Key features of the operation of VOS are described in the Program Guidelines for the Visiting Optometrist Scheme (DoHA 2011e). VOS is administered by DoHA officers situated in both central and state/territory offices. The Department enters into funding agreements with individual optometrists or optometry organisations who receive funding to support the provision of outreach services. Funding agreements are usually for a three year period, but have been extended in some instances. Current agreements have been extended to 1 July 2012. DoHA obtains advice in relation to planning (priority locations) and specific proposals from a VOS National Advisory Committee and state/Northern Territory based reference groups.

Figure 18 depicts some of the main administrative processes involved with the scheme. These are described in more detail in the following sections. These processes involve: planning (specifically the setting of priority locations for outreach services), the development, assessment and approval of proposals, the provision of outreach optometry services and the payment of VOS allowances, and the processes associated with data collection.
Administrative processes for VOS
Figure 18 – Administrative processes for VOS

Assessment of need

VOS is targeted at rural and remote communities located in ASGC Remoteness Areas 2-5 (inner regional to very remote), although the emphasis is on Remoteness Areas 4-5 (remote to very remote). Consideration is given to ASGC 2-3 (inner regional to regional) communities based on identified need and a letter of support from the local AMS or a local health professional.

At the commencement of a cycle of funding (usually three years), DoHA creates a list of priority locations for which VOS funding will be available. The priority list is based on advice received from the VOS National Advisory Committee, which also considers advice from state/Northern Territory reference groups.

The National Advisory Committee currently is made up of eight members. The chair is The National Manager, Regional Health Australia, Primary and Ambulatory Care Division, who is the Minister’s delegate. The Committee also includes two members from the Optometrists Association of Australia, one representative from Vision 2020 and four DoHA officers (two from state/Northern Territory offices, one from the Office for Aboriginal and Torres Strait Islander Health and one from the Office for an Ageing Australia). The role of the committee as stated in the terms of reference is to:
    • Identify gaps in service delivery and determine priority locations in need of optometric services at a national level in consultation with state reference groups, and make recommendations to the delegate.
    • Identify potential linkages between VOS supported services and existing primary care and specialist services to ensure better integration of service delivery at all levels of government, in order to avoid duplication and overlaps between programs.
    • Review the assessment of applications for funding under VOS provided by each state and the Northern Territory reference group and make recommendations to the Delegate.
    Advise the delegate on other program issues as required.
(DoHA 2011e, p. 19)

All six states and the Northern Territory have reference groups for VOS. The reference groups play a role in setting priorities and advising with regard to service proposals within their respective jurisdiction. The groups are expected to convene at least once a year to review applications. Members of these groups include state/Northern Territory representatives of the Optometrists Association of Australia, state/Northern Territory health authority representatives, DoHA representatives and other stakeholders deemed necessary, including where appropriate a representative of the NACCHO affiliate. Secretarial support for the reference groups is provided by the relevant state/Northern Territory DoHA office. The reference groups are required to:
    • Identify areas of need and determine priority locations to ensure VOS services may be directed to remote and very remote locations, and other rural areas of identified need.
    • Ascertain the capacity of an identified area of need to sustain a new optometric service, or improve an existing service.
    • Identify potential linkages between VOS supported services and existing primary care and specialist services to ensure better integration of service delivery at all levels of government, in order to avoid duplication and overlaps between programs.
    • Provide a recommended list of national priority locations to the National Advisory Committee for consideration in any national ‘Invitation to Apply’ processes.
    • Assess Applications received from optometrists seeking to provide VOS supported services and make recommendations to the National Advisory Committee.
(DoHA 2011e, p. 19)

As part of the latest round of VOS invitation to apply (ITA) process (for funding from July 2011 to June 2012), two sets of priority locations were identified: For Core VOS; and priority locations for VOS Indigenous Expansion (DoHA 2011c). The priority locations were identified through discussions with the state/Northern Territory reference groups and the VOS National Advisory Committee. Considerations in recommending priority locations included an identified need for outreach services to the community, whether an optometry practice already operated in the locality, and whether there was a VOS supported outreach service already visiting the location.

DoHA issued a call for expressions of interest inviting potential providers of outreach services to submit a proposal for the provision of services to the priority locations. The call for expression of interest was advertised nationally. Optometrists were encouraged to speak with the state/territory office of the Department to discuss their application for submission. If the application was approved, it provided the basis for a service plan and funding agreement. Applications can be accepted outside this process at any time during the year, on a needs basis.

