GOC discusses delegating refraction to DOs
Delegation of refraction was one of the issues covered during a wide-ranging discussion at the latest meeting of the optical regulator
28 March 2023
GOC members discussed feedback received by the optical regulator as a result of the call for evidence on the need for change to legislation that underpins optometry.
Introducing the call for evidence discussion, GOC chair, Anne Wright, highlighted that the optical regulator received 353 responses from stakeholders expressing their views on whether changes are needed to the Opticians Act.
She emphasised that there was “a large degree of stakeholder consensus on many issues.”
Wright added that the focus of council discussions would be on the two most contentious issues within the call for evidence – delegation of refraction and business regulation.
Business regulationOn the topic of business regulation, the draft GOC response to the call for evidence highlights, “We think regulation should apply to all such businesses regardless of their name, corporate structure or who owns and manages them.”
As part of Council discussions, GOC council member David Parkins highlighted that only around 50% of optical businesses are currently regulated in the UK.
He shared that public and patient safety must be the optical regulator’s overarching priority.
“There needs to be a level playing field,” Parkins said.
GOC director of regulatory strategy, Steve Brooker, told council that there is broad support across the sector bodies for the regulation of all businesses carrying out restricted activities.
“Business-level decisions shape the behaviour of individual registrants,” he said.
Brooker observed that while the risks to public at present are “quite low,” they are best addressed by a consistent level of oversight.
GOC council member, Tim Parkinson, shared that the optical regulator’s Companies Committee convened for a “suitably lively debate” on the issue.
“There was an agreement that business regulation should extend to all businesses carrying out restricted functions. That agreement was subject to regulation being proportionate,” he said.
For example, Parkinson shared that a comprehensive inspection regime may not be warranted on the grounds of risk and cost.
He added that the Companies Committee agreed that an individual with appropriate experience within each business would need to be accountable for clinical practice.
“There is a lot of detail to be worked out if we do end up going down this road,” he said.
The proposed GOC response to the call for evidence states that “at this point in time we are not satisfied that dispensing opticians should be permitted to refract for the purposes of the sight test.”
During council discussions, GOC director of regulatory strategy, Steve Brooker, described the issue as an “emotive” one for the sector.
“There are strongly held views among stakeholders on this issue and they do tend to split along professional lines,” he said.
Brooker shared that while research found that members of the public would be open to dispensing opticians performing refraction, clinical advisers flagged concerns around missed pathology.
“There are subtle clues about pathology that appear in different parts of the sight test. It is only when you piece those parts of the jigsaw together that some eye health conditions can be properly detected,” he said.
Parkinson shared that he has “no doubt” dispensing opticians would be capable of performing refraction as part of the sight test with the right amount of training. However, he did not think that was the central issue.
“I think what came through to me loud and clear was the end-to-end nature of the sight test. The optometrist gathers together the results of the component parts of the sight test to form a holistic picture of the health of the patient,” he said.
Parkinson also questioned whether the need for a debrief between the dispensing optician and the optometrist following a refraction would negate any time savings.
While Council member, Josie Forte, also supported the optical regulator’s position on refraction, she cautioned the GOC to keep in mind technological changes.
“We don’t want decisions we make here to inhibit the use of technology,” she said.
GOC council member, William Stockdale, spoke in favour of delegating refraction to dispensing opticians.
“The world is changing. As I have re-read the evidence, I have moved against the consensus to think that we should allow dispensing opticians to refract,” he said.
Stockdale highlighted the increasing role of autorefraction in optometry practices.
He added that the declining number of dispensing opticians in the UK is linked to a lack of opportunity.
Changes to healthcare regulation
Alongside the call for evidence, the GOC council meeting also addressed proposals for regulatory reform by the Department of Health and Social Care (DHSC).
GOC chief executive, Leonie Milliner, shared that DHSC officials had made it clear that they were willing to engage with the GOC ¬– both during the consultation period and beyond.
“We heard that transitional arrangements would be tailored to each regulator which was encouraging given the extent of the change that would need to be enacted,” she said.
The deadline for responding to the consultation is 16 May, although Milliner highlighted that the GOC intended on submitting its response “sooner rather than later.”
Wright noted that the framing of initial proposals suggests that the regulator would be prevented from collecting or building reserves.
“This is not only a power as a charity but also a duty. It is something that matters a great deal to us,” Wright said.
GOC Council member, Clare Minchington, highlighted that talks with DHSC officials around reserves were helpful.
“I was reassured that they did appear to understand the issues that it created and were looking for a solution going forward,” she said.
Council discussions focused on the formation of a unitary board as part of regulatory reforms.
Forte questioned whether the change would affect registrant representation.
“It would be a different role for registrants. It is welcome that registrants are able to join the unitary board but I do think there may be some issues recruiting going forward,” she said.
GOC council member, Mike Galvin, highlighted that there have been successful examples of unitary boards within other regulators.
Galvin emphasised that the right skillset would need to be present on the board, as well as representation from the different nations of the UK.
“We have a number of ducks we need to get in a row,” he said.
GOC council member, Sinead Burns, added that discussions with DHSC had been helpful.
“I was heartened and reassured that they did appreciate the importance of the four nations,” she said.
Burns also touched on proposals to streamline fitness to practise processes across all regulators.
“The focus is very much on public protection – only the most serious cases, where there are issues of public protection, will proceed to a full hearing. I think everyone will welcome that – including the public and registrants,” she said.
She added that her only potential concern was around a new provision for the appeal and review of cases.
“My concern is that on one hand we are simplifying procedures and on the other we are introducing a whole other system that could clog things up again. Where is the evidence that suggests that this is needed? I would certainly want to be persuaded that it is necessary,” she said.
The AOP view
Reflecting on the GOC’s response to the call for evidence following the meeting, AOP chief executive, Adam Sampson, shared: “We are pleased to see that the GOC has heeded concerns expressed by the AOP, along with other stakeholders in the profession, and in particular the importance of optometrists remaining in control of the sight test.”
He noted that while it was never the intention to limit the aspirations of dispensing opticians, the AOP recognises the significant concerns expressed by members – particularly regarding missed pathology.
“The patient benefit and protection must be at the centre of any reform,” he said.
Sampson shared that the AOP received feedback from around 3000 members on the call for evidence, which informed the AOP’s submission to the GOC.
“The GOC’s commitment to a full consultation before any changes are implemented is also a welcomed move. This is pertinent when it comes to issues of funding, online sales and business regulation which require interrogation and we look forward to positive engagement on these,” he said.