The long wait
The notification of a GOC investigation is a moment that many optometrists dread. But what if the process drags out for years? OT examines fitness to practise waiting times
22 December 2023
When the letter came from the General Optical Council, his first reaction was disbelief.
“You freeze and you are in a state of shock. It is the only thing you think about. I didn’t sleep much for the first few weeks,” he said.
During the initial period of facing an investigation, the optometrist, who OT has agreed not to name, clung on to one thought that provided him relief.
The GOC had advised him that his case would be resolved within 18 months.
“There was a countdown in my life – like I was in prison. I would think ‘There are this many months until freedom.’ But then it kept on going,” the optometrist shared with OT.
The optometrist would not receive an outcome on his case until seven years after the letter first arrived on his doorstep.
He is not the only one who has faced an extended wait to have his fitness to practise case heard. It is an issue that has seen the General Optical Council repeatedly reprimanded by the body responsible for its oversight, the Professional Standards Authority.
Although the General Optical Council has made improvements on timeliness in recent years, its latest annual report shows that there were 78 cases on the regulator’s books that have been open for more than a year.
The mental health effects of extended fitness to practise proceedings are documented within research.
A 2016 BMJ Open article explored what doctors found most stressful about the complaints process through a series of qualitative surveys.
Prolonged duration was cited as one of the most stressful components of the complaints process, alongside a variety of factors including the unpredictability of procedures and poor communication.
More than a numberThe optometrist who experienced a seven year wait for his case to be heard told OT that it was the state of uncertainty that was the most challenging aspect of the ordeal.
“If you know what is happening and when your case is going to happen, then you can work towards that. But when you don’t know, it is like there is no light at the end of the tunnel,” he said.
To deal with the stress of facing a GOC investigation, the optometrist took up running and discussed his worries with his network of family and friends.
At the time, I was probably just a number to the GOC. They have to appreciate that behind the number there is also a person
He would like people working at the GOC to have a greater understanding of the impact that long waiting times can have on registrants facing fitness to practise hearings.
“At the time, I was probably just a number to the GOC. They have to appreciate that behind the number there is also a person,” he said.
The optometrist, who continues to practise, believes that his experience of waiting seven years to have his case heard has seen him change from the person he was when he first graduated.
“To be treated like you don’t actually matter by the GOC, the same people who are your governing body, that is a real kick in the teeth,” he shared.
“I don’t know whether I have the same passion for the job that I did have,” the optometrist said.
Life on pauseAnother optometrist, who waited close to three years for his case to be heard, also found the uncertainty challenging.
“You are not in control of it. You wake up and feel fine for about 10 seconds and then it hits you: This is still going on,” he said.
The optometrist shared that people can be left in limbo as they wait for their case to be heard.
“People can’t really move on with their lives. You could take a chance and change your career, but then maybe three years later you will be told that you can be an optometrist again,” he said.
The support from the AOP was unbelievable. If I hadn’t had that support I’m not sure where I would have been
The optometrists emphasised that long fitness to practise waiting times are an issue that is relevant to everyone within the profession.
“All optometrists need to worry about it because at the end of the day, you can’t be perfect all the time,” he said.
“Whether it is personal lapse or a professional lapse, don’t think you are immune to it,” he shared.
During the process, the optometrist valued being able to talk with his family and friends, as well as guidance from the AOP legal team.
“The support from the AOP was unbelievable. If I hadn’t had that support I’m not sure where I would have been,” he said.
The AOP viewSolicitor, Nan Mousley, who works within the professional discipline team at the AOP, is responsible for guiding members through the fitness to practise process.
She shared with OT that the impact of facing a fitness to practise investigation can vary depending on whether an optometrist is subject to an interim order while they wait for their case to be heard.
“If they are made subject to an interim order, which means that their practice is curtailed in some way or is conditional, that has an immediate and concerning impact for the practitioner,” she said.
Optometrists may struggle to find work while they are subject to conditions. There is an administrative and sometimes financial burden of being subject to regular supervision.
“That can have the effect of making someone feel like they are serving a punishment before they have been found guilty,” she said.
For optometrists who are not restricted in their practice, the impact will vary between individuals. Some optometrists will be advised that they are at risk of suspension or erasure if the facts against them are proven.
“There is the exhaustion of thinking ‘I have to go through this.’ They have to make provision financially for their family and for their expenses,” Mousley highlighted.
Optometrists who are suspended will need to apply to rejoin the NHS Performers List, meaning the period they are unable to provide NHS sight tests is often longer than the suspension period.
“There is always a sting in the tail – it is not necessarily limited to the immediate impact of the GOC investigation,” Mousley said.
Mousley sees her role as supporting members with realistic advice.
“You have to look after people and be sympathetic to their position. You want to ensure that process works as well as it can for them,” she said.
While Mousley appreciates that some members may feel a lack of support from the GOC, she highlighted that the statutory duty of the optical regulator is to protect the public.
“Their role is not to support the registrant – it is fair, timely prosecuting,” she said.
Reflecting on how the fitness to practise process could be improved, Mousley would like to see more stringent criteria applied to when an investigation is opened against a practitioner.
“I think the acceptance criteria could be more rigorous. They should think about the impact of opening a fitness to practise investigation,” she said.
She also highlighted the disproportionate impact of lengthy fitness to practise waiting times for student optometrists and those in their pre-registration period.
“These cases are not huge in number, but the delays can be devastating for them,” Mousley observed.
Work in progress
The PSA monitors the performance of different healthcare regulators across a range of criteria – including the timeliness of fitness to practise investigations.
This year was the first time since 2013–2014 that the GOC met the PSA’s expectations in this area.
“We have been critical of the time it has taken the GOC to progress cases through its fitness to practise system for a number of years,” the authority highlighted in its periodic review of the optical regulator.
“However, the GOC has maintained the improvements in timeliness we saw last year, and its performance now compares favourably against the other regulators,” the PSA noted.
A GOC spokesperson highlighted that the regulator has made improvements across fitness to practise processes, including reducing the number of open older cases and bringing down end-to-end timeliness.
“We recognise that involvement in fitness to practise cases can impact an individual’s wellbeing. It is extremely important that, where appropriate, cases are closed or progressed at pace and any undue stress is prevented,” the spokesperson said.
Turning to challenges the GOC faced in reaching timely decisions, the regulator shared that an increase in the number of cases involving health allegations had affected timeliness.
“Significant work in recent years has also been conducted to bring down the backlog of cases arising from the COVID-19 pandemic, particularly in digitising physical files and evidence,” the spokesperson stated.
The GOC spokesperson emphasised that the regulator would continue to make improvements across its fitness to practise processes in the coming years.
“Retaining the confidence of the optical professions and supporting them to deliver high standards of care is vital to ensuring public protection, and fitness to practise is an important part of this,” the spokesperson concluded.