Service Level Agreement

Between
Wirral Primary Care Trust
And
PROVIDERS NAME
For the provision of a
Low Visual Aid Service
May 2011

Service Level Agreement Referral Refinement Service for LVA

Contents
Clause
Number

Page
Number

Contents Page
1. Parties to the Agreement
2. Purpose of the Agreement
3. Agreement Term
4. Obligations of the Parties to this Agreement
5. Representatives
6. Services and Objectives
7. Fees and Payments
8. Monitoring and Information Requirements
9. Complaints
10. Serious Untoward Incidents
11. Patient Safety Incidents
12. Risk Management
13. Service Monitoring and Quality
14. Demand Management
15. Confidentiality and Data Storage (Caldecott)
16. Discrimination
17. Dispute Resolution
18. Termination
19. Consequences of Termination
20. Variation
21. Notices
22. Waiver
23. Insurance
24. Indemnity
25. Staff
26. Prevention of Corruption
27. Force Majeure
28. Access to services
29. Equality and Diversity
30. Freedom of Information
31. Representation and Warranties
32. Entitlement to Contract
33. Signatories
Appendix 1: Service Specification
Appendix 2: Map of Medicine Care Pathway
Appendix 3:- Invoice / data Collection Form Example

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Service Level Agreement Referral Refinement Service for LVA

Service Level Agreement for the provision of a Low Visual Aid Service.
1.

Parties to the Agreement

1.1 Wirral Primary Care Trust whose principal office is at Old Market House, Hamilton Street,
Birkenhead, Wirral, CH41 5FL, and
1.2 PROVIDER NAME (the Provider) whose principal business is at PROVIDERS
ADDRESS.
2.

Purpose of the agreement

2.1 The agreement is for the provision of a Low Visual Aid Service within Wirral PCT.
3.

Agreement Term

3.1 This is a fixed term agreement that shall operate for the period DATE to DATE (the term)
and will terminate on the expiry of the Term but subject to early termination should the
provider not comply with the obligations of this agreement as stated in clause 18.
3.2 If both partners mutually agree to the extension of the term of the agreement beyond the
expiry date, the written notice to extend the service must be served one calendar month prior
to the expiry date.
4.

Obligations of the Parties to this Agreement

4.1 The Provider:

4.1.1 agrees to perform the obligations set out in the Service Specification (Appendix 1) and
in accordance with the provision and Term of this agreement.
4.1.2 acknowledges that the designated funds shall be used for the specific function of this
SLA
4.1.3 shall not sub contract any of the functions within the provision of this agreement unless
expressly allowed to by NHS regulations and with the written consent of the PCT.
4.1.4 will ensure any protocols or guidance issues identified by the Provider in relation to the
services delivered are communicated to and followed by all relevant staff.
4.1.5 agree to provide any necessary authorisations to auditors, both internal and external
and to disclose any information necessary for the proper conduct of audit work within the
PCTs organisation.
4.1.6 agrees to comply with the performance monitoring and information requirements laid
out in clause 8.
4.1.7 shall use reasonable endeavors to avoid creating any circumstance which may
undermine patient or public confidence in the services of either the PCT or the Provider, or
otherwise damage the profile and integrity of the other party or this agreement.
4.1.8 shall keep up to date with appropriate legislation and comply with all legislation relevant
to the operation of the organisation.

Service Level Agreement Referral Refinement Service for LVA

4.1.9 shall provide at its own expense all staff, equipment, tools, appliances, materials or
items required for the provision of the Services to the contract standard which excludes initial
set up costs/equipment.
4.1.10 agrees that the responsibility for cover for long term sickness, maternity, paternity,
adoptive and other long term leave is the responsibility of the Provider.
4.2 The PCT:
4.2.1 agrees to make payments to the Provider in accordance with the provisions of this
agreement provided that the Provider complies with its obligations.
4.2.2 is able to review its funding for subsequent periods after the expiration of the Terms of
this Agreement.
4.2.3 reserves the right to review the funding based upon performance of the Provider
including but not limited to the non provision of the activities outlined within this agreement.
4.2.4 will inform the Provider, with a reasonable period of notice, of service developments,
timetable or other changes that impact on the delivery of services under this agreement.
4.2.4 will ensure that any protocols or guidance issues identified by the Provider in relation to
the services delivered are communicated to and followed by the relevant staff.
4.2.5 agrees to provide any necessary authorisations to Auditors, both internal and external,
to disclose any information necessary for the proper conduct of audit work within the
Providers organisation.
4.2.6 shall use reasonable endeavors to avoid creating any circumstance which may
undermine patient or public confidence in the services of the of the PCT or the Provider, or
otherwise damage the profile and integrity of the other party or this agreement.
5.

Representatives

5.1 For the terms of this agreement the Provider shall appoint a Provider Contract
Representative who shall be the key point of contact to whom all queries and day to day
communications regarding the operation of this agreement should be addressed.
5.1.1 The Provider Contract Representative is:
NAME
PRACTICE NAME
ADDRESS
ADDRSSS
ADDRESS
Wirral
POSTCODE
5.2 For the terms of this agreement the PCT shall appoint a Commissioner Contract
Representative who shall be the key point of contact to whom all queries and day to day
communications regarding the operation of this agreement should be addressed.
5.2.1 The Commissioning Contract Representative is:
Glenn Coleman
Deputy Director of Primary Care
NHS Wirral
Service Level Agreement Referral Refinement Service for LVA

Old Market House

Hamilton Street
Birkenhead
Wirral
CH41 5FL
6.

