Regulation consultation and future thinking for optometry

The national context

Chief executive of the AOP, Adam Sampson, pointed out that this was the first meeting of the AOP Council since the UK election, sharing: “That has substantially changed the landscape – or has the potential to.”

Sampson celebrated the work of the sector in highlighting the role of optometry to policy makers. “Just getting our issues up there, and optometry as an opportunity into the debate during the election, constitutes a win. In theory, we’re operating from a position of strength,” he said.

This has been given additional credibility by Lord Darzi’s report, which highlighted that health policy needs to be rebalanced towards primary care. Meanwhile, the Government’s three key shifts for the delivery of NHS services: hospital to community, treatment to prevention, and analogue to digital, are all relevant for optometry, he added.

However, a number of hurdles remain, Sampson noted, including a lack of NHS funding for primary care, “strong voices” in healthcare and some areas of government with concerns regarding private sector healthcare, and an ambition of hospital services to “ramp up” community offerings, rather than transferring services to existing High Street providers.

He emphasised that when discussing the “critical” role of eye care to the NHS 10-year plan, “we need to be specific about what version of eye care delivery in the community and whether that is a High Street optometry-led version.”

Business regulation 

Dr Peter Hampson, clinical and policy director at the AOP, introduced a group discussion on the General Optical Council’s (GOC) proposed framework for business regulation.

The GOC consultation runs until 22 January 2025, and Councillor insights, along with the views of members, will inform the AOP’s response.

The discussion focused on four areas of the proposed model, including mandatory GOC registration for all providers of restricted functions, the introduction of a head of optical practice role, expansion of enforcement with inspection powers and uncapped fines, and reforming the Optical Consumer Complaints Service (OCCS).

Councillors questioned what the scope of the mandatory business registration requirement would be, and whether there is evidence suggesting the change would be effective. Council members also considered whether this move would create a ‘double charge’ for smaller practices.

Nicholas Hagan, AOP Councillor for the East of England, commented: “Online vendors or businesses that sell glasses but are not fulfilling the restricted function won’t fall under the scope of this drive.”

Regulatory responsibility 

Karan Vyas, AOP Councillor representing employees of multiple practice, shared his view that optical services in the UK should be regulated: “There is an argument about not just doing right in the testing room, but making sure those leading the business are not putting undue pressure on the employees.”

Karen Gennard, AOP Councillor for South West England, pointed out the need for any new regulatory guidance to be clear: “You as a practitioner need to know where those lines are – where your responsibility is and where your employer’s responsibility is.”

The consultation poses the introduction of a head of optical practice role, which would be responsible for business or practice compliance with GOC regulatory standards.

Councillors discussed whether the role already existed, to some extent, in hospital settings or larger organisations, along with the potential implications this role could have for independently-run businesses or those owned by non-clinicians.

Kevin Thompson, AOP Councillor representing directors of independent practices, pointed out that a key question with the creation of the role is who takes responsibility in the case of something going wrong. Under current legislation, this falls to the individual practitioner.

Proportionality in regulation

The GOC consultation poses a regulatory model of expanding enforcement with inspection powers and uncapped fines.

Councillors felt that any financial sanctions imposed by the GOC should be proportional, with some suggesting that it could be related to the turnover of the business, and also queried how the training and funding of an inspector would be resourced.

The GOC consultation also explores mandating that businesses be participants of the OCCS scheme, and whether decisions from the scheme should be made legally binding.

Optometry in 10 years

With a government consultation open to provide insight for its 10-year plan for the NHS, the AOP sought Council perspectives on the future of optometry.

Rachel Hiscox, AOP Councillor for South East England and a Board member, shared: “I would hope we would move towards more clinical services. However, my big concern with that would be how it is going to be funded.”

Johnathan Waugh, an AOP Councillor for Scotland, reflected on the influence of the changing demographic of patients, sharing: “Our job is potentially going to shift more towards an older population. So I think, to a degree, what we do is protected.”

Adding that not all patients will want online services, he continued: “The core work is care – whether clinical or retail – but looking after people will always matter.”

Will Holmes, AOP Councillor representing university lecturers, noted: “I think we’ve got to remember refraction is a clinical task. I think we’ve fallen into a trap in the past of talking about refraction as if it is not a clinical activity – it is.”

Looking at the future of clinical working in 10 years’ time, he shared that with the potential for more services to be moved into the community, “there is a massive strategic piece around what we do as a profession with the opportunities that are going to come our way.”

Josie Evans, AOP Councillor representing employees of independent practices, suggested that independent prescribing could become more commonplace in practice.

She added that, with optometrists already successfully performing selective laser trabeculoplasty and YAG laser capsulotomy in hospital settings, the service could grow in this environment.

Dr Vijay Anand, an AOP Councillor representing hospital optometrists, discussed the role of optometrists in hospital eye care, providing an example of glaucoma at Moorfields, where 50,000 appointments a year are delivered by optometrists, with optometry-led clinics making up 8000 of these.

He said: “There is a lot of work already being done by optometrists with these qualifications, but that doesn’t necessarily mean these need to be in optometry practice, or in the secondary care setting.”

The profession of the future

Councillors were asked for their thoughts on what would need to happen to unlock the full potential of the profession in the next decade. Feeding back from a group discussion, Evans suggested a framework of support and advice for optometrists who are expanding their competence, such as new IP-qualified registrants.

Councillors agreed that appropriate funding was one of the biggest challenges.

Summaya Ali, AOP Councillor representing newly-qualified and early career optometrists, said: “The biggest challenge is funding and making sure we have something more consistent.”

Understanding NHS England Eyecare Transformation

James Palmer and Vittoria Polito from the NHS England Transformation Directorate joined the Council meeting to answer questions about the NHS England Eyecare Transformation Model.

A summary of the discussion will form a starting point for an open policy dialogue with NHS England, and the wider eye health sector, on the future adoption of the model, the AOP has said.

Councillors considered the potential implications of the model, and how the AOP could contribute and collaborate with NHS England to support implementation.