Development and approval of proposals

Optometrists interested in providing outreach services are required to prepare and submit an expression of interest using a standard application form. The VOS application form for 2011 was a revised version of the form used for the 2010 ITA process. The application form for 2011 was revised to require additional information. This included:
    • a statement of the capacity to undertake the project
    • details of how the finances for the project will be managed
    • the project governance arrangements
    • a risk management plan
    • details of the applicants ‘financial performance and position’, including for companies or incorporated organisation copies of their last ‘three audited financial statements’, or for other applicants ‘suitable financial statement such as business taxation returns’.
The application requires information on the applicant, and justification for the provision of outreach services to the nominated locations. Applicants are able to nominate multiple locations and these can be combined to make a circuit. A circuit is a combination of locations that are visited in one round of visits.
The applicant is required to identify whether the proposal relates to Core VOS, VOS IA or a combination of both. Details from the service provider (including Medicare provider number/s, public liability and professional indemnity insurance) are required for each application. Each location to be nominated requires information on:
    • number of proposed visits
    • ASGC-RA of the location
    • the federal electorate of the location
    • whether the location is a national priority location
    • evidence of need (this is requested for both national priority locations and other locations).
The application form has separate sections for information on national priority locations and non-priority locations. The applicant is required to provide letters of support for non-priority locations. To assist with the assessment process, the applicant is required to justify why optometric services are needed in the nominated location.

Considerations are given to special need clients in the area and how the application links to achieving the broader aims of VOS.
Information required for each nominated circuit includes:
    • How outreach services will be delivered:
        • facilities to be used in the location
        • estimated number of ‘daily’ patients to be seen
        • whether the stay will be overnight
        • length of stay at the location (number of nights)
    • total kilometres travelled for the circuit and the number of travelling hours
    • number of times per year the circuit will be undertaken
    • a detailed budget for each individual circuit (see below)
    • justification and identification of need.
Justification of need can include letters of support from local AMSs or health professionals. These are a requirement where a nominated location is not a national priority location.

Budgets for each circuit are required and must only include costs that are claimable under the VOS Guidelines.
Allowances claimable under the VOS Guidelines are included at Table 73 below. When preparing the budget, the applicant is required to consider the guidelines and provide a breakdown and justification of the costs claimed for each nominated location. As per the guidelines, some allowances are capped to maintain program expenditure which ensures VOS operates within budget allocations.
Table 73 – Categories of cost eligible for re-imbursement under VOS (Core and Indigenous Australians)Top of page

Cost category

Eligibility

Travel costs

Cost of travel by the most cost effective means to and from the outreach service location. This may include commercial air, bus or train fares, charter flights, and/or expenses associated with the use of a private vehicle or hire care. Other incidental costs such as fuel for hire cars, parking and taxi fares may also be covered.

Accompanying health professionals

Travel costs only are considered on a case by case basis for accompanying staff with specific technical skills/qualifications who are required to assist with procedures where personnel with these skills are not available locally. An optometry dispenser accompanying an optometrist to an outreach location is ineligible to receive financial assistance under VOS.

Accommodation

Costs of overnight accommodation for the visiting optometrist.

Meals and incidentals

Meals and incidentals for visiting optometrist may be paid at a set rate.

Administrative support
for visiting optometrists

VOS optometrists delivering outreach services to locations classified as ASGC-RA 4 and 5 (remote and very remote) may be eligible to receive funding support for staff providing administration associated with the delivery of the services at the outreach location. VOS may cover costs calculated at the hourly rate for a medical receptionist with three years’ experience and the number of working hours (consultations/ treatment time) of the optometrist. A cap on the payment for administrative support applies $11,069.

Locum support

VOS optometrists delivering outreach services to locations classified as ASGC-RA 4 and 5 (remote and very remote) may be eligible to receive funding to support a locum at his/her principal practice.  The hourly rate payable is $86 for a maximum of 8 hours a day.  An annual cap of $41,280 applies.

Absence from Practice Allowance

Payable to VOS optometrists to compensate for ‘loss of business opportunity’ due to the time spent travelling to and from a location.  This is based on an hourly rate of $136.70.  A cap of $1,367 is applied for a single circuit. An annual cap of between $8,202 and $16,404 is also applied based on the RA of the locations visited and number of circuits.

Equipment lease and equipment transport

Assisting with equipment lease arrangements will be considered. Purchase of equipment is not covered.  Transport of equipment will be considered.  VOS may assist with the transportation of equipment.

Facility fees

Fees incurred in hiring appropriate venues or facilities to support outreach service provision up to $200 per day, although consideration is given to rates up to $400 a day on a case by case basis.  A cap on facility fees is applied (either $6,000 or $12,000) depending on of the number and location of circuits.

Cultural training and familiarisation

Cultural training and familiarisation for visiting optometrists who provide outreach services, which may include: formal cultural awareness courses; self-learning cultural awareness education program. 

