a list, the name and address of the registered office of that body and details of the Local Health Board or equivalent body concerned;

(l) where the practitioner is or was, in the preceding six months or at the time of the originating events, a director of a body corporate, details of any combined list or equivalent list to which that body has been refused admission, in which it has been conditionally included, from which it has been removed, contingently removed or from which it is currently suspended, with an explanation as to why and details of the Local Health Board or equivalent body concerned;

(m) any other information the Local Health Board may reasonably require.

Supplementary lists: undertakings and consents

6

A qualified practitioner applying to be included in a Local Health Board’s supplementary list must provide the following undertakings and consents—

(a) an undertaking to provide the information and document, if applicable, required by regulation 16;

(b) an undertaking not to assist in the provision of primary ophthalmic services in the area of another Local Health Board or equivalent body from whose combined list or equivalent list the qualified practitioner has been removed, except where that removal was at the qualified practitioner’s request or in accordance with regulation 17(3)(e), without the consent in writing of that Local Health Board or equivalent body;

(c) an undertaking to notify the Local Health Board within 7 days of any material changes to the information provided in the application until the application is finally determined;

(d) an undertaking to notify the Local Health Board if the qualified practitioner is included, or applies to be included, in any other combined list or equivalent list held by a Local Health Board or equivalent body;

(e) consent to the disclosure of information in accordance with these Regulations;

(f) consent a request being made by the Local Health Board to any employer (or former employer), licensing, regulatory or other body in the United Kingdom or elsewhere, for information relating to a current investigation, or an investigation where the outcome was adverse, by them into the qualified practitioner.

Declarations

7

(1) A qualified practitioner applying to be included in the Local Health Board’s combined list must declare whether the qualified practitioner—

(a) has any criminal convictions in the United Kingdom;

(b) has been bound over following a criminal conviction in the United Kingdom;

(d) has accepted a conditional offer under section 302 of the Criminal Procedure (Scotland) Act 1995[^f00051] (fixed penalty: conditional offer by procurator fiscal) or agreed to pay a penalty under section 115A of the Social Security Administration Act 1992[^f00052] (penalty as alternative to prosecution);

(e) has, in proceedings in Scotland for an offence, been the subject of an order under section 246(2) or (3) of the Criminal Procedure (Scotland) Act 1995 (admonition and absolute discharge) discharging the practitioner absolutely;

(f) has been convicted elsewhere of an offence, or what would constitute a criminal offence if committed in England and Wales;

(g) is charged in the United Kingdom with a criminal offence, or is charged elsewhere with an offence which, if committed in England and Wales, would constitute a criminal offence;

(h) is currently the subject of any proceedings which might lead to such a conviction, which have not yet been notified to the Local Health Board;

(i) has been subject to any investigation into the professional conduct of the qualified practitioner by any licensing, regulatory or other body anywhere in the world, where the outcome was adverse;

(j) is currently subject to any investigation into the professional conduct of the qualified practitioner by any licensing, regulatory or other body anywhere in the world;

(k) is, or has been where the outcome was adverse, the subject of any investigation into the professional conduct of the qualified practitioner in respect of any current or previous employment;

(l) becomes to the qualified practitioner’s knowledge the subject of any investigation by the NHS Counter Fraud Authority in relation to fraud, or is notified of the outcome of such an investigation, where it is adverse;

(m) is the subject of an investigation by another Local Health Board or equivalent body, which might lead to the qualified practitioner’s removal from a primary care list or equivalent list;

(n) has been removed, contingently removed or suspended from, refused admission to or conditionally included in a primary care list or equivalent list, and if so, why and the name of that Local Health Board or equivalent body;

(o) is, or has ever been, subject to a national disqualification.

(2) A declaration under sub-paragraph (1) must give details, including approximate dates, of where the investigation or proceedings were or are to be brought, the nature of that investigation or those proceedings, and any outcome.

(3) If the qualified practitioner applying to be included in the Local Health Board’s combined list is, has in the preceding 6 months been, or was at the time of the originating events, a director of a body corporate, the qualified practitioner must declare whether the body corporate—

(a) has any criminal convictions in the United Kingdom;

(b) has been convicted elsewhere of an offence, or what would constitute a criminal offence if committed in England and Wales;

(c) is currently the subject of any proceedings which might lead to such a conviction, which have not yet been notified to the Local Health Board;

(d) is charged in the United Kingdom with a criminal offence, or is charged elsewhere with an offence which, if committed in England and Wales would constitute a criminal offence;

(e) has been subject to any investigation into its provision of professional services by any licensing, regulatory or other body anywhere in the world, where the outcome was adverse;

(f) is currently subject to any investigation into its provision of professional services by any licensing, regulatory or other body anywhere in the world;

(g) becomes to the qualified practitioner’s knowledge the subject of any investigation by the NHS Counter Fraud Authority in relation to fraud, or is notified of the outcome of such an investigation, where it is adverse;

(h) is the subject of any investigation by another Local Health Board which might lead to its removal from a primary care list or equivalent list;

(i) has been removed, contingently removed or suspended from, refused admission to or conditionally included in a primary care list or equivalent list, and if so, why and the name of that Local Health Board or equivalent body.

(4) A declaration under sub-paragraph (3) must give the name and address of the registered office of the body corporate and details of any investigation or proceedings which were or are to be brought, including the nature of the investigation or proceedings, where and approximately when that investigation or those proceedings took place or are to take place, and any outcome.

