Consultation

GOC's draft Strategic Plan 2020-2027

Our response to the consultation, January 2020

Optometrist in practice

The consultation

In December 2019 the GOC launched a short consultation on its draft strategic plan for the period 2020-2027. The consultation invited views on the GOC’s mission statement, vision and values, and its strategic objectives and aims as a regulator.

Introduction

The Association of Optometrists (AOP) is a UK-wide membership organisation for optometrists and other optical professionals. We represent over 80% of the UK’s 15,000 optometrists, registered healthcare professionals regulated by the General Optical Council (GOC) who play a vital role in delivering eye healthcare. We also represent some Dispensing Opticians (DOs), another eyecare profession regulated by the GOC.

AOP response to the consultation questions

4.  Thinking about our mission statement, do you agree with the current wording with a focus on 'continuously' raising standards?

We do not agree with the current wording of the draft mission statement, because it doesn’t take account of the level of regulation that is actually needed to protect patients and the public. In particular, the word “continuously” is inappropriate in this context and could have unintended consequences, such as leading to regulatory requirements which are more demanding, and more burdensome on registrants, than is necessary to protect the public.  

That would go against the principles of good regulation, which require regulation to be targeted and proportionate. It also goes beyond the GOC’s statutory remit in s.1(2) of the Opticians Act 1989, of “promoting high standards of professional education, conduct and performance among registrants”. 

We understand from GOC Council paper C36(19) that the word “continuously” has been included in the draft mission statement to avoid the perception that standards are not already high. We do not think the risk of that perception justifies the use of this unhelpful wording. The perception issue could be managed by more proportionate and appropriate wording for the mission statement, such as “to protect the public by maintaining high standards in the optical professions”, or “to protect the public by ensuring appropriate standards…”.

In this context the conclusions of the GOC’s 2019 research report on risk in the optical professions are relevant. That report found that the optical professions involve lower levels of risk to patients and the public than some other healthcare professions, but that the risks may increase as professional roles develop and become more clinical. 

We therefore suggest expanding the mission statement to reflect the potential for the risk profile of the optical professions to change during the lifetime of the strategic plan, and the need for the GOC to be ready to adapt its regulatory approach in response. For instance, the statement could read:

“to protect the public by [maintaining high standards/ensuring appropriate standards] in the optical professions as professional roles develop”.

5.  Thinking about our vision, what does excellent customer service mean to you?

We welcome the GOC’s ambition of being recognised for high quality regulation and excellent customer service. We also welcome the recognition in the draft strategic plan that the “customers” the GOC serves include registrants, and that the GOC needs to improve the way it works with registrants as well as other stakeholders.

From our members’ perspective, we would expect excellent customer service from the GOC to include ensuring that all the GOC’s interactions with registrants:

  • Take registrants’ needs and priorities into account
  • Minimise burdens and stress. For instance, fitness to practise proceedings are inherently burdensome and stressful for the parties involved. The GOC should recognise that and aim not to make things more difficult than necessary – for example, by avoiding unnecessary delays, and respecting statutory requirements on timetables for disclosure and response 
  • Avoid cutting across the role of representative bodies such as the AOP – for instance, when contacting a registrant about an investigation, the GOC should ensure they are aware of their right to representation and support 
  • Are consistent with the principles of good regulation

From the AOP’s own perspective, as the representative body for the large majority of registrant optometrists, many owners and managers of registrant businesses, and some registrant dispensing opticians, we would expect excellent customer service from the GOC to include:

  • Ensuring effective communication with both the AOP and the registrant where the GOC is aware that the AOP is instructed In fitness to practise cases
  • Resolving complaints which are vexatious, trivial or outside the GOC’s remit at the earliest possible opportunity 
  • Avoiding short notice changes to hearing arrangements which cause us unnecessary costs
  • Inviting our input on proposals for changes to the GOC’s policies and operations at the earliest possible stage, including informally where appropriate
  • Giving due weight to the representations we make on behalf of our members, which reflect  member input from our expert committees, our elected Council, and our wider membership via our own consultation channels 
  • Providing clear and timely feedback on how our input has been taken into account in the GOC’s decisions

We suggest that the GOC reconsiders some of the wording in its draft vision statement, to ensure it is as clear and accurate as possible. In particular:

