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The GOC looks ahead

The General Optical Council’s chair, Gareth Hadley, tells OT  why preparing optometrists for an ever-evolving healthcare landscape is a public protection issue

10 Aug 2018 by Selina Powell

Keeping the big picture in mind is important for General Optical Council (GOC) chair, Gareth Hadley.

The GOC’s task of completing the first review of optometry education in 35 years involves hundreds of hours of meetings and traversing a mountain of paperwork.

Although there may be a tendency for some to get lost in mechanics, Mr Hadley believes it is important to keep in mind the purpose that the newly engineered programme aims to fulfil.

“In this changing world we have got to make sure that our registrants are able to safely perform not only their existing work but work that will come their way in the future,” he shared.

“We can’t predict all of it. There will be things happening in five years’ time that we haven’t got an inkling of now,” Mr Hadley added.

Equipping the profession to take on an extended range of clinical services will ultimately help to ensure that more patients are seen within the community, and take the burden off an overloaded hospital eye service.

Mr Hadley observed that, in this way, the Education Strategic Review (ESR) will support the key purpose that underpins the optical regulator.

“This is a public protection issue because unless the work undertaken by our registrants does grow, and they absorb more of the activities that have been traditionally reserved for hospital eye departments then people are going to go blind – it’s as bald as that,” he emphasised.

Future focus

Looking ahead, Mr Hadley highlighted several factors that are influencing change across all healthcare professions.

These include the rapid pace of technological advancement, the development of new care pathways and the demands of an ageing population.

Use of artificial intelligence technology in a healthcare setting has the potential to change the weighting of an optometrist’s role in favour of clinical tasks.

“The advance of technology will mean that certain activities that have put food on the tables of optometrists for hundreds of years, like refraction, will become less significant,” Mr Hadley said.

He also emphasised the increasing role of multi-disciplinary healthcare teams.

“If you were to go back about 30 years, most healthcare professionals stuck to their own group. That is no longer so clearly the case,” Mr Hadley added.

Mr Hadley shared his view that the present system is “creaking at the seams,” with hospital eye departments struggling to meet demand.

“I see no reason why the line of distinction between an ophthalmologist and an optometrist should remain fixed in the position it’s in at the moment. If an optometrist can perform the work that is traditionally done by an ophthalmologist, then that’s progress,” he said.

“What we do need to do is make sure that they have the appropriate level of skills, experience and confidence to do that work,” he added.

Changes to regulation

In October last year, the Department of Health launched a consultation on reforming the regulation of healthcare professions across the UK.

The consultation document stated that there is “no clear rationale” for the current number of healthcare regulators within the UK.

While research suggests efficiencies begin to accrue when a regulator has a registrant base of between 100,000 and 200,000, only five of the UK’s nine healthcare regulators have fewer registrants than this (the GOC has around 30,000).

Mr Hadley highlighted that the GOC does believe there is a need for change in regulation.

“From our perspective, we need a system that is fleet of foot and can cope with change,” he shared.

He emphasised that while there are opportunities for greater cooperation between healthcare regulators, he does not believe that a merger is the best approach to take.

Mr Hadley shared that there are benefits from having regulators that are focused on particular professional groups.

“It is a concern of mine when there are discussions regarding the future of regulation it can so easily descend into administrative solutions,” he elaborated.

“The real issue is how are we enhancing our capacity to protect the public,” Mr Hadley added.

“Public protection is first and foremost. They won’t be going down the path of experimentation” 

A new shape for the GOC

While overseeing changes within the optical profession, the GOC is undergoing its own internal restructure. In May, the optical regulator announced plans for a new operating model.

Mr Hadley shared with OT that, following a staff consultation, the GOC has decided not to proceed with the model that was tabled initially.

“What we will be doing is working with staff over the coming months to design a model that best meets the objectives of the work,” he said.

The key drivers behind the new model are improving operational performance and efficiency while also producing a more targeted and flexible approach to regulation.

“We also need to produce an operating model that is break even or better,” Mr Hadley explained.

The GOC has signalled an intention to continue with deficit budgets in the short-term, and registrants face modest year-on-year increases in registration fees.

When asked for the rationale behind this, Mr Hadley explained that the GOC has a significant amount work to complete within its strategic plan for 2017 to 2020.

“We have taken the view that it is appropriate for the delivery of the major pieces of our outward facing work – the ESR, the continuing education and training (CET) review and business standards – that we deploy some of our reserves to fund those activities,” he elaborated.

However, he added: “That can’t go on. In a stable state organisation, we ought to be funding from our current revenues the investment that we need to make in our policy development and policy change.”

The deficit would “undoubtedly” be an issue that the GOC will discuss as part of the next strategic planning period, Mr Hadley shared.

An enhanced skillset

At present, the GOC plans on consulting on new standards for education providers from autumn this year, with individual education providers given the chance to move forward within the new system from September 2019.

The revised standards would then be rolled out more generally from September 2020.

The regulator also plans to bring forward a review of CET by two years from 2022 to 2020, with 2019 becoming a transitional year.

Mr Hadley shared that feedback from an initial consultation on the ESR demonstrated a willingness to move quickly.

“There are a number of educational establishments who are saying, ‘Can we get on and do something now please’,” he added.

There is leeway within the planned framework for some institutions to become ‘early-adopters.’

Mr Hadley moved to provide reassurance that these institutions will still be working to quality-assured standards.

“Public protection is first and foremost. They won’t be going down the path of experimentation,” he observed.

A key shortcoming of the present system highlighted through the consultation process includes a lack of clinical exposure within the undergraduate programme.

There was also a feeling that current CET requirements are too rigid and do not allow for professional development.

“The way it’s constructed at the moment means that for some – not for all – it is a tick-box exercise. ‘How many points have I got?’ not ‘What is my learning from this?’ or ‘In what way will this change my professional practice?’,” Mr Hadley observed.

Mr Hadley shared that while most of the feedback from stakeholders to date has pointed in a similar direction, the GOC is committed to engaging with the profession to navigate through any future differences that may arise.

“A model that looks perfect on paper to ourselves is not going to butter any parsnips. We need something that everyone can buy into,” he added.

Mr Hadley emphasised that having regular discussions with registrants ensures that the GOC can be effective in its role. He highlighted the importance of having registrant members on the Council.

“From my perspective having six registrants on the council is critical because they bring that understanding that we wouldn’t have if we did our work in isolation,” Mr Hadley elaborated.

“They have an insight into what it’s like to have a patient sitting down in the chair,” he said. 

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