(5) Where the qualified practitioner applying to be included in a Local Health Board’s ophthalmic list is a corporate optician, the qualified practitioner must declare whether any of its directors—

(a) has any criminal convictions in the United Kingdom;

(b) has been bound over following a criminal conviction in the United Kingdom;

(d) has accepted a conditional offer under section 302 of the Criminal Procedure (Scotland) Act 1995 (fixed penalty: conditional offer by procurator fiscal) or agreed to pay a penalty under section 115A of the Social Security Administration Act 1992 (penalty as alternative to prosecution);

(e) has, in proceedings in Scotland for an offence, been the subject of an order under section 246(2) or (3) of the Criminal Procedure (Scotland) Act 1995 (admonition and absolute discharge) discharging that director absolutely;

(f) has been convicted elsewhere of an offence, or what would constitute a criminal offence if committed in England and Wales;

(g) is currently the subject of any proceedings which might lead to such a conviction which have not yet been notified to the Local Health Board;

(h) is currently subject to any investigation into that director’s professional conduct by any licensing, regulatory or other body;

(i) is to that director’s knowledge the subject of any investigation by the NHS Counter Fraud Authority in relation to fraud, or is notified of the outcome of such an investigation, where it is adverse;

(j) is the subject of any investigation by another Local Health Board or equivalent body which might lead to that director’s removal from a primary care list or equivalent list;

(k) has been removed, contingently removed or suspended from, refused admission to, or conditionally included in a primary care list or equivalent list, and if so, why and the name of that Local Health Board or equivalent body.

(6) A declaration under sub-paragraph (5) must give details, including approximate dates, of where any investigation or proceedings were or are to be brought, the nature of that investigation or those proceedings, and any outcome.

PART 3 — Determination of applications

8

The grounds on which a Local Health Board must refuse to include a qualified practitioner in its combined list are that—

(a) the qualified practitioner has been convicted in the United Kingdom of murder;

(b) the qualified practitioner is the subject of a national disqualification;

(d) the qualified practitioner has not notified the Local Health Board under regulation 28(6);

(e) the Local Health Board is not satisfied of the qualified practitioner’s intention to provide or assist in the provision of primary ophthalmic services (as the case may be) in the Local Health Board’s area;

(f) the qualified practitioner—

(i) applies to be included in the ophthalmic list, but is included in the supplementary list of any Local Health Board, or

(ii) applies to be included in the supplementary list, but is included in either the ophthalmic list of any Local Health Board or the supplementary list of another Local Health Board unless, in either case, the qualified practitioner has given notice in writing to that Local Health Board that they wish to withdraw from that list;

(g) except in relation to a student optometrist, the Local Health Board considers that the qualified practitioner is not qualified to provide, or assist in the provision of, primary ophthalmic services (as appropriate);

(h) in relation to a student optometrist, the Local Health Board considers that the person is not qualified to assist in the provision of services under supervision.

9

The grounds on which a Local Health Board may refuse to include a qualified practitioner in its combined list are that—

(a) the Local Health Board, having reviewed the qualified practitioner’s application and any other relevant information or documents, considers the qualified practitioner is unsuitable to be included in its combined list;

(b) the Local Health Board, having checked the information provided by the qualified practitioner, is not satisfied with the information provided in the qualified practitioner’s application;

(c) having obtained references from the referees named by the qualified practitioner under Part 2 of Schedule 3, the Local Health Board is not satisfied with those references;

(d) having checked with the NHS Counter Fraud Authority for any facts that the Local Health Board considers relevant relating to any past or current fraud investigation involving or relating to the qualified practitioner and, having considered these and any other facts in its possession relating to fraud or relating to the qualified practitioner, the Local Health Board considers that these justify such refusal;

(e) the Local Health Board considers that there are reasonable grounds for concluding that including the qualified practitioner in the combined list would be prejudicial to the efficiency of the services which the qualified practitioner would provide or assist with;

(f) having checked with the Welsh Ministers for any facts that they consider relevant relating to past or current investigations or proceedings involving or relating to the qualified practitioner and, having considered these and any other facts in its possession involving or relating to the qualified practitioner, the Local Health Board considers that these justify such refusal;

(g) on or after 30 July 2002 in the case of the ophthalmic list, or on or after 1 February 2006 in the case of the supplementary list, the qualified practitioner has been convicted in the United Kingdom of any criminal offence (other than murder) and has been sentenced to a term of imprisonment (whether suspended or not) of over 6 months.

10

(1) Where the Local Health Board is considering a refusal of a qualified practitioner’s application on a ground contained in paragraph 9, it must consider all facts which appear to it to be relevant including—

(a) the nature of any offence, investigation or incident;

(b) the length of time since any such offence, incident, conviction or investigation;

(d) any action taken or penalty imposed by any licensing, regulatory or other body, the police or the courts as a result of any such offence, incident or investigation;

(e) the relevance of any offence, investigation or incident in respect of the qualified practitioner’s provision of (or assistance in providing, as applicable) primary ophthalmic services and any likely risk to any patients or to public finances;

(f) whether any criminal offence was a sexual offence for the purposes of Part 1 of the Sexual Offences Act 2003[^f00053], or which if it had been committed in England and Wales, would have been such an offence;

(g) whether the qualified practitioner has been refused admission to, conditionally included in, removed, contingently removed, or is currently suspended from, a primary care list or equivalent list, and if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or equivalent body for such action;

(h) whether the qualified practitioner is, has in the preceding 6 months been, or was at the time of the originating events, a director of a body corporate which was refused admission to, conditionally included in, removed or contingently removed from a primary care list or equivalent list or is currently suspended from any such list, and if so, what the facts were in each such case and the reasons given by the Local Health Board or equivalent body in each case for such action;

(i) in the case of a corporate optician, whether any of its directors, or anyone who has in the preceding 6 months been one of its directors, has been refused admittance to, conditionally included in, removed, contingently removed or suspended from a primary care list, or equivalent list and, if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or equivalent body for such action.

(2) When the Local Health Board takes into consideration the matters set out in sub-paragraph (1), it must consider the overall effect of all the matters being considered.

PART 4 — Deferral of decisions

11

(1) The circumstances referred to in regulation 15 are—

(a) the qualified practitioner is suspended from a primary care list or equivalent list;

(b) a body corporate of which the qualified practitioner is, has in the preceding 6 months been, or was at the time of the originating events, a director, is suspended from a primary care list or equivalent list;

(c) any of the circumstances mentioned in sub-paragraph (2), where the Local Health Board considers it likely that a conviction, or equivalent to a conviction, or a finding against the qualified practitioner would lead to the qualified practitioner’s removal from its combined list if they were included on it.