  • The term “world class regulation” implies an intention to benchmark the GOC’s performance against international comparators. We doubt that would be meaningful, and do not think the costs involved (which would be funded by our members and other registrants) could be justified. It would be simpler and more appropriate to talk about providing “excellent” or “high quality” regulation which fully meets the standards  of the Professional Standards Authority
  • While the term “customer service” is positive in emphasising that the GOC sees the need to provide a good service to those it deals with, it reads a little oddly in the context of regulation, given that the GOC has significant regulatory and sanctioning powers over its registrant “customers”. It may be clearer – and less likely to generate false perceptions that the GOC is too close to those it regulates – if the vision statement talked about providing excellent service to the public, registrants and other stakeholders  

6.  Thinking about our five values, what types of behaviour or actions would you like to see the GOC demonstrate to meet these values? Please give examples where possible.

We consider three of the five values listed in the draft strategic plan – integrity, respect for others, and behaving fairly – as inherent requirements for any regulator or public body, rather than values that are aspirational or a matter of choice. We already expect the GOC to demonstrate all these characteristics in all its dealings with registrants and other stakeholders, and to take very seriously any stakeholder concern that it has failed to demonstrate them. For that reason, we think the “our values” section of the strategic plan should commit the GOC to comply with, rather than “aspire to”, the Nolan principles of public life.

We welcome the GOC’s inclusion of empathy in its proposed set of values. We would like to see this reflected in the way the GOC treats registrants, patients and others in its fitness to practise casework and its other activities – for instance by minimising avoidable burdens and stress, as outlined in our response to question 5.

We also welcome the GOC’s commitment to pursue excellence, provided this ambition is pursued in a proportionate and cost-effective way – bearing in mind that registrants fund the GOC’s activities. We suggest that the GOC Council should monitor how the GOC is performing against this aim as a routine part of its scrutiny and oversight of the GOC’s operational and policy work.   

Given the range of external factors that are likely to affect the optical professions during the lifetime of this plan (as discussed in our response to question 8 below), the GOC may wish to consider adopting an additional value about being agile and responsive to change.

7.  To what extent do you agree or disagree that our mission, vision and values are clear?

[strongly disagree/disagree/neither agree nor disagree/agree/strongly agree]

Disagree. We think the mission statement needs to be changed for clarity and to avoid unintended consequences, as set out in our response to question 4. The vision and values are clearer than the mission statement, but we have suggested some changes in our responses to questions 5 and 6.

8.  Are there any other external influences that might affect our work?

Yes. As a general point, we are not sure it is necessary to include a comprehensive list of external influences in the strategic plan. There is nothing we disagree with in the current list, but some of the factors discussed need more detail in order to be meaningful. 

For instance, the discussion of an ageing population and new treatments does not point out that the optical professions regulated by the GOC can help to address capacity issues in ophthalmology, or flag the challenges involved in them doing so, which potentially include greater levels of clinical risk. 

Similarly, the section on technological development refers to OCT, remote consultations and artificial intelligence (AI) but does not draw out their implications. At present the limitations of technology mean that informed professionals will often choose to override its findings in their diagnostic decision making. As the algorithms and data sets underpinning technology become more effective, professionals – and their educators, their insurers and the GOC as their regulator – will need to develop and maintain a clear understanding of what technology can do, what its limitations are and when it is appropriate for professionals to override it.     

One important factor not included in the current list is the commercial environment of the optical practices in which most primary eye healthcare is provided in the UK. This can raise significant contextual risks for the work of GOC registrants, as recognised in the GOC’s 2019 risk research and in the new standards for registered optical businesses. Optical practices are also subject to changes that could have a significant impact on registrants’ clinical practice, including growing cost pressures, various workforce issues, the introduction of new technology, a rise in competition from online suppliers of optical appliances, and potential structural changes such as mergers, acquisitions and business failures.   

Another key external factor is the influence of the NHS over the work of the optical professions, via its funding for GOS and extended services, and its associated regulation of contractor performance. Political factors naturally affect NHS funding, and in turn have an impact on the optical professions. Given the long timescale covered by the strategic plan, there will be elections in every part of the UK before the end of the plan, so there is a great deal of scope for political developments to affect the work of the optical professions. It may also be helpful for the strategic plan to spell out here the need for the GOC’s work to reflect the way in which the roles of the optical professions are evolving in each part of the UK.