Services and Objectives

6.1 The functions and activities to be provided under this agreement are outlined in detail in
the Service Specification (Appendix 1).
7.

Fees and Payment

7.1 The PCT shall make payments on a monthly basis in accordance with invoices received
based on the number of assessments undertaken. The invoice will be incorporated into the
Monitoring and Information Requirements spread sheet at 8.1.
7.2 The invoices will be produced by the Provider and sent to the PCT monthly, in arrears.
Such an invoice to contain details of a number of activities which the Provider has carried out
during the previous month, together with its calculation of the amount of fees payable to it.
The Provider is to check, sign and submit the invoice to the PCT.
7.3 The PCT will pay within 30 days of receipt of the signed invoice for all invoices submitted
by the Provider in accordance with this contract.
7.4 The PCT shall be entitled to deduct part or all of the fees payable to the Provider under
this clause in circumstances where the Provider has failed to provide the Services in
accordance with the provisions of this Contract and providing the PCT has given prior written
notice to the Provider of its intention to deduct part or all of the fees payable.
7.5 If:
7.5.1 The PCT disputes any or part of the invoice calculated in accordance with sub-clause
7.2; or
7.5.2 The Provider disputes an amount which the PCT has deducted pursuant to its rights
under sub-clause 7.4. then in the case of sub-clause 7.5.1, the undisputed amount of the
invoice shall be paid by the PCT in accordance with sub-clause 7.2. In relation to both subclauses 7.5.1 and 7.5.2 the parties shall use reasonable endeavors to resolve the dispute
within 20 working days. If they fail to resolve it then either party may refer to clause 17.
Following resolution of the dispute, any amount agreed or determined to have been payable
shall now be paid.
7.6 Fees will be reviewed by the PCT at the expiry of the Initial Term and any proposed
changes to the amount of fees shall be dealt with in the Renewal notice.
7.7 The only sums payable by the PCT for the provision of services shall be the fees as set
out in this clause.
7.8 The fees will be subject to annual negotiation which may not lead to an increase and any
increase would not exceed National NHS uplift except under very exceptional circumstances.
The effective date of the increase will be 1st April each year which runs from April to the
following March.

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7.9 The initial workshop around accreditation will be facilitated by the PCT.
8.

Monitoring and Information Requirements

8.1 The Provider shall provide the information specified within this clause and within Quality
Standards and Performance Indications as per the service specification (Appendix 1).
8.1.1 The following activity data is required as a minimum by the Provider:
Date of referral
NHS number (where available)
Patient name
Patients address including postcode
Patients GP Practice
Date of consultation
Patients Optometrist Practice
Clinical reason for Low Visual Aid Assessment
Outcome of consultation
8.1.2 The information / invoice is to be provided on a monthly basis on a spreadsheet and
emailed to confidential PCT email address to be password protected or a secure postal
system (recorded delivery) to the PCT at the address below:
Glenn Coleman
Deputy Director of Provider Services
NHS Wirral
Old Market House
Hamilton Street
Birkenhead
Wirral
CH41 5FL
8.1.3 If Information is not reported on a monthly basis, there will be no penalty for the first
month in which the information is not provided. However, subsequent missing monthly
activity will be subject, at the discretion of Wirral PCT to withhold 10% of the monthly
payments.
8.1.4 Subject to clauses 8.1.4.1 and 8.1.4.2, the funds withheld in clause 8.1.3 will be
released to the Provider within 10 operational days of receipt of the information.
8.1.4.1 the information provided is fit for purpose and meets the criteria laid out in
clause 8.1.1.
8.1.4.2 the information is received within 3 calendar months of the date it was
originally due.
8.1.5 Activity will be jointly monitored by the Provider and the PCT within the Service
Specification.
8.1.6 Activity will be measured on a monthly basis using the following criteria:
Number of patients seen
Where patients are seen
Source of referral
Reason for referral
Outcome of referral

Service Level Agreement Referral Refinement Service for LVA

Details of over/under performance

8.2 During the contract period, the PCT may inspect and examine the provision of the
Services being carried out at the location with appropriate notice. The Provider shall provide
to the PCT all such facilities as required for inspection.
8.3 If the performance of any part of any Service by the Provider is found to be defective,
incomplete or performed in a negligent manner the PCT will inform the Provider of this
problem. The Provider shall at its own expense re-perform the services in question within
such time as the PCT may reasonably specify failing which the PCT shall be entitled to
procure performance of the defected services from a third party or to execute the task in
question itself. If the cost to the PCT of executing or procuring such services exceeds the
amount that would have been payable to the Provider for such services; the excess shall be
paid by the Provider to the PCT on demand in addition to any other sums payable by the
Provider to the PCT in respect of the breach of contract.
9.