(2) The circumstances are—

(a) active criminal proceedings in relation to the qualified practitioner in the United Kingdom;

(b) active proceedings in relation to the qualified practitioner elsewhere in the world relating to conduct, which, if it had occurred in the United Kingdom, would constitute a criminal offence;

(c) in respect of a body corporate of which the qualified practitioner is, has in the preceding 6 months been, or was at the time of the originating events a director—

(i) active criminal proceedings in relation to that body corporate in the United Kingdom;

(ii) active proceedings in relation to that body corporate elsewhere in the world relating to conduct, which, if it had occurred in the United Kingdom, would constitute a criminal offence;

(d) in the case of a corporate optician, where in respect of any of its directors—

(i) there are active criminal proceedings in the United Kingdom;

(ii) there are active proceedings elsewhere in the world relating to conduct, which, if it had occurred in the United Kingdom, would constitute a criminal offence;

(e) there is an active investigation anywhere in the world by the qualified practitioner’s licensing or regulatory body or any other investigation (including one by another Local Health Board or equivalent body) relating to the qualified practitioner in their professional capacity;

(f) the First-tier Tribunal is considering an appeal by the qualified practitioner against a decision of a Local Health Board to refuse to admit the qualified practitioner to its combined list, or to conditionally include them in, or to remove or contingently remove them from any list kept by the Local Health Board;

(g) the First-tier Tribunal is considering an appeal by a body corporate of which the qualified practitioner is, has in the preceding 6 months been, or was at the time of the originating events a director against a decision of a Local Health Board to refuse to admit the body corporate to its combined list, or to conditionally include them in, or to remove or contingently remove them from any lists kept by a Local Health Board or equivalent body;

(h) the qualified practitioner is being investigated by the NHS Counter Fraud Authority in relation to any fraud;

(i) a body corporate, of which the qualified practitioner is, has in the preceding 6 months been, or was at the time of the originating events, a director, is being investigated in relation to any fraud;

(j) the First-tier Tribunal is considering an application from a Local Health Board for a national disqualification of the qualified practitioner;

(k) the First-tier Tribunal is considering an application from a Local Health Board for a national disqualification of a body corporate of which the qualified practitioner is, or has in the preceding 6 months been, or was at the time of the originating events a director.

PART 5 — Removal from a combined list

Procedure for removal under these Regulations

12

(1) In the circumstances in sub-paragraph (4), a Local Health Board must give the qualified practitioner—

(a) notice of any allegation against the qualified practitioner;

(b) notice of the action the Local Health Board is considering and on what grounds;

(c) the opportunity to make written representations to the Local Health Board within 28 days of the date of notification under paragraph (b) (“the specified period”);

(d) the opportunity to make representations at an oral hearing before the Local Health Board within the specified period if the qualified practitioner requests one.

(2) If the qualified practitioner requests an oral hearing, the hearing must take place within the specified period and before the Local Health Board reaches its decision.

(3) If the qualified practitioner makes written representations or an oral hearing takes place, the Local Health Board must take any representations made by the qualified practitioner into account before reaching its decision.

(4) This paragraph applies where a Local Health Board is considering—

(a) removal on the grounds in regulation 17(3),

(b) removal for breach of a condition imposed under regulation 14, or

Procedure for removal under the Act

13

A Local Health Board must follow the procedure set out in paragraph 12(1) to (3) where it is considering—

(a) removing a qualified practitioner from its ophthalmic list under section 107 of the Act (disqualification of practitioners), or

(b) contingently removing a qualified practitioner from its ophthalmic list under section 108 of the Act.

Factors to be considered before removal

14

In making any decision under section 107 of the Act (disqualification of practitioners) or regulation 17(3)(d) of these Regulations, the Local Health Board must take into account the overall effect of any relevant incidents and offences relating to the qualified practitioner of which it is aware, whichever condition it relies on.

Factors relating to unsuitability cases

15

(1) Where a Local Health Board is considering whether to remove a qualified practitioner from its combined list under section 107(4) of the Act (disqualification of practitioners) or under regulation 17(3)(d) of these Regulations, in relation to an unsuitability case, it must—

(a) consider any information relating to the qualified practitioner which it has received in accordance with any provision of Part 2 of Schedule 3 or Schedule 4,

(b) check with the Welsh Ministers for, and consider, any facts that the Welsh Ministers consider relevant relating to past or current investigations or proceedings involving or relating to the qualified practitioner, and

(2) The matters referred to in sub-paragraph (1)(c) are—

(a) the nature of any offence, investigation or incident;

(b) the length of time since any offence, incident, conviction or investigation occurred or was concluded;

(d) any action taken or penalty imposed by any licensing or regulatory body, the police or the courts as a result of any such offence, incident or investigation;

(e) the relevance of any offence, incident or investigation to the qualified practitioner’s provision of (or assistance in providing, as applicable) primary ophthalmic services and any likely risk to any patients or to public finances;

(f) whether any offence was a sexual offence for the purposes of Part 1 of the Sexual Offences Act 2003, or which if it had been committed in England and Wales, would have been such an offence;

(g) whether the qualified practitioner has been refused admission to, conditionally included in, removed, contingently removed, or is currently suspended from, a primary care list or equivalent list, and if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or equivalent body for such action;

(h) whether the qualified practitioner is, has in the preceding 6 months been, or was at the time of the originating events, a director of a body corporate which was refused admission to, conditionally included in, removed or contingently removed from a primary care list or equivalent list or is currently suspended from any such list, and if so, what the facts were in each such case and the reasons given by the Local Health Board or equivalent body in each case for such action;

(i) in the case of a corporate optician, whether a person who, at the time of the originating events, was one of its directors, has been refused admittance to, conditionally included in, removed, contingently removed or suspended from a primary care list, or equivalent list and, if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or equivalent body for such action.

