“It is worth pausing for a second to celebrate what we have achieved”

If we’d have known this at the outset, we may all have approached the past 12 months in a more settled fashion. The irony is that the vast bulk of the potential changes that the GOC was floating were things which would require legislation and are therefore some years away. Although changes in the Health and Care Act give the Secretary of State the power to amend legislation more quickly and easily than before, there is already a queue of Department of Health and Social Care (DHSC) asks (queues in healthcare – the very idea). And ultimately, the GOC has too little political heft to be able to muscle its way in front of the General Medical Council and the Nursing and Midwifery Council, to name but two.

There is one exception in the GOC’s conclusions, which is based on the suggestion that sight test refraction could be carried out by dispensing opticians (DOs). While in the AOP’s view, as well as most of our peers in the sector, this would be a clear breach of the terms of the Act, the GOC continues to argue that this change would not have required any amendment to the legislation. Regardless, and thankfully, the GOC appears to have finally accepted what AOP members strongly advised: that allowing DOs to refract would expose patients to increased risk of eye conditions being overlooked. It is only sad that it took that same message to be rearticulated by the eminent Professor Bruce Evans (the worthy recipient of the most recent AOP Lifetime Achievement Award) before the GOC finally bowed to the weight of clinical expertise.

While the decision not to allow the delegation of refraction is welcome, some action in this space is still urgently required

Welcome though the GOC’s decision is, there is further work to be done. Even before the call for evidence, the question of exactly what is and is not allowed in performing a refraction was subject to considerable confusion. The official GOC policy in this area dated from 2013, and while it remains a simple and unobjectionable statement of principle, it is insufficiently specific and up to date to manage the challenges posed by the technology-driven models operated by, for example, Brillen. While the decision not to allow the delegation of refraction is welcome, some action in this space is still urgently required.

Similarly, the decision – in principle, at least – to introduce statutory business regulation into the optometry sector, which is again in line with what the AOP argued in our evidence, only signals the start rather than the end of a journey. Business regulation will, in our view, furnish the regulatory armoury with a powerful new tool, enabling the regulator to hold businesses rather than individual registrants to account for commercial decisions. For example, if a key piece of clinical equipment is not maintained properly, if non-registrant staff are not trained and supervised properly, if unreasonable time limits are imposed on staff for the completion of procedures – in such cases, the GOC will be able to take action against those with corporate rather than only patient-facing roles.

Business regulation will, in our view, furnish the regulatory armoury with a powerful new tool, enabling the regulator to hold businesses rather than individual registrants to account for commercial decisions

Yet business regulation comes with costs as well as benefits. In particular, the burden of regulation, both financial and operational, on businesses can be significant, particularly if the regulator chooses to operate a stringent inspection and reporting regime. While larger, more established businesses may be well set-up to respond, smaller, newer businesses may be disproportionately affected. It will therefore be essential that the GOC works with the sector over the next few months to design a model of business regulation which maximises the advantages and minimises the burden.

That is for the future, and before we get there, it is worth pausing for a second to celebrate what we have achieved. Reading the GOC’s papers again today: Yes, we might have wanted some of the detail phrased a little differently. And yes, the way the pattern of responses is tabulated in the graphs is misleading – the AOP’s input is merely counted as a single response instead of proper weight being given to the fact that our response was based on the explicit polling of over 3000 optometrists (perhaps next time, we might ask members to send their feedback directly to the GOC?). But overall, the results are in line with what we would have wanted.

That is a tribute to the support we have had from you, our members, and the input from our committees, especially our policy committee and our Council. Thank you to you all. And, as uncharacteristic as it may be for me to say: thank you to the GOC for having the good sense to listen to reasoned argument and evidence.