Complaints

9.1 The PCT and the Provider shall maintain a complaints procedure
compliant with all
Law (including any NHS Complaints Regulations in force) applicable to it and shall provide
the other Parties with such details relating to that complaints procedure as required.
9.2 The Provider shall inform patients and appropriate family members and carers known to
the Provider that they are entitled to use the complaints procedure and shall make details of
it and any relevant Independent Advocacy Service available to the patient, a family member
or other carers on request.
9.3 All complaints received by the Provider in writing shall be acknowledged in writing within
the period of 3 working days beginning with the day on which the complaint was received or,
where that is not practicable, as soon as reasonably possible. All complaints shall be
properly investigated by the Provider and the results of such investigations shall be notified
to the patient.
9.4 Any complaint received by the PCT as a result of the above will be investigated by the
PCT in accordance with the PCTs complaints procedure.
10.

Serious Untoward Incidents (SUIs) Reporting

10.1 The Provider shall promptly provide to the Commissioning representative, a full copy of
any notification made by the Provider to the CQC or Commission for the Social Care
Inspection or any successor body where such notification directly or indirectly concerns any
patient.
10.2 This clause shall survive the termination or expiry of this agreement. Any serious
incidents, near misses or complaints will be reported on a monthly basis in accordance with
this clause and will be verbally reported to the PCT Commissioning Manager within one
working day.
11.

Patient Safety Incidents

11.1 With regard to Patient Safety Incidents, the Provider will:

11.1.1 report to Wirral PCT who on their behalf will, where required, report patient safety
incidents to the National Patient Safety Agency (NPSA) or any successor organisation or
system.
Service Level Agreement Referral Refinement Service for LVA

11.1.2 expect the PCT to implement NPSA guidance.

11.1.3 have local risk management procedures in place to analyse and learn from patient
safety incidents.
12.

Risk Management

12.1 The Provider and the PCT will work together to manage the risks relating to this
agreement and shall have in place appropriate systems for risk identification, eradication and
mitigation. Should an incident arise staff will bring it to the attention of the appropriate officers
of both parties using agreed incident reporting processes.
13.

Service Monitoring and Quality

13.1 In addition to any more specific obligations imposed by the terms of the Contract, it shall
be the duty of the Provider to provide the Services to the Contract Standard which in all
respects shall be to the satisfaction of PCT.
13.2 During the Contract Period, the PCT may inspect and examine the provision of the
Services being carried out at the Location with appropriate notice. The Provider shall provide
to PCT all such facilities as PCT may require for such inspection and examination.
13.3 If the performance of any part of any Service by the Provider (or members of his staff or
sub-contractors) is found to be defective, incomplete or performed in a negligent manner the
PCT will inform the Provider of this problem. The Provider shall at its own expense reperform the Services in question (without additional remuneration therefore) within such time
as the PCT may reasonably specify failing which the PCT shall be entitled to procure
performance of the defective Services from a third party or to execute the tasks in question. If
the cost to the PCT of executing or procuring such Services exceeds the amount that would
have been payable to the Provider for such Services, the excess shall be paid by the
Provider to the PCT on demand in addition to any other sums payable by the Provider to the
PCT in respect of the breach of Contract.
13.4 The Provider will adopt a process for significant or adverse event audit, sharing the
outcomes and follow-up actions with the PCT and co-operating with the PCT instigated
audits when requested. An audit will also be carried out annually.
13.5 The Provider agrees that it will only issue patient literature previously approved by the
PCT to its Patients. This will normally be edited and approved by the Plain Language
Commission or other editing service.
13.6 The Provider shall also comply with the standards and recommendations from time to
time:
13.6.1 Technology Appraisals, Clinical Governance and Clinical Interventions and guidance
issued by the National Institute for Health and Clinical Excellence (or any successor)
13.6.2 Issued by the UK National Screening Committee and the National Specialist
Commissioning Advisory Group (or any successors) and agreed in writing between the PCT
and the Provider.
3.6.3 Issued by any relevant professional body and agreed in writing between the PCT and
the Provider; and such other quality standards and recommendations from time to time
agreed in writing between the PCT and the Provider; and all such standards and
Service Level Agreement Referral Refinement Service for LVA

recommendations, when agreed must be added to Quality standards and performance

indicators.
14.

Demand Management

14.1 The PCT and the Provider have a mutual responsibility to manage demand for the
services.
14.2 The Provider agrees to ensure that its agents and employees shall adhere to any
referral and treatment protocols.
15.

Confidentiality and Date Storage (Caldecott)

15.1 The PCT and Provider acknowledge that their respective duties under the Data
Protection Act 1998 and the Freedom of Information Act 2000 and hereby confirm they will
comply with their obligations and duties under the said Acts and shall give all reasonable
assistance to each other where appropriate or necessary to comply with any obligations
arising under the said Acts.
15.2 All parties will maintain appropriate confidentiality regarding information that is
proprietary to the other party consistent with the context of shared working. In addition, the
Provider will ensure that appropriate written confidentiality clauses are present in all of its
staff contracts so that its staff are obliged to preserve Patient confidentiality at all times.
15.3 The Provider must not use Patient information obtained as a result of the provision of
the Services under this Contract for marketing purposes or commercial activities.
15.4 Where, for the purposes of delivering the Services, it is necessary for the Provider to
hold patient identifiable information (i.e. information that is subject to NHS Rules on
protection and disclosure under the supervision of a named Caldecott Guardian on behalf
of the PCT), it shall not disclose such documentation from which the patient identifiable
information has originated to any party except as may be permitted in sub-clause 15.5.
15.5 The Provider may disclose patient identifiable information for proper purposes where
such disclosure is supervised by and given with the consent of the Caldecott guardian of the
PCT. This consent may be given in general or specific terms, but cannot authorise any
greater degree of disclosure than would be permitted under the Caldecott arrangements of
either party.
16.