A third important factor missing from the current list is the role of education providers, including universities, assessment providers such as the College of Optometrists and ABDO College, employers as providers of workplace-based learning and supervision, and CET providers including the AOP. As the GOC has recognised in its recent work on the Education Strategic Review (ESR), these organisations are crucial to the ongoing provision of optical professional education. They also face their own pressures which could have a significant impact on the delivery of the ESR, and therefore on the optical professions – and ultimately on patient safety and public confidence.  

9.  To what extent do you agree or disagree with our three strategic objectives: world class regulatory practice; improved customer service; and continuous improvement?

[strongly disagree/disagree/neither agree nor disagree/agree/strongly agree]

Agree. Subject to the wording points in our response to question 5, we think these objectives are sensible as a way of putting the mission and vision statements in the plan into action. 

Given the long timescale covered by the plan, we support the proposed approach of evaluating progress against the plan and considering whether these priorities need to be revised to reflect developments. In view of the wide range of external factors that can affect the work of the optical professions and the GOC, we suggest that this evaluation should take place at least every two years during the life of the plan, rather than after three years as currently proposed.

10.  To what extent do you agree or disagree with our aims under each of the three strategic objectives?

World class regulatory practice

[strongly disagree/disagree/neither agree nor disagree/agree/strongly agree]

Agree. We think the aims identified in the draft plan capture the main priorities for the near future, subject to our comments below and to two additional aims which we propose in our response to question 11, relating to illegal practice and supporting registrants’ development.  

On the aim of reforming business regulation, the plan says the GOC will consider the merit of seeking new powers, including inspection powers in line with other professional regulators. Any case for new powers must be consistent with the principles of good regulation – and so be proportionate, targeted, transparent and accountable. New regulatory powers or procedures should only be introduced if their benefits, in terms of patient safety and public confidence, justify the costs involved, and if regulatory burdens are kept to the minimum necessary. 

It will be particularly important to consider how any new powers would mesh with the roles and responsibilities of other regulators and the NHS, particularly since over the lifetime of the plan the optical professions are likely to be increasingly involved in multi-disciplinary working in a wide range of clinical settings.   

On the aim of revising the standards for individual practitioners, it may be unhelpful for the strategic plan to talk about “taking opportunities to harmonise standards across the different healthcare professions”, since this could lead to unnecessary complexity which would reduce the clarity and effectiveness of the standards. It would be more realistic and appropriate to talk about ensuring that the standards take account of the different settings in which practitioners work, including multi-disciplinary settings.  

On the aim of implementing the ESR, it would be helpful to refer to the need for the GOC to maintain required standards of quality assurance across all programmes, old and new, during the transition period. The importance of this has been highlighted by recent events at the University of Portsmouth. The GOC should also aim to ensure that students and prospective students have clear and helpful information about what the ESR changes mean.

Improved customer service

[strongly disagree/disagree/neither agree nor disagree/agree/strongly agree]

Agree. We particularly welcome the commitment to address the long-standing issues with the GOC’s fitness to practise processes. As the leading provider of support to registrant optometrists involved in GOC fitness to practise cases, we look forward to being consulted and engaged in the GOC’s plans so that we can help to ensure they are successful. 

We also welcome the intention to develop a learning culture and feed back lessons from regulatory work to practitioners and their representative bodies. 

The draft strategic plan talks about “developing our relationships with internal and external stakeholders and working in partnership with specialist organisations”. In this context we are not clear what the GOC regards as “internal” stakeholders or “specialist” organisations, and this should be clarified. 

Continuous improvement

[strongly disagree/disagree/neither agree nor disagree/agree/strongly agree]

Agree. Given the challenges the GOC has sometimes faced in delivering on its ambitious plans for change in recent years, it is vital that the aims of the strategic plan are realistic and proportionate to the GOC’s resources. We welcome the GOC’s intention to maximise value for money and resource new work without seeking more funding from registrants. 

