01 August 2022
We’ve all heard about the Opticians Act and its importance for optometry – from defining the legal framework in which millions of sight tests are delivered to patients each year, to regulations about the sale and supply of spectacles and contact lenses. It even defines how the General Optical Council (GOC) is constituted, its responsibilities for setting education standards and holding professional registers. But considering it was established over 60 years ago, does it still work today? Does it need to be changed? And how can it protect patients and enable optical care into the future that our ageing population needs? These are the kinds of questions that the GOC’s recently closed call for evidence on the Opticians Act posed to us.
The Opticians Act was first introduced in 1958, marking a seminal moment for the UK as one of the first countries to legally recognise the professional roles of the ophthalmic optician (optometrist) and optician (dispensing optician). It also established the GOC as the professional regulator and defined what a sight test should be, and who should carry it out.
An updated Opticians Act in 1989 made further revisions to the law. The Act has been further amended through rule changes several times since – including the introduction of the requirement for optical professionals to undertake continuous education training in 2005.
Why change the legal fundamentals?
The Opticians Act is woven through the very fabric of the optical profession and the services it provides to patients. This is why the GOC’s call for evidence on the Opticians Act and consultation on associated GOC policies is a really big deal for the AOP and our members, for the optical sector, and for patients.
So why did the GOC run this call for evidence? Here’s the important background – for several years the Government has been carrying out consultations and work within the Department of Health and Social Care (DHSC) to review how all healthcare professionals are regulated, with a view to making things more consistent across all healthcare regulators. Some of the more radical possibilities from that work could see the GOC merged into a ‘super regulator.’ Whilst the GOC may not be perfect, removing it could reduce the knowledge and understanding of optical practice in the regulation setting, and even weaken the perception of the profession in wider healthcare. Regulatory reorganisation is likely to be costly and disruptive, and the AOP has argued against changes to the configuration of health regulators for a number of reasons.
In our opinion, the likeliest outcomes of the DHSC work are that we will see greater standardisation of regulatory powers, with some shared administrative functions across different regulators. This would include removing optical students from the requirement to register with the GOC, bringing us into line with other professions.
With regard to why the call for evidence has come about, the answer is simple – opportunity. The GOC has used the opportunity created by the DHSC’s drive for regulatory reform to launch a review of the provisions in the Opticians Act. The starting point of this process is the recently closed call for evidence and associated consultation on the future of optical regulation.
The sight test
Protecting the integrity of the sight test was at the cornerstone of our response to the call for evidence. The GOC asked if the refraction and eye health checks could be regulated as separate episodes of care. Like our members, we passionately believe it must remain as a single inseparable sight test. The sight test ensures that when patients with vision correction needs obtain a prescription, the eye health check is also delivered. This provides a vital way to detect signs of developing ocular pathology, and is important for detection of early stage and asymptomatic eye disease, and ensuring better patient outcomes. Supply restrictions mean that patients need to attend these regularly to obtain new spectacles or contact lenses, adding another layer of patient protection. We know that NHS service funding, especially general ophthalmic services in England, needs improvement. But our current Act allows innovative and more equitable systems, such as those in Scotland and Wales, to develop, without risking the delayed diagnosis that sight test separation would lead to.
The GOC also suggested that refraction in the sight test could be carried out by other professionals without changing legislation. In fact, refraction and the sight test are inseparable, and the Act, in effect, defines sight testing as refraction with the intention to prescribe, with mandatory eye health checks to also be conducted. We believe that the whole of the sight test must remain under the control of the optometrist as other options increase the risk to patients.
Although everyone’s focus has rightly been on the risks that could result from changes to sight test regulation, other potential legislative changes could also have positive outcomes. We are supportive of GOC proposals to extend its regulation of business as a mandatory requirement on all organisations that provide legally restricted optical services. This will help balance the playing field between individual and business registrants, as risks in practice are rarely attributable simply to the practitioner. However, this must happen in a fair way, without disproportionate costs for practices, particularly smaller ones, and avoid duplicating existing NHS contractual requirements.
The road ahead
The good news is that nothing in the Opticians Act will be changing tomorrow. The GOC has told us that it will run a further full public consultation on any proposal for changes to the Act which are developed following its call for evidence. This is vital, and we will be calling on the GOC to properly consult and to listen to the whole sector’s views before taking any case for change to the DHSC. The profound implications of changes to the Act, its scope and scale for optical practice, demand that there is further robust consultation on proposals and that this is both transparent and responsive to feedback. The future process of any resulting legislative changes will likely take a few years, and government priorities will impact how quickly this piece of work progresses. Our members will continue to be an essential guide to how we respond to whatever lies ahead. As the membership body for the optometric profession, we will continue to listen to the views of our members and work with our sector partners and stakeholders to lead and influence future changes to clinical practice and the development of the profession.
About the author
Saqib Ahmad is a policy officer at the AOP.
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