“Preparing registrants for the future”

Independent prescribing for optometrists was first introduced in 2008, following a joint consultation by the Medicine and Healthcare Products Regulatory Agency (MHRA) and the Department of Health (DoH). Optometrists with an independent prescribing specialty can take responsibility for the clinical assessment of a patient, establish a diagnosis and determine the clinical management required, including prescribing, where necessary.

As of August 2021, there are almost 1100 independent prescribers on our register. To become an independent prescriber, one must be a registered optometrist; have been practising in the UK and registered with the GOC for two full years before beginning the clinical placement, and train in competencies which focus on consultation, prescribing effectively and prescribing in context.

We are proposing to allow appropriately trained and qualified, registered healthcare professionals with independent prescribing rights, including optometrists, to supervise clinical placements

What does the future of IP look like? The current qualifications for IP were introduced in 2011 and are available on our website. 

As part of our review of optical education, we are proposing new updated requirements for IP, which we opened for consultation in July.

We have a range of key proposals. First, trainees will acquire a single GOC-approved qualification, leading to specialist entry to the GOC register in either the additional supply, supplementary prescribing and/or independent prescribing categories, instead of the two sequential GOC-approved qualifications required at present (the theoretical component, normally delivered by a university, followed by the College of Optometrist’s Therapeutic Common Assessment).

Second, the approved qualification will be either an academic award or a regulated qualification at a minimum of Regulated Qualification Framework (RQF) (or equivalent) Level 7.

Third, the trainee’s supervision can be co-ordinated by an appropriately trained and qualified registered healthcare professional with independent prescribing rights (called a designated prescribing practitioner or DPP) rather than an ophthalmologist (designated medical practitioner or DMP). The DPP must be an active prescriber competent in the clinical area(s) they will be supervising the trainee in, have the relevant core competencies and be trained and supported to carry out their role effectively.

Fourth, an outcomes-based approach will be used to specify knowledge, skills and behaviours using an established competence and assessment hierarchy known as ‘Miller’s Pyramid of Clinical Competence,’ mapped to relevant external prescribing frameworks, including the draft Royal Pharmaceutical Society’s Competency Framework for all Prescribers (2021). 

Last, IP registrants will no longer be required to renew their specialty separately and supply details of prescribing decisions undertaken in the previous 12 months.

In developing these proposals, we consulted our IP expert advisory group, which is made up of expert stakeholders from across the sector.

The COVID-19 landscape

The COVID-19 pandemic has impacted everyone, everywhere, in many ways, and this includes the way optical education and training is undertaken. Over the past several years, the profession has become established and therefore some current requirements are no longer needed. Currently, registrants can only undertake a clinical placement as part of IP training under the supervision of an ophthalmologist within the hospital eye service.

We are proposing to allow appropriately trained and qualified, registered healthcare professionals with independent prescribing rights, including optometrists, to supervise clinical placements. This would remove the requirement that only an ophthalmologist can supervise trainees. The integrated nature of the qualification also removes the requirement for optometrists to have practised for two years before being eligible to train to become an IP.

In the meantime, while the current requirements for IP qualifications are in place, we continue to work with the College of Optometrists to review what temporary adaptations can be put in place to ensure progression whilst also ensuring trainees meet current requirements.

As we go forward, it’s important that we hear views from various people across the wider sector as we finalise these new IP requirements. We encourage you to take part in the consultation.

We look forward to working together to prepare registrants for the future to ensure patients and the public continue to receive high quality eye care.

About the author

Leonie Milliner is director of education at the General Optical Council.