Factors relating to fraud cases

16

(1) Where a Local Health Board is considering whether to remove a qualified practitioner from its combined list under section 107(3) of the Act (disqualification of practitioners) or under regulation 17(3)(d) of these Regulations, in relation to a fraud case, it must—

(a) consider any information relating to the qualified practitioner which it has received in accordance with any provision of Part 2 of Schedule 3 or Schedule 4,

(b) check with the Welsh Ministers for, and consider, any facts that the Welsh Ministers consider relevant relating to past or current investigations or proceedings involving or relating to the qualified practitioner, and

(2) The matters referred to in sub-paragraph (1)(c) are—

(a) the nature of any cases of fraud;

(b) the length of time since the last case of fraud occurred and since any investigation into it was concluded;

(d) any action taken by any licensing, regulatory or other body, the police or the courts as a result of any such offence, investigation or case;

(e) the relevance of any investigation into a case of fraud to the qualified practitioner’s provision of (or assistance in providing, as applicable) primary ophthalmic services and the likely risk to patients or to public finances;

(f) whether the qualified practitioner has been refused admission to, conditionally included in, removed, or contingently removed or is currently suspended from, a primary care list or equivalent list, and, if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or equivalent body for such action;

(g) whether the qualified practitioner is, has in the preceding 6 months been, or was at the time of the originating events, a director of a body corporate, which was refused admission to, conditionally included in, removed or contingently removed from, a primary care list or equivalent list, or is currently suspended from any such list, and if so, what the facts were in each such case and the reasons given by the Local Health Board or equivalent body in each case;

(h) in the case of a corporate optician, whether a person who, at the time of the originating events, was one of its directors, has been refused admittance to, conditionally included in, removed, contingently removed or suspended from a primary care list or equivalent list and, if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or equivalent body for such action.

Factors relating to efficiency cases

17

(1) Where a Local Health Board is considering the removal of a qualified practitioner from its combined list under section 107(2) of the Act (disqualification of practitioners) or under regulation 17(3)(d) of these Regulations, in relation to an efficiency case, it must—

(a) consider any information relating to the qualified practitioner which it has received in accordance with any provision of Part 2 of Schedule 3 or Schedule 4,

(b) check with the Welsh Ministers for, and consider, any facts that the Welsh Ministers consider relevant relating to past or current investigations or proceedings involving or relating to the qualified practitioner, and

(2) The matters referred to in sub-paragraph (1)(c) are—

(a) whether the continued inclusion of the qualified practitioner in the combined list would be prejudicial to the efficiency of the primary ophthalmic services—

(i) provided by the qualified practitioner, or

(ii) which the qualified practitioner assists in providing;

(b) the length of time since the last incident occurred and since any investigation into it was concluded;

(c) any action taken by any licensing, regulatory or other body, the police or the courts as a result of any such incident;

(d) the nature of the incident and whether there is a likely risk to patients;

(e) whether the qualified practitioner has previously failed to supply information, make a declaration or comply with an undertaking required by these Regulations;

(f) whether the qualified practitioner has ever failed to comply with a request by the Local Health Board to take an assessment by NHS Resolution or any of its predecessor bodies;

(g) whether the qualified practitioner has been refused admission to, conditionally included in, removed or contingently removed or is currently suspended from, a primary care list or equivalent list, and if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or the equivalent body for such action;

(h) whether the qualified practitioner is, has in the preceding 6 months been, or was at the time of the originating events, a director of a body corporate which was refused admission to, conditionally included in, removed or contingently removed from a primary care list or equivalent list, or is currently suspended from any such list, and if so, what the facts were in each such case and the reasons given by the Local Health Board or equivalent body in each case for such action;

(i) in the case of a corporate optician, whether a person, who, at the time of the originating events, was one of its directors, has been refused admittance to, conditionally included in, removed, contingently removed or suspended from a primary care list or equivalent list and, if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or equivalent body for such action.

PART 6 — Interpretation

Interpretation

18

In this Schedule—

“mobile practice” (“practis symudol”) means a contractor who— has made arrangements with the Local Health Board to provide mobile services, and does not have premises in that Local Health Board’s area;

“originating events” (“digwyddiadau cychwynnol”) means the events that gave rise to the conviction, investigation, proceedings, suspension, refusal to admit, conditional inclusion, removal or contingent removal that took place;

“the register” (“y gofrestr”) means— in relation to an ophthalmic medical practitioner, a register maintained by the General Medical Council under the Medical Act 1983, or in relation to a qualified practitioner other than an ophthalmic medical practitioner, a register maintained by the General Optical Council under the Opticians Act 1989.

SCHEDULE 4 — Terms of Service

Incorporation of provisions

1

(1) Any provisions of the following affecting the rights and obligations of contractors form part of the terms of service—

(a) these Regulations;

(b) the Statement;

(d) so much of Part 2 of the National Health Service (Service Committees and Tribunal) Regulations 1992[^f00054] as relates to—

(i) the investigation of questions arising between contractors and their patients, other investigations to be made by the ophthalmic discipline committee (“the Committee”), and the action which may be taken by the Committee as a result of such investigations, including the withholding of remuneration from a contractor where there has been a breach of the terms of service;

(ii) appeals to the Welsh Ministers against decisions of the Committee;

(iii) the investigation of excessive issuing of optical vouchers following the testing of sight;

(e) regulation 9 of the National Health Service (Optical Charges and Payments) Regulations 1997[^f00055] (issue of vouchers by ophthalmic medical practitioners or opticians).

(2) The contractor must secure that any person the contractor employs to assist in the provision of primary ophthalmic service complies with the provisions listed at paragraph (1)(a) to (e) in so far as they apply to such persons.

(3) In this paragraph, “fee directions” has the meaning given in regulation 32.