Discrimination

16.1 The PCT and the Provider shall not discriminate unlawfully within the meaning and
scope of any Law, enactment, order, regulation, or similar instrument relating to
discrimination (whether relating to race, gender, disability, religion or otherwise) in
employment or performance of the services and each of them shall take all reasonable steps
to ensure observance of this clause.
17.

Dispute resolution

17.1 Both parties to this Contract will use all reasonable endeavors to resolve any dispute or
differences between them in accordance with this Clause.
17.2 During any dispute, including a dispute as to the validity of the Contract, it is mutually
agreed that the Provider shall continue its performance of the provisions of the Contract

Service Level Agreement Referral Refinement Service for LVA

(unless PCT requests in writing that the Provider does not do so). The PCT will pay the
Provider in accordance with the provisions of clause 7 as if the contract were valid.
17.3 Where one party considers that the other party has not performed its obligations under
this Contract, that party will give written notice to the other party specifying the nature of the
breach and requiring the other party to attend a meeting with the party serving the notice at a
mutually convenient time but in any event within four weeks after the date of such written
notice.
17.4 Unless another course of action (such as but not limited to mediation) is agreed
between the parties at the meeting referred to in sub-clause 17.3, the party which was in
receipt of the notice served pursuant to sub-clause 17.3 shall remedy the breach referred to
in that notice within twelve weeks after the date of the meeting.
17.5 Where non-performance has not been rectified within the timescale set out at subclause 17.4 (or such other timescale as may be agreed between the parties), the other party
will have the right to terminate the Contract in accordance with clause 18.
17.6 In circumstances where the notice issued pursuant to sub-clause 17.3 relates to a
breach, the PCT may require the Provider to suspend the provision of the Services whilst the
Dispute Resolution Procedure is ongoing until such date the Provider has remedied the
breach to the reasonable satisfaction of the PCT.
18.

Termination

18.1 Either Party may terminate this Contract on three months prior written notice.
18.2 The PCT may terminate this Contract on one months written notice to the Provider if:
18.2.1 the Provider is in material breach of an obligation under this Contract and the breach
is not capable of remedy in accordance with the Dispute Resolution Procedure;
18.2.2 the Provider is in material breach of an obligation under this Contract, which was
capable of being remedied but which has not been remedied in accordance with the Dispute
Resolution Procedure; or
18.3 The PCT may terminate this Contract with immediate effect if:
18.3.1 the Provider becomes insolvent or otherwise ceases to be capable of providing the
Services.
18.4 The Provider may terminate this Contract on three (3) months written notice to the PCT
if:
18.4.1 the PCT is in material breach of an obligation under this Contract and the breach is
not capable of remedy in accordance with the Dispute Resolution Procedure;
18.4.2 the PCT is in material breach of an obligation under this Contract, which was capable
of being remedied but which has not been remedied in accordance with the Dispute
Resolution Procedure; or
18.4.3 the PCT has failed to pay by the due date any sum properly due and owing by it to the
Provider under this Contract and such non-payment continues unremedied and is not the
subject of a dispute at the expiry of a period of ninety (90) days following the date of the letter
of notification by the Provider of such non-payment to the PCT.
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18.4.4 In circumstances where the PCT has issued a termination notice to the Provider as a
result of one of the circumstances in sub-clause 18.2.1 or 18.2.2 having occurred, the PCT
may require the Provider to immediately suspend its provision of the Services during the
notice period in circumstances where:
18.4.5 the breach relates to a complaint in respect of a serious alleged incident or a serious
clinical governance issue;
18.4.6 it is alleged that the Provider has been falsifying records/claims under this Contract;
and/or
18.4.7 the Provider or its Accredited Optometrist(s) is alleged to have committed a serious
professional misconduct and/or is under investigation by the General Optical Council.
18.5 The PCT may withdraw the termination notice in circumstances where an independent
investigation has determined that the Provider and/or its Qualified Personnel are found not to
have committed the alleged incident/breach as set out in sub-clauses 18.2.1 to 18.2.2 above.
19.

Consequences of Termination

19.1 If any party terminates this contract prior to the expiry of the Initial Term or the Renewal
Term:
19.1.1 The PCT shall pay to the Provider within 20 working days of the termination date and
all arrears of Fees properly due to and payable under the provisions of the contract.
19.1.2 The Provider shall pay to the PCT within 20 working days of the termination date an
amount equivalent to the proportion of any fees already paid by the PCT to the Provider but
which relates to a period which falls after the termination date.
19.1.3 The Provider must within 20 working days of termination return all equipment unused
consumables, promotional literature, etc provided by the PCT.
20.