However, we would like to see the strategic plan go further and commit to seeking to deliver the GOC’s objectives in as cost-effective a way as possible. This should include ongoing consideration of the level of risk that registrants’ work poses to patients and the public, what level of regulatory activity is needed to manage that risk, and how regulation can be best and most cost-effectively delivered. 

On a drafting point, the strategic plan says “we will complete the investment in our IT infrastructure” but IT investment is never completed. It may be better to talk about completing the current plans for investment and then continuing with planned maintenance and capital investment as needed.   

11.  Are there any other aims you think we should consider including under our strategic objectives?

Illegal practice

As noted in our response to question 10, we think the “world class regulatory practice” objective should include an additional aim relating to illegal practice.

The AOP’s position statement on illegal practice says the GOC should do more to protect patients and the public against illegal practice, and particularly the online sale of contact lenses by suppliers registered overseas who don’t comply with UK legal requirements. The GOC’s own past research1 has identified the online supply of contact lenses as an area of heightened risk.  

We appreciate the practical challenges in enforcing UK law against overseas suppliers. But we are concerned that when UK patients buy contact lenses from websites which appear to be based in the UK and are clearly aimed at the UK market, they may reasonably assume that the vendor is subject to UK legal requirements and GOC regulation, when in fact it is not. 

We have therefore called for the GOC:

  • To amend its protocol for investigating criminal offences, to enable it to investigate complaints about suspected illegal practice where the supplier is based abroad 
  • To publish information for the public about the benefits of sourcing contact lenses from suppliers that comply with UK legal requirements

The GOC has indicated in recent discussions that it is willing to consider further steps in this area. We think this is an important area of work which should be included in the strategic plan.

Supporting registrants’ development

Given the scale of change facing the optical professions over the lifetime of the plan, we also suggest the plan should include a specific aim of ensuring that the GOC’s work: 

  • supports registrants in developing their clinical roles and working in multi-disciplinary settings, and 
  • does not create avoidable barriers to registrants developing their roles and expanding their scope of practice 

Several of the aims under the “world-class regulatory practice” objective already refer to the need for flexibility and multi-disciplinary working, but we think this is such an important issue for the profession that it should be stated and evaluated as an aim in its own right.

12.  How can we better involve patients/public in our work?

We recognise that it can be difficult to achieve meaningful patient and public engagement in regulatory work. The way in which this is done, and the amount of effort devoted to it, needs to be considered on a case by case basis. 

The “our values” section of the draft strategic plan refers to the interests of the general public and to the Nolan principle of openness, but does not include any specific commitment to seek the views of patients and the public on the GOC’s work where appropriate. It may be helpful to add this to the plan, so that it is borne in mind when evaluating the GOC’s performance against the plan. 

13.  To what extent do you agree or disagree with our measures for success?

[strongly disagree/disagree/neither agree nor disagree/agree/strongly agree]

Agree. The success measures listed in the draft strategic plan are reasonable. We welcome the commitment to develop a robust baseline for customer satisfaction with the GOC, and to measure the confidence of the optical professions via surveys.

14.  Is there anything else you think we should include?

The success measures in the plan are inherently high-level, and will not provide detailed feedback on how the GOC has performed against the key aims set out in the plan. We therefore suggest that when evaluating the GOC’s performance against the plan, the GOC Council should also review more in-depth qualitative and (where relevant) quantitative assessments of how well the key aims set out in the plan have been delivered, drawing on stakeholder consultation as well as on hard evidence such as data on the speed of resolution of fitness to practise cases. 

15.  How can we better promote equality, diversity and inclusion in our work?

We welcome the integration of the GOC’s EDI strategy with the overall strategic plan, and the commitment to ensure that all projects have an EDI strand and consider EDI issues from the outset. Where the GOC plans to engage with EDI issues in eye healthcare provision, as in the proposal to “raise awareness among customers with disabilities of what they can reasonably expect from their eye-care provider”, it is vital that it consults thoroughly with registrants, representative bodies and others with an interest or involvement, including the NHS. 

16.  Do you have any further comments on anything in our draft strategic plan?

No.

 

January 2020

Notes

  1. ‘Health Risk Assessment of Illegal Optical Practice – final report for the General Optical Council’, Europe Economics, August 2013, pages 39-41