Duty to make available basic glasses

2

(1) Sub-paragraphs (2) and (3) apply where—

(a) in the course of its business, a contractor supplies glasses for the purpose of correcting visual defects, and

(b) a person presents that contractor with a voucher for supply of optical appliances issued under the National Health Service (Optical Charges and Payments) Regulations 1997.

(2) A contractor may accept the voucher in substitution for payment in relation to a pair of glasses only if the contractor has made available to the person at least one pair of basic glasses (whether or not the payment is in relation to those basic glasses or another pair of glasses).

(3) For the purposes of this paragraph, “basic glasses” means a pair of glasses that are an appropriate fit for the person which—

(a) meet the person’s prescription, and

(b) are of a value equal to or less than the face value of the voucher.

(4) In sub-paragraph (3), “face value” has the meaning given in the National Health Service (Optical Charges and Payments) Regulations 1997.

Premises at which primary ophthalmic services are to be provided

3

Subject to paragraph 4, a contractor may provide primary ophthalmic services only at the contractor’s registered premises.

Provision of mobile services

4

(1) A contractor who has made arrangements with a Local Health Board to provide mobile services in that Local Health Board’s area may only provide them in accordance with sub-paragraph (2).

(2) The contractor may only provide mobile services if—

(a) the patient has requested the contractor provides those services to them, or where the patient is not capable of making such a request, a relative or primary carer of that patient, or a duly authorised person, has made such a request,

(b) the patient’s circumstances related to their physical or mental illness or disability make it impossible or unreasonable for them to receive primary ophthalmic services at a registered premises, and

Premises and equipment

5

(1) Subject to sub-paragraphs (2) to (6) and paragraph 18(4), a contractor must provide, as necessary, proper and sufficient consulting and waiting room accommodation and suitable equipment for the provision of primary ophthalmic services which the contractor has undertaken to provide.

(2) A contractor, who has made arrangements with the Local Health Board to provide mobile services, must provide suitable equipment for the provision of such services.

(3) Where the circumstances in sub-paragraph (4) apply, a contractor may, instead of providing the accommodation and equipment, as required under sub-paragraph (1), or equipment as required under sub-paragraph (2), enter into arrangements of the kind described in sub-paragraph (5), provided the conditions set out in sub-paragraph (6) are met.

(4) The circumstances referred to in sub-paragraph (3) are that a contractor who was included on the ophthalmic list of a Local Health Board on 31 January 2006—

(a) does not provide or no longer provides accommodation and equipment, as required under sub-paragraph (1), or equipment as required under sub-paragraph (2), and

(b) is not employed, in relation to the primary ophthalmic services which the contractor has undertaken to provide in the area of that Local Health Board, by another contractor.

(5) The arrangements referred to in sub-paragraph (3) are legally enforceable arrangements under which the following are available to the contractor for the provision of primary ophthalmic services that the contractor has undertaken to provide, which permit inspection as required under sub-paragraph (7) or (8)—

(a) requisite, proper and sufficient consulting and waiting room accommodation and suitable equipment, or

(b) in the case of the provision of mobile services, suitable equipment.

(6) The conditions referred to in sub-paragraph (3) are that the contractor has satisfied the Local Health Board that—

(a) the arrangements are legally enforceable and permit inspection as required under sub-paragraph (7) or (8);

(b) the accommodation and equipment or, in the case of the provision of mobile services, equipment, provided under the arrangements are adequate and suitable.

(7) Subject to sub-paragraph (8) and paragraph 18(4), a contractor, on receipt of a written request from the Local Health Board to do so, must admit at all reasonable times for the purposes of inspecting the contractor’s accommodation or equipment an authorised officer of the Welsh Ministers, or an authorised officer or member of the Local Health Board.

(8) On receipt of a written request from the Local Health Board or the Welsh Ministers, a contractor who has made arrangements with the Local Health Board to provide mobile services must—

(a) arrange for an authorised officer of the Local Health Board or of the Welsh Ministers to be allowed to inspect at a reasonable time the facilities and equipment that the contractor uses;

(b) allow an authorised officer of the Welsh Ministers or that Local Health Board to inspect the facilities and equipment that the contractor uses when providing those services.

(9) A contractor must have regard to the code of practice on access to premises prepared and published by the Welsh Ministers under section 19(1) of the Health and Social Care (Quality and Engagement) (Wales) Act 2020[^f00056] (code of practice on access to premises) (so far as the code is relevant) in exercising any function that relates to the provision of health services or social services (within the meaning of those terms in section 21 of that Act).

Displaying of notices

6

(1) Subject to sub-paragraph (2), a contractor must prominently display at each place at which the contractor provides primary ophthalmic services—

(a) a notice and leaflets supplied or approved by the Local Health Board, indicating that primary ophthalmic services are available and indicating to which descriptions of the contractor’s patients a payment may be made under the National Health Service (Optical Charges and Payments) Regulations 1997, and

(b) details of the days on which and hours between which the contractor has agreed to provide primary ophthalmic services at that place.

(2) Where mobile services are being provided, a notice is required to be displayed only in so far as it is reasonably practicable to do so.

Welsh Language

7

(1) Where the contractor provides primary ophthalmic services through the medium of Welsh, the contractor must notify the Local Health Board of that fact.

(2) The contractor must make available a Welsh language version of any document or form provided by the Local Health Board for use by patients and other members of the public.

(3) Where the contractor displays a new sign or notice in connection with primary ophthalmic services, the text on the sign or notice must be in English and Welsh.

(4) The contractor may utilise the translation service offered by the Local Health Board for the purposes of sub-paragraph (3).

(5) The contractor must encourage persons delivering primary ophthalmic services who speak Welsh to wear a badge provided by the Local Health Board conveying that they are able to speak Welsh.

(6) The contractor must encourage persons delivering primary ophthalmic services to utilise information and/or attend training courses and events provided by the Local Health Board, so that they can develop—

(a) an awareness of the Welsh language (including awareness of its history and its role in Welsh culture), and

(b) an understanding of how the Welsh language can be used when delivering primary ophthalmic services.