Variation

20.1 The PCT reserves the right to vary any part of the contract at any time as a result of any
Act of Parliament or direction by Central Government or outcome of a review or audit carried
out by the PCT as a result of significant changes having occurred in national, regional and
local circumstances which have the potential of having a significant impact on demand,
provided that 3 months notice has been given in writing to the Provider in respect of such
variation.
20.2 In the event that either party requires a change to the service specification and/or the
terms of this agreement, the party shall immediately inform the other party in writing the
details relating to the service change.
20.2.1 Such changes shall not come into effect until a written acceptance of the proposed
variation, detailing the consequential amendments, is signed by both parties Contract
representatives.
21.

Notices

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21.1 Any notices required to be given under this agreement must be in writing and delivered
to the Commissioning/Provider representative by personal delivery, post (special delivery),
electronic mail or facsimile.
21.1.1 Notices delivered by hand shall be effective upon delivery.
21.1.2 Notices given by post shall be effective upon the earliest of actual receipt or 5
operational days after mailing.
22.

Waiver

22.1 The failure by any party to enforce at any time or for any period any one or more terms
and conditions of this agreement shall not be construed as a waiver of its rights at any time
subsequently to enforce such terms or conditions.
23.

Insurance

23.1 The PCT and Provider shall maintain such insurance policies as are appropriate and
adequate having regard to its obligations and liabilities under this agreement.
24.

Indemnity

24.1 The Provider shall indemnify and keep indemnified the PCT against all actions, claims,
damages, demands, proceedings, costs and expenses that may arise in respect to the
provision of the services by the Provider under this contract. This will include injury to or
death of any person, loss of or damage to any property except and to the extent that it arises
out of the negligence of the PCT, its employees or agents.
24.2 In the event of any claim for damages, or of circumstances coming to the notice of the
PCT which might give rise to a claim for damages, which might give rise to a claim for
indemnity from the Provider pursuant to this contract, the PCT shall promptly notify the
Provider thereof in writing, whereupon
24.2.1 immediately, by themselves, their representatives or there insurers, the Provider and
PCT shall consult together without admitting liability, making a payment or generally
engaging in the handling of the claim for damages;
24.2.2 the parties shall seek to act together to reject, defend, minimise or mitigate the claim
for damages and to seek contribution, indemnity or re-imbursement from some other person
as they may agree; and
24.2.3 the handling of the claim for damages shall be delegated to the Provider, his
representatives or his or their insurers and the PCT shall take action in relation to any such
claim for damages as the Provider, his representatives or his or their insurers shall
reasonably require including, without limitation, defending, resisting, compromising or settling
any proceedings or threatened proceedings and appealing any judgement or decision.
25.

Staff

25.1 The appointment of staff, including volunteers, shall be subject to the Providers own HR
and risk assessment process and must include the provision of two satisfactory written
references, one of which should be from a previous/current employer (where applicable).
These should be obtained before individuals commence employment.

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25.2 The Providers recruitment process should ensure that all staff and volunteers who work
on a one-to-one basis with vulnerable people and children will be subject to satisfactory
Criminal Records Bureau checks.
25.3 Staff shall be recruited and employed in accordance with all relevant Equality
Legislation.
25.4 Staff employed for the service shall be suitably qualified.
26.

Prevention of Corruption

26.1 The provider shall not offer, give or agree to give to any person any gift or consideration
of any gift as an inducement or reward for undertaking or agreeing to undertake any action in
relation to obtaining this contract or, for showing or agreeing to show any favour or disfavour
to any patient or perspective patient in relation to the contract.
27.

Force Majeure

27.1 The provider shall not be liable for default arising from circumstances beyond its
reasonable control (such as but not restricted to flood, fire and civil unrest). The funding
bodies shall in such circumstances be entitled to take such action as is deemed necessary to
protect the interests of the service users and make a fair and reasonable adjustment to the
price. In order to reflect any savings in costs that the Provider may make as a consequence
of not funding the service due to the force majeure event provided it is not remedied and the
service is reinstated within 4 months, the PCT shall have the right to terminate this
agreement in accordance with clause 18.
27.2 In the event of a Force Majeure the affected party shall notify the other party as soon as
practicable. The notification shall include details of the Force Majeure Event, including
evidence of its effect on the obligations of the affected party and any action proposed to
mitigate its effect.
28.

Access to services

28.1 The Provider will comply with the Disability Discrimination Act and all related legislation
and have regard to any relevant Government Codes of Practice and guidance.
29.

Equality and diversity

29.1 In providing the service, the Provider shall not unlawfully discriminate against any
groups or individuals on the grounds of race, gender, sexual orientation, age, religious
beliefs, disability or any other circumstances listed in the PCTs Equality and Diversity Policy
and seek to promote equality of opportunity and good relations between people from different
backgrounds. The Provider shall comply with the relevant equality legislation and appropriate
codes of good practice.
30.

Freedom of Information

30.1 Both parties acknowledge that they are subject to the Freedom of Information Act 2000
(FOIA) and the Environmental Information Regulations 2004 (EIR) and either party may be
required to disclose information about this contract to ensure compliance of the PCT with the
FOIA and/or the EIR. Both the Provider and the PCT will act in accordance with the FOIA, the
EIR and the Codes of Practice to the extent that they apply to the Providers Performance
under the contract.

