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Practice team guide

Conundrums in practice

From the balance between selling and recommendation to tricky ethical and clinical issues, practice members share their tips

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For every member of the practice team, it is important to be able to explain to patients the different optical solutions that are available to them.

But where does thorough guidance become selling? How can patients be informed without feeling pressured?

The latest public perceptions research by the General Optical Council revealed that the most common reason patients are uncomfortable about visiting an optical practice is pressure to buy contact lenses or spectacles.

One in five respondents specified this as the reason for their discomfort, compared to one in 10 respondents who said they were worried about being diagnosed with an eye condition, while one in 20 patients expressed concern about someone being close to them during the sight test.

Andy Clark
Optometrist, Andy Clark
Optometrist Andy Clark created the Can I help you with that? system to help practice owners and their staff recommend rather than sell.

Clark shared that navigating the difference between the two approaches can be challenging for staff members.

He highlighted that selling is when you take away the patient’s control, put time pressure on the purchase or influence the patient to purchase a product that they may not need.

“Recommending is finding out why someone might want to buy something, educating them about why it is a great idea and then letting them choose when they buy it. Selling is in the best interest of the cash register, whereas making recommendations is in the best interest of the patient,” Clark emphasised.

Selling is in the best interest of the cash register, whereas making recommendations is in the best interest of the patient

Andy Clark
 
Specialist contact lens optician Nick Howard emphasised the importance of being genuine in conversations with patients, supported by expert knowledge and an understanding of patient needs.

“Have evidence-based, up-to-date research and comprehensive product benefits as a platform for your recommendation and guidance. The best sale is driven by the confidence of the patient, not the practitioner,” Howard observed.

For optometrist and AOP councillor, Josie Evans, it is the responsibility of eye care professionals to introduce optical solutions that will help a patient to see well and look good.

“It’s important to inform and guide, not to persuade,” she said.

Evans added that the advantages and limitations of products should be discussed with the patient.

“If one option is better suited to an individual’s needs than another, this recommendation should be justified. With this approach, you’re acting in the best interests of the patient and providing them with the information they need to make an informed decision,” Evans emphasised.

Dispensing optician Simone Mason highlighted the importance of getting to know the patient and understanding if there could be any improvements in their current optical solutions.

“Ask what a typical day is like, including weekends and hobbies,” she added.

Explaining the benefits of your recommendation for their needs is also key, Mason said.

Ethical and clinical dilemmas in practice

There are a wide variety of conundrums that face optical practice team members – from patient confidentiality issues to non-tolerance of spectacles.

Practice support staff play an important role in addressing issues that arise in practice as they are often the first point of contact for patients.

Knowing the correct processes to follow and the relevant rules that regulate safe eye care is key.

AOP clinical and regulatory adviser, Roshni Kanabar, shares guidance on common ethical and clinical dilemmas in optical practice.

Supplying contact lenses

Roshni Kanabar
AOP clinical and regulatory adviser, Roshni Kanabar
Contact lenses can only be prescribed and fitted on the basis of a valid spectacle prescription.

This means that practice support staff booking a patient for a contact lens assessment need to check that the patient has a valid spectacle prescription and advise the patient to bring it in to the appointment if the sight test was performed elsewhere.

Kanabar highlighted that the need for a valid spectacle prescription also applies when providing aftercare.

She added that staff can supply contact lenses against a valid contact lens specification, even if the sight test is overdue, provided the supply does not take the patient over the expiry date on the specification.

Kanabar explained that zero powered contact lenses, or contact lenses for a patient in a restricted group, can only be supplied if there is a registered optometrist or contact lens optician on the premises who can supervise the supply.

In other circumstances, contact lenses can be supplied under the general direction or supervision of a registered practitioner.

This means that where contact lenses are posted from the supplier to patient, for patients under the age of 16 the lenses would need to be posted to the practice first so that they can be supplied under the supervision of a registrant.

Confidentiality

Kanabar emphasised that the duty of confidentiality is the same for children as that owed to an adult, so the practitioner needs to seek their consent first for the disclosure of information.

For adults, before speaking to a relative about a patient, you must seek consent from the patient themselves, and this should be documented on the file and can be revoked at any time.

Regarding another practice phoning for patient information, Kanabar highlighted that consent should be obtained from the patient before this information is disclosed.

“We do not recommend disclosing prescriptions over the phone, because there is a high risk of errors arising, even when speaking to a registered optician. Instead, we recommend asking for consent to send the information by fax, email or post” she shared.

Patient requests for pupillary distance

Kanabar confirmed that optical practices are not required to specify the pupillary distance (PD) as part of the spectacle prescription. This measurement is considered to be part of the dispensing process.

Patients can be charged for providing this service. However, practitioners should keep in mind that if the PD has previously been recorded then they can obtain this by making a subject access request on their records.

Kanabar recommended having a practice policy on this topic as frontline staff may commonly come across the issue.

“Sometimes patients can feel that practice staff are purposely being ‘difficult’ when declining to provide these measurements,” she shared.

Non-tolerance

A patient may be unhappy with their spectacles for a wide range of reasons – from comfort issues and poor frame fit, to prescription errors or spectacles that are incompatible with a patient’s lifestyle needs.

Kanabar emphasised the importance of having a practice protocol in place to manage these patients.

She highlighted the importance of listening to patient concerns without dismissing them, before handing the patient to a dispensing optician or senior optical consultant if appropriate.

Troubleshooting can then take place, including checking dispensing measurements, frame measurements and ruling out any causes of non-tolerance due to lens design.

If it is obvious that the issue is a prescription error or non-tolerance or efforts to manage the patient outside the consultation room have been unsuccessful then they should be booked for a recheck.

Safety spectacles

Kanabar highlighted that if patients have not received a work-based assessment to determine the most appropriate protective eyewear for their role, then dispensing opticians are usually best placed to offer this kind of advice.

She added that spectacles must be ordered from a recognised safety eyewear manufacturer, and even minor repairs will need to be sent back to them to avoid invalidating the protection guarantee.

Booking patients for an early GOS test

Kanabar highlighted that the AOP regulatory team is increasingly finding that area teams will attempt to reclaim GOS fees for early sight tests, where the patient's presenting symptoms are not likely to be visual or refractive in nature, on the basis that an early ‘sight test’ was not clinically justified.

“Therefore, to avoid the risk of reclaims, we advise contractors against using early GOS where the presenting symptoms are not visual or refractive in nature, such as patients presenting with red eye, for example,” Kanabar emphasised.