(7) The contractor must encourage those delivering primary ophthalmic services to establish and record the Welsh or English language preference expressed by or on behalf of a patient.

Times at which primary ophthalmic services must be provided

8

The contractor must provide primary ophthalmic services during times agreed with the Local Health Board.

Records

9

(1) Subject to paragraph 10, a contractor must keep a proper record in respect of each patient to whom the contractor provides primary ophthalmic services.

(2) Subject to paragraphs 10 and 18(4), a contractor must retain all such records for a period of 10 years after the date the patient was last seen or until the patient turns 25 years old, whichever is the later.

(3) During the period referred to in sub-paragraph (2), a contractor must produce those records when required to do so by a Local Health Board or the Welsh Ministers—

(a) to an officer authorised by a Local Health Board or by the Welsh Ministers, and

(b) within such period, not being less than 14 days, as the Local Health Board or the Welsh Ministers may specify.

Alternative records arrangements

10

(1) Where the circumstances in sub-paragraph (2) apply, a contractor may, instead of keeping the records required under paragraph 9, comply with the conditions set out in sub-paragraph (3).

(2) The circumstances referred to in sub-paragraph (1) are that a contractor—

(a) was included on the ophthalmic list of a Local Health Board on 31 January 2006,

(b) does not keep or no longer keeps records as required under paragraph 9, and

(c) is not employed, in relation to the primary ophthalmic services the contractor provides in the area of that Local Health Board, by another contractor.

(3) The conditions referred to in sub-paragraph (1) are that the contractor has—

(a) made legally enforceable arrangements that—

(i) a proper record in respect of each patient to whom the contractor provides primary ophthalmic services is kept,

(ii) all such records are kept for a period of 10 years after the date the patient was last seen or until the patient turns 25 years old, whichever is the later, and

(iii) during that period such records must be produced when and as required under paragraph 9(3),

(b) satisfied the Local Health Board’s requirements as to the keeping of records and that the arrangements are legally enforceable and require such production, and

Audits

11

(1) A contractor must—

(a) complete such audits as the Local Health Board on whose ophthalmic list the contractor is included may require in each financial year, and

(b) submit those audits to that Local Health Board in the form and manner required by the Local Health Board.

(2) Nothing in this paragraph requires a contractor to complete more than three such audits in any financial year.

(3) The audits required by sub-paragraph (1) are audits—

(a) relating to services provided by the contractor, and

(b) which the Local Health Board requires for the purpose of exercising its functions under the Act.

(4) For the purposes of this Schedule, “financial year” has the meaning given in section 206 of the Act (interpretation).

Workforce reporting

12

(1) A contractor must provide such workforce data to the Local Health Board on whose ophthalmic list the contractor is included as the Local Health Board may, from time to time, require.

(2) Nothing in these terms of service requires a contractor to do anything contrary to data protection legislation.

(3) For the purposes of this paragraph—

“data protection legislation” (“deddfwriaeth diogelu data”) has the meaning given in section 3 of the Data Protection Act 2018[^f00057] (terms relating to the processing of personal data);

“workforce data” (“data am y gweithlu”) means data relating to those employed by the contractor.

Optometry collaborative

13

(1) A contractor must—

(a) attend at least four meetings of the relevant optometry collaborative in each financial year, and

(b) vote in the election of the optometric lead of the relevant optometry collaborative (and any vote regarding that person’s continued appointment).

(2) For the purposes of complying with the requirements in sub-paragraph (1), a contractor may appoint an individual who is an optometrist, an ophthalmic medical practitioner or a dispensing optician to act on the contractor’s behalf.

(3) For the purposes of this paragraph—

“optometric lead” (“arweinydd optometreg”) means the person elected by an optometry collaborative to represent it within a primary care cluster;

“optometry collaborative” (“cydweithredfa optometreg”) means a group of contractors providing primary ophthalmic services within the geographic area of the same primary care cluster;

“primary care cluster” (“clwstwr gofal sylfaenol”) means a group of health and social care providers that have agreed to work collaboratively to deliver primary care services across a specified geographical area;

“relevant optometry collaborative” (“cydweithredfa optometreg berthnasol”) means the optometry collaborative in whose area the contractor provides primary ophthalmic services.

Quality improvement and governance

14

(1) A contractor must—

(a) complete a quality improvement and governance self-assessment, in the form required by the Local Health Board on whose list the contractor is included, in each financial year,

(b) submit the completed self-assessment to that Local Health Board, and

(c) undertake, and ensure that relevant employees of the contractor undertake, appropriate training in relation to quality improvement and governance provided by Health Education and Improvement Wales, as required by the Local Health Board on whose list the contractor is included.

(2) The requirement in sub-paragraph (1)(c) that the contractor must undertake training does not apply to a contractor that is a corporate optician.

(3) For the purposes of this paragraph, “relevant employees” means, in relation to a contractor, employees of such a description as required by the Local Health Board.

Declarations of Convictions etc.

15

(1) On becoming aware of a change to the information the contractor provided in accordance with paragraph 7 of Schedule 3 when applying to be included in a Local Health Board’s ophthalmic list, the contractor must notify the Local Health Board in writing within 7 days.

(2) Where sub-paragraph (1) applies, the contractor must provide all necessary authority to enable a request to be made by the Local Health Board to any employer (or former employer), licensing, regulatory or other body in the United Kingdom or elsewhere, for information relating to the notification given by the contractor under sub-paragraph (1).

(3) A contractor who is included in an ophthalmic list of a Local Health Board must supply that Local Health Board with an enhanced criminal record certificate under section 113B of the Police Act 1997 in relation to them, if the Local Health Board at any time, for reasonable cause, gives the contractor notice to provide such a certificate.