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30.2 Where the Provider or the PCT is managing a request, the other shall co-operate and
respond within 5 working days of any request.
31.

Representations and Warranties

31.1 The PCT, on the one hand, and the Provider, on the other hand hereby represents and
warrants to the other that:
31.1.1 It has full power and authority to enter into this agreement and has taken all
necessary corporate or other action to authorize the execution, delivery and performance
thereof and no restriction on the powers of its officers will be contravened by such execution,
delivery or performance.
31.1.2 All governmental or official approvals and consents have been obtained and are in full
force and effect, and all other actions have been taken, conditions satisfied and things done
in order to enable it lawfully to enter into, comply with its obligations and enforce its rights
under this agreement, and to ensure that this agreement is admissible in evidence in
England.
31.1.3 the execution of the agreement, the performance of obligations and exercise of rights
under them by it does not and will not contravene or conflict with the constitution, Terms of
Authorisation or any law, regulation, contract, charge or undertaking affecting it, any of its
assets or any agreement or document to which it is party or which is binding on it or any of its
assets.
31.1.4 the copies of all documents supplied in the other party or any of its advertisers by or
on its behalf are complete and the contents of them are true.
31.1.5 all information supplied by either party to the other during the award procedure
leading to the execution of this agreement is, to the reasonable knowledge and belief of the
other party, true and accurate in all material aspects and each party is not aware of any
material facts or circumstances which have not been disclosed to the other which would, if
disclosed, be likely to have an adverse effect on a reasonable public sector entitys decision
whether or not to contract with either party substantially on the terms of this agreement.
32.

Entitlement to contract

32.1 This is not an exclusive agreement and the PCT reserves the right to contract with any
persons, firm or company, other than the Provider, for the supply and delivery of similar
services.
33.

Signatories

In witness whereof the parties have signed this agreement on the date shown below
Date______________________________
Signed by for and on behalf of the Commissioner Wirral Primary Care Trust
Signed __________________________
Name:
Designation

Service Level Agreement Referral Refinement Service for LVA

14

Signed by for and on behalf of the Provider

Signed
Name:
Designation

Service Level Agreement Referral Refinement Service for LVA

15

Appendix 1 Service Specification

PERFORMANCE REQUIREMENTS SPECIFICATION, QUALITY AND

PRODUCTIVITY
Service
Commissioner Lead
Provider Lead
Period

Low Visual Aid Service

Glenn Coleman
NAME
DATES???

1. Purpose
1.1 Aims
To provide a Wirral wide Low Vision Aid service offering a range of services and aids for people
with low vision to enable them to make maximum use of their eyesight.
To provide an easily accessible Low Visual Aid service nearer to patients home.
To provide an exchange and or recycling scheme, as all aids remain the property of the health
service and as such are loan items.
1.2 Evidence Base
A person with low vision is one who has an impairment of visual function for whom full
remediation is not possible by conventional spectacles, contact lenses or medical intervention
and which causes restriction in their everyday life.
A low vision aid is any piece of equipment used by a person with low vision to enhance their
vision.
Visual aids support and promote independence, such as checking medication, reading cooking
instructions and shopping lists.
1.3 General Overview
Low vision is a disability which can substantially reduce the independence of a person and
affect their lifestyle significantly.
The total number of visually impaired persons in the UK is unknown, as many are not registered
as blind or partially sighted.
However approx 90% of visually impaired people are aged over 60, which can in turn increase
mobility problems and lead to dependence, fall related problems. Added to this life expectancy
is increasing.
LVA provision is patchy across Wirral, with WUTH providing some appointments, but only within
the acute hospital, at tariff price, without domiciliary visits. As assessment is at APH, this alone
can cause attendance problems, as this group of patients will be non drivers.

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A Map of medicine pathway for low vision aid has been developed and was approved at PEC,
May 2009. This would support the development of a community based service, an alternative to
the tariff based service currently delivered at the acute trust.
Patient feedback via the Wirral Society for the blind and partially sighted and via the
rehabilitation officers for visual impairment suggests that patients would prefer a local service
close to home.
1.4 Objectives
o
o
o
o
o
o
o
o

Optometrists to provide community LVA assessments as an addition to the normal

domiciliary eye examination.
Where the provider is an existing Domiciliary Service provider, optometrists to provide
domiciliary LVA assessments as an addition to the normal domiciliary eye examination
To provide annual review for patients in the system
Low visual aid kits to be available in optometrist practices to support correct provision,
education and training there will be no initial outlay.
A list of products that will be permitted within NHS funding are provided in appendix 1
however the option will be available for the patient to purchase any supplementary
equipment.
Provide LVA equipment with monitoring, to ensure goals met
Referral mechanisms to voluntary sector where appropriate
Recycling/exchange of LVA equipment