Marketing costs

Costs incurred by an optometrist to market an outreach optometric service are not covered under VOS.


Notes: Amounts quoted in this table are those that apply from 1 July 2011 and exclude GST
Source: DoHA 2011e


For the 2011 round, applications were submitted to the central office of DoHA through the Department’s Tender Box. Previous rounds had received applications by mail or email. The DoHA central office conducted an initial compliance check on the applications. The applications were then referred to the state/Northern Territory DoHA office and then to the VOS reference group with each state/Northern Territory. The reference group assessed the application against the scheme’s evaluation criteria including:
    • the community to receive the service is classified as ASGC-RA 2-5 (inner regional to very remote) and is identified as a national priority location; or is identified as having a genuine need for outreach optometric services and endorsed by the local reference group
    • the level of community need for the service
    • details of the current level of optometric service available in the region
    • the capacity of the local workforce to support such a service
    • linkages with other state/Northern Territory or Australian government health programs, including subsidised spectacle scheme
    • the appropriateness of the proposed service
    • value for money.
(DoHA 2011e, p. 15)

Stakeholders interviewed suggested the processes around the reference group varied considerably across the states/Northern Territory. One reference group has not formally met for some years, with all work undertaken by email exchange.

Based on advice from the reference groups, a report was provided by the state/Northern Territory office to the central office in DoHA. This report was consolidated and then presented to the VOS National Advisory Committee for consideration and endorsement. The recommendations were presented to the National Manager, Regional Health Australia, who, as mentioned previously, has the delegations to approve applications.

Applicants were then notified of the outcome in writing. A draft Funding Agreement was prepared for the successful applicants and negotiations were entered into. Funding Agreements included a ‘service plan’, which detailed the circuits, frequency, duration, locations to be visited and estimated number of patients per visit per location. The Funding Agreement also specified reporting requirements and payment schedules. VOS optometrists must have had or created a bank account specifically related to VOS income and expenditure.

Provision of service and payment of optometrists

Once an agreement has been reached and the Funding Agreement has been executed by the Department, the provision of the outreach service can commence. An initial upfront payment is made to service providers upon execution of the Funding Agreement. Subsequent payments are scheduled on a six monthly basis, and coincide with the delivery of reports and invoices that are outlined in the schedule of the Funding Agreement. The reports must include all services provided during the period which relate to the approved circuit. Reports for each circuit visited during the reporting period must include:
    • the provider number of the visiting optometrist
    • the number of visits undertaken
    • the number of patients seen who identified as Aboriginal and Torres Strait Islander
    • total number of patients seen
    • the type of service provided.
The optometrist is also required to provide comments on whether they “have identified any cases of eye disease” at the outreach location. This is an unstructured response covering all locations visited. The optometrists can also provide comments or document concerns about VOS.

In addition, an Income and Expenditure Statement is required, which relates to the specific VOS related bank account required by the funding agreement. This statement includes a section for the Income from DoHA and any interest earned. The statement also includes a section for Expenditure, which details the cost incurred for ‘travel’, ‘meals and incidentals’, ‘accommodation’, ‘absence from practice allowance’, ‘admin support’ and ‘locum support’. It appears ‘expenditure’ includes a transfer of funds from the VOS account to other accounts related to circuits conducted and reflecting the budget for the circuits. Receipts are not required. Provision is also made to report on Current liabilities.

In addition, a valid tax invoice must be provided, reflecting the agreed budgeted amounts per circuit and the number of circuits conducted in the reporting period.
In the final report (at the end of the Funding Agreement), the service provider is required to provide a comparison between the achievement of the aims of the project against expected objectives and outcomes for the program, an explanation as to why some or all of the aims of the project were not achieved and a complete version of ‘Project Material and all Commonwealth Material’

At the end of the final period, a statement of the balance of funds in the specified VOS bank account of the service provider is required to be provided as an audited statement of receipts and expenditure and prepared by an approved auditor in compliance with the Australian Auditing Standards. The audited statement must include a definitive statement as to whether the financial accounts are complete and accurate, and all funds provided have been spent whilst delivering services in accordance with the Funding Agreement.

Review and evaluation

Current funding agreements are in place until 30 June 2012. The current program guidelines indicate approved services are to be reviewed on an annual basis by DoHA officers, in consultation with state/Northern Territory reference groups and the VOS National Advisory Committee. The review is intended to determine wither the service continues to fulfil the objectives of VOS.

Occasionally, an optometrist “takes up residence and opens an Optometry practice in a location where VOS funds support visiting optometry services” (DoHA 2011e, p.18). This circumstance will trigger a review to determine whether the continuing VOS service is required.Top of page