Applications to other lists

16

A contractor who is an ophthalmic medical practitioner or optometrist must inform the Local Health Board in whose list they are included—

(a) if they or a body corporate of which they are a director apply to be included in a primary care list or equivalent list, and of the outcome of any such application;

(b) if they become a director of a body corporate that is included in any primary care list, or apply to be included in such a list, and the outcome of any such application;

(c) in the case of a corporate optician, if any of its directors applies to be included in a primary care list or equivalent list and the outcome of any such application.

Deputies

17

(1) A contractor may arrange for a deputy to provide primary ophthalmic services on the contractor’s behalf.

(2) Any contractor who makes an arrangement for the regular provision of services by a deputy must notify the Local Health Board of that arrangement.

(3) A contractor is responsible for all acts and omissions of any person acting as their deputy and of any employee of that person.

(4) A deputy who is also a contractor is jointly responsible to the same extent as the contractor for whom the deputy is deputising.

Employees

18

(1) A contractor may employ—

(a) to assist in the provision of primary ophthalmic services, an ophthalmic medical practitioner or optometrist included in a combined list;

(b) to assist in the provision of primary ophthalmic services to the extent they are qualified to do so, and under the supervision of an ophthalmic medical practitioner or optometrist whose name is included in a combined list, a student optometrist whose name is included in a supplementary list;

(i) is authorised to test sight by rules made under section 24(3) of the Opticians Act 1989[^f00058] (testing of sight), under the supervision of an ophthalmic medical practitioner or optometrist whose name is included in a combined list, but

(ii) is not a student optometrist;

(d) to assist in the provision of eye examination services to the extent they are accredited to do so, an accredited dispensing optician.

(2) A contractor who regularly employs an ophthalmic medical practitioner, optometrist, student optometrist or accredited dispensing optician must notify the Local Health Board accordingly.

(3) A contractor is responsible for all acts and omissions of its employees.

(4) An employee of the contractor who is also a contractor is jointly responsible but only, in the case of paragraphs 5(1) and (7) and 9(2), to the extent that the employee has not taken all reasonable steps to secure that the requirements of those provisions are met.

(5) In this paragraph—

“accredited dispensing optician” (“optegydd cyflenwi achrededig”) means a person who— is registered as a dispensing optician in the register maintained under section 7 of the Opticians Act 1989 (register of opticians) with a contact lens specialty entry, has been accredited by Health Education and Improvement Wales to undertake elements of the eye examination service, and has provided evidence of (b) to the contractor;

“employee” (“cyflogai”) includes, in the case of a body corporate, a director and “employ” (“cyflogi”) must be interpreted accordingly.

Concerns procedure

19

(1) A contractor must have in place arrangements which comply with the requirements of the National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011[^f00059] (“the 2011 Regulations”), for the handling and consideration of any concerns.

(2) References in this paragraph and in paragraph 20 to a “concern” are to a concern notified in accordance with the 2011 Regulations.

Co-operation with investigations

20

(1) A contractor must co-operate with any investigation of a complaint or concern in relation to any matter reasonably connected to the contractor’s provision of primary ophthalmic services undertaken by a “relevant body”, which includes—

(a) the Local Health Board;

(b) the Welsh Ministers;

(2) The co-operation required by sub-paragraph (1) includes—

(a) answering questions reasonably put to the contractor by a relevant body;

(b) providing any information relating to the complaint or concern reasonably required by a relevant body;

(c) attending any meeting to consider the complaint or the concern (if held at a reasonably accessible place and at a reasonable hour, and due notice has been given), if the contractor’s presence is reasonably required by a relevant body.

Complaints made against and concerns notified about ophthalmic medical practitioners

21

(1) Where a contractor who, being an ophthalmic medical practitioner, also performs primary medical services under a GMS contract for any person for whom the contractor provides primary ophthalmic services, the complaints procedure or procedure for notifying concerns established and operated in accordance with the terms of that GMS contract applies in relation to any matter reasonably connected with the contractor’s provision of primary ophthalmic services as it applies as respects the provision of services under the GMS contract.

(2) Any requirement as to co-operation with investigations of complaints or concerns by other bodies imposed on a GMS contractor under the terms of the contractor’s contract which gives effect to paragraph 102 of Schedule 3 to the National Health Service (General Medical Services Contracts) (Wales) Regulations 2023[^f00060] also applies in relation to complaints or concerns about the matters referred to in sub-paragraph (1).

(3) For the purposes of this paragraph, “GMS contract” means a general medical services contract under section 42 of the Act (general medical services contracts: introductory) and “GMS contractor” must be interpreted accordingly.

Payment claims

22

(1) Any claim by a contractor for fees for the provision of primary ophthalmic services under these Regulations must be made by completing a primary ophthalmic services form and sending it to the Local Health Board in whose area the primary ophthalmic services were provided within 3 months beginning with the date of completion of the provision of those services.

(2) Any such claim—

(a) may be submitted electronically or on paper, and

(b) must be—

(i) signed by the optometrist or ophthalmic medical practitioner whose name is included in a combined list and who provided or assisted in the provision of the primary ophthalmic services in respect of which the claim is made (“the practitioner”), and

(ii) in a case where the practitioner is not on the ophthalmic list of that Local Health Board, counter-signed on behalf of the contractor by a person (who may be the contractor) duly authorised by the contractor to counter-sign, whom the contractor has previously notified the Local Health Board as being so authorised.

(3) In the case of a claim signed under sub-paragraph (2)(b)(i), the practitioner must supply with their signature, their professional registration number with the prefix and suffix given to that number in the combined list in which the qualified practitioner’s name is included.

(4) In the case of a claim counter-signed under sub-paragraph (2)(b)(ii), the person authorised to counter-sign must supply, with that person’s counter-signature, the professional registration number of the contractor.

(5) A signatory or counter-signatory is to sign any electronic claim or paper claim in digital ink or in ink, in the signatory or counter-signatory’s own handwriting and not by means of a stamp or reproduced image, with the signatory or counter-signatory’s—

(a) initials or forename, and

(b) surname.