1.5 Expected Outcomes

To provide
Local service, closer to home
Safe timely practice
An exchange/recycling scheme
Annual review
Value for money initiative
2. Scope
2.1 Service Description
The service will be provided as an enhanced service via optometric practices by an optometrist
or a dispensing optician with a low vision qualification. Optometrists will be accredited with NHS
Wirral. A list of accredited participating practitioners within practices will be available from NHS
Wirral.
A training and accreditation package has been developed by LOCSU in conjunction with
WOPEC (Wales Optometric Postgraduate Education Centre).
The accreditation is not a requirement for the following practitioner groups:
registered dispensing opticians who hold the Association of British Dispensing Opticians
Honours Diploma in Low Vision FBDO(Hons)LVA
registered optometrists who hold the Association of British Dispensing Opticians Honours
Diploma in Low Vision ABDO(Hons)LVA
registered optometrists who hold the College of Optometrists Low Vision Diploma DipRVI

The pathway will be restricted to practices that employ these trained and accredited low
Service Level Agreement Referral Refinement Service for LVA

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vision practitioners.
Demonstration kits containing optical and non-optical LVAs will be available.
LVAs will be available from a catalogue of devices and ordered direct from the supplier.
If an LVA (on loan) is no longer required it should be returned to the optometrist and practice
where it was issued for recycling.
Participating accredited optometrists will receive payment in the form of an agreed local tariff.
2.2 Accessibility/acceptability
o

All those with an impairment of visual function for whom full remediation is not possible (by
glasses, contact lenses or medical/surgical intervention), correctable vision worse than 6/18
causing restrictions in everyday life.

2.3 Whole System Relationships

The service will have links with the following:

Healthcare workers, including GPs and health visitors

Social care workers including social workers, rehabilitation officers for visual
Impairment
Secondary care clinicians
Third sector providers e.g. Wirral Society partially Sighted, RNIB, Action for Blind
2.4 Interdependencies
It is the responsibility of the providers to ensure that all appropriate details are communicated to
the necessary recipients and appropriate notes are made in the patients records. Patients
clinical progress and post discharge care will be reported to the GP by the Provider.
2.5 Relevant networks and screening programmes
Service provision will be monitored to ensure the maintenance of care standards and that the
service is safe. All members of staff will adhere to provider policies and procedures. All incidents
will be reviewed and actions implemented as required. All staff working within the service will
have achieved competency in both assessment and procedure management including a clear
understanding of possible complications.
The service is to fully participate in local networks and national networks.
2.6 Sub-contractors
Should the Provider wish to subcontract the provision of all or part of a service (to an NHS or
non-NHS provider) the commissioner will be informed before any agreements are made or
implemented. This will allow discussion between interested parties of whether the service might
be provided at the same, or higher quality, and for better value for money by another provider.
Subcontracted services will remain the responsibility of the Provider. The commissioner will
have access to the full range of monitoring material where appropriate.

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3. Service Delivery
3.1 Service model
Patients will be identified either at

o
o
o
o
o

Sight test, or
during ophthalmology assessment at WUTH/other service provider, or
via GP, Health visitor etc
via the social services rehabilitation officers for visual impairment as part of a general
assessment in the patients home, or
via third sector, or

Each first low vision assessment will take at least half an hour (one assessment per year) by

an optometrist in their own practice. Each annual follow up thereafter will be 15 minutes.
LVA assessments should include detailed discussion and recording of patients needs and

o
o

o
o
o

expectations, analysis of cause of sight loss, determination of most appropriate low visual
aids and a demonstration of how to use prescribed aids.
LVAs will be stored in participating optometrist practices.
If an LVA is supplied, a short follow up appointment with the optometrist will be required. If
this is conducted at WUTH post Lucentis, patients will receive a follow up appointment and
then discharged into the low vision passport scheme. Follow-up will be required between 1
and 2 months post LVA supply.
A 2 month 15 minute follow-up appointment is required to check appropriateness and
correct use. This may be incorporated into the assessment conducted by the rehabilitation
officers for visual impairment.
LV passport record cards updated, if appropriate information will be sent to GP
The annual assessment will be in the form of an annual review, 1 year post LVA supply with
an opportunity to recall those LVAs no longer required.

NB referral to ophthalmologist would be required should the need to certify a person as blind or
partially sighted arise.
3.2 Care Pathways

MoM pathway attached (see appendix 1)

All GP practices to be sent service information from the provider

4. Referral, Access and Acceptance Criteria

4.1 Geographic coverage/boundaries
This service is to be provided on a Wirral wide basis and NHS Wirral aims to ensure good
coverage to enable patients to be able to access the service close to home. It will therefore be
ensured that there is reasonable geographic coverage.
4.2 Location(s) of Service Delivery
The service will be provided within individual accredited optometrist practices on Wirral and will
ensure reasonable geographic coverage.
4.3 Days/Hours of operation
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The service will be provided within existing working hours within each individual accredited
optometrist practice on Wirral who wishes to provide the service where the practice is open for
a minimum of 4.5 days per week
4.4 Referral criteria & sources
All those with an impairment of visual function for whom full remediation is not possible (by
glasses, contact lenses or medical/surgical intervention) causing restrictions in everyday life.
All individuals affected by sight loss including those eligible to be certified as sight impaired and
those whose vision is not yet sufficiently poor for legal classification but experiences difficulties
with the visual aspects of every day life.
All those with binocular distance visual acuity of 6/18 or worse and or binocular near acuity of
N8 or worse (with a plus 4 dioptre reading addition) or significantly constricted visual fields.
All patients must have had a sight test within the period recommended by Optometrist or
ophthalmic medical practitioner, usually within the past 2 years. If sight loss is new then a more
recent sight test is required.
4.5 Referral route
Referrers to the service
Ophthalmologists
GPs and Health Visitors
Optometrists
Social Workers
Patients or carers via self referral
4.6 Exclusion criteria
People without low vision
People requiring medical intervention
Under 16 years
4.7 Response time & detail and prioritisation
Response within 20 days of referral
5. Discharge Criteria & Planning
As per patient care plan and accompanying MoM pathway