(6) Except as provided in these Regulations, in the Statement or in sub-paragraph (7), a contractor must not demand or accept from any patient or from other persons the payment of any fee or other remuneration in respect of the provision of primary ophthalmic services.

(7) A contractor is entitled to demand and recover from a patient, or person having charge of a patient, a sum in respect of loss of remunerative time resulting from that patient’s failure to keep an appointment.

(8) A contractor must not demand or accept from the Local Health Board the payment of any fee or other remuneration in respect of any item of service—

(a) which has not been provided under primary ophthalmic services, or

(b) for which another claim has already been submitted to the Local Health Board.

Testing of sight

23

(1) Where a contractor has accepted an application for the testing of sight under these Regulations, the contractor must—

(a) test the sight of the patient to determine whether the patient needs to wear or use an optical appliance,

(b) in doing so, must fulfil any duty imposed on the contractor by, or in regulations made under, section 26 of the Opticians Act 1989[^f00061] (duties to be performed on sight testing), and

(2) A prescription for glasses issued following a testing of sight under general ophthalmic services must—

(a) be completed by the method recommended in guidance published by the British Standards Institution, and

(b) comply with any requirements as to its form specified in the Statement for the purposes of payment in respect of the sight test.

(3) Where a contractor provides a sight test as part of mobile services, the contractor must record the reason given by the patient, or on their behalf, for requiring mobile services on the primary ophthalmic services form.

(4) A contractor must keep a record of the eye health advice provided to a patient under this paragraph.

(5) For the purposes of this paragraph, “relevant eye health advice”, in relation to a patient, means—

(a) advice about any risks to eye health or vision that appear to the contractor to be relevant to that patient,

(b) advice about how to mitigate any identified risks to their eye health or vision,

(d) such other advice, for the purpose of increasing the patient’s knowledge and understanding of any health issues connected to the patient’s eye condition, eye health or vision, which appears to the contractor to be relevant to the patient’s personal circumstances.

Eye examinations

24

(1) A contractor must provide an eye examination to a person in the circumstances in sub-paragraph (2).

(2) The circumstances are that a qualified practitioner considers that it is clinically appropriate to provide an eye examination to a person—

(a) due to clinical findings that have become apparent during the provision of general ophthalmic services or during a sight test provided otherwise than under the Act, to that person,

(b) following a recommendation by a health care professional that the person should be examined by a qualified practitioner,

(d) for the purpose of reviewing the person’s eye health following—

(i) treatment at an ophthalmic hospital, or

(ii) a previous eye examination under sub-paragraph (c).

(3) Where a contractor provides an eye examination as part of mobile services, the contractor must record the reason given by the patient, or on their behalf, for requiring mobile services on the primary ophthalmic services form.

(4) For the purposes of this paragraph, “health care professional” means a person who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002[^f00062] (the Professional Standards Authority for Health and Social Care).

Refusal to provide services

25

(1) Paragraphs (2) and (3) apply—

(a) where—

(i) a person applies for a sight test, and

(ii) the contractor is satisfied that the person is eligible for a sight test in accordance with these Regulations, or

(b) where one of the circumstances in paragraph 24(2) applies in relation to a person.

(2) The contractor may refuse to provide the relevant service to that person only if they have reasonable grounds for doing so.

(3) For the purposes of paragraph (2), reasonable grounds may not relate to the person’s age, ophthalmic condition or related medical condition.

Referrals

26

(1) Where a contractor, or qualified practitioner assisting the contractor in the provision of primary ophthalmic services, is of the opinion that a patient who has received a sight test pursuant to paragraph 23 or an eye examination pursuant to paragraph 24 of this Schedule—

(a) shows on examination signs of injury, disease or abnormality in the eye or elsewhere which may require medical treatment, or

(b) is not likely to attain a satisfactory standard of vision notwithstanding the application of corrective lenses,

the contractor must, if appropriate, and with the consent of the patient, take the steps set out in sub-paragraph (2).

(2) The steps referred to in sub-paragraph (1) are—

(a) in the first instance, a referral to an optometrist with qualifications appropriate to the needs of the patient;

(b) if the contractor considers that a referral of the kind specified in paragraph (a) would not meet the patient’s needs, a referral to an ophthalmic hospital.

(3) Where a contractor makes a referral in accordance with this paragraph, the contractor must immediately—

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The National Health Service (Ophthalmic Services) (Wales) Regulations 2023

Specific evidence of eligibility for certain persons

2

SCHEDULE 2 — Recognition of ophthalmic medical practitioners

Qualifications of ophthalmic medical practitioners

1

Approval of qualifications of ophthalmic medical practitioners

2

Appeals from Ophthalmic Qualifications Committee

3

Interpretation

4

SCHEDULE 3 — Combined lists

PART 1 — Information in the combined list

Information in the ophthalmic list

1

Information in the supplementary list

2

PART 2 — Information and undertakings to be provided in applications

Ophthalmic lists: information to be included in an application

3

Ophthalmic lists: undertakings and consent

4

Supplementary lists: information to be provided in an application

5

Supplementary lists: undertakings and consents

6

Declarations

7

PART 3 — Determination of applications

8

9

10

PART 4 — Deferral of decisions

11

PART 5 — Removal from a combined list

Procedure for removal under these Regulations

12

Procedure for removal under the Act

13

Factors to be considered before removal

14

Factors relating to unsuitability cases

15

Factors relating to fraud cases

16

Factors relating to efficiency cases

17

PART 6 — Interpretation

Interpretation

18

SCHEDULE 4 — Terms of Service

Incorporation of provisions

1

Duty to make available basic glasses

2

Premises at which primary ophthalmic services are to be provided

3

Provision of mobile services

4

Premises and equipment

5

Displaying of notices

6

Welsh Language

7

Times at which primary ophthalmic services must be provided

8

Records

9

Alternative records arrangements

10

Audits

11

Workforce reporting

12

Optometry collaborative

13

Quality improvement and governance

14