6. Self-Care and Patient and Carer Information

Information leaflets must be provided, containing relevant information with contact details
The leaflet should contain information on returning LVAs once a need is no longer required
7. Quality and Performance Standards
Quality
Performance
Indicator

Threshold

Method
of
measurement

Consequence of
breach

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Report Due

20

Infection Control

The
Provider
must
ensure
compliance with
the Health and
Social Care Act
2008: Code of
Practice for the
Prevention
and
Control
of
Healthcare
Associated
Infection in all
provider services
identified in this
SLA.
The
following
must
take place in the
next 12 months
.

A
selfassessment of all
services against
Essential Steps to
Safe Clean Care.
Where provider
services
undertake clinical
interventions that
fall outside the
scope
of
the
Essential Steps
framework,
the
Saving
Lives
programme and
relevant
High
Impact
Intervention Care
Bundles (HII) will
be incorporated
into
the
assessment
process

An action plan
(if required) to
be agreed with
the PCT from Month 9
the assessment.

Service User
Experience

Questionnaire
and
evaluating
A user survey is
process to be
offered
to
all
agreed
in
annually
advance with the
commissioners.

Report
detailing
experience
An action plan (if with
required) to be recommende
agreed with the d
PCT
improvement
s due end of
month 9 of
the year.

Reducing
Barriers

The service to
identify
3
Monthly
characteristics
meeting feedback
that are barriers
to access

An action plan (if

required) to be Quarterly
agreed with the reporting
PCT

Improving
Productivity

Achieve
a
monthly DNA rate
Determine
An action plan (if
of 5%
baseline
for
required) to be
a agreed with the
DNAs
and Achieve
monthly
cancellations.
PCT
cancellation rate
of 5%

Access

Adherence
accessibility
targets

Care
Management

All service users Identify number of An action plan (if Bi Annually

to be provided LTC patients on required) to be

to

Performance
Indicators

Evaluation
report on
strategy by
the end of Q4

An action plan (if

required) to be Bi Annually
agreed with the
PCT

Service Level Agreement Referral Refinement Service for LVA

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with
a
passport

LV

the list and what

agreed with the
% have a LV
PCT
passport

8. Activity
Performance
Indicators
1. Number of
referrals via GP,
ophthalmologists,
optometrists,
social workers.
Number of self
referrals.

Threshold

Method
of
measurement
Monthly data
reporting.

Consequence of
breach

Report Due

Monthly data
reporting

2. Number of
referrals seen
within 4 weeks

Monthly data
reporting.

3. Number of
annual reviews
4. Clinical
outcomes
number of
discharges, LVA
changes reported

Quarterly data
reporting

5. Adverse
incidents reported

Quarterly data
reporting.

6. The number of
recorded
complaints

Quarterly data
reporting.

9. Activity
Activity Performance
Indicators

Method of
measurement

Baseline
Target

Threshold

Frequency
Monitoring

All patients receiving

LVA who meet the
criteria in 4.4 will
receive Low Visual
Aid assessment and
appropriate aid(s) on
loan

Audit

100%

95 100%

Monthly reporting

Audit

100%

95 100%

Monthly reporting

All patients due an

annual Low Visual
Aid Assessment will
receive an annual

Service Level Agreement Referral Refinement Service for LVA

22

of

review within one

calendar month of
the anniversary of
their previous
assessment.
10. Currency and Prices
10.1 Currency and Price
For the purposes of these costings the fee payable to Optometrists per patient seen / treated
has been calculated as follows:Initial Low Visual Aid Assessment - 60.00
One two month follow up Visual Aid Assessment - 30.00
Annual Low Visual Aid Assessment - 30.00
Payments can be claimed using the PCT claim form. This will be emailed out to participating
practices once they have signed up to the service.

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Appendix 1

Appendix 1 NHS Funded Low Vision Aids

Hand Magnifiers
4x, 6x
Stand Magnifiers
3x, 6x,
Illuminated Stand Magnifiers
2x, 3x, 5x, 7x, 10x, 15x, 22x, 30x (LED & tungsten)
Distance Telescopes
4x, 8x (monoc)
Pair 1.9x with near focus
(inc spec clip)
2.1x (binoc) e.g. MaxTV, SeeTV
* Based on recommendations by LOCSU 2011

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Appendix 2 Map of Medicine Care Pathway

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Service Level Agreement Referral Refinement Service for LVA

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Service Level Agreement Referral Refinement Service for LVA

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Service Level Agreement Referral Refinement Service for LVA

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Appendix 3 LVA Pathway

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Appendix 4 - Self assessment questionnaire

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