Response to the GOC consultation on guidance on speaking up

Our response to the consultation, March 2021

A man on the phone

The consultation

This is our response to the GOC consultation on Speaking Up. The consultation ran from December 2020 to March 2021.

Our response

Clarity of draft guidance

Q1. Is the guidance presented in a way that is clear, accessible and easy to use?

It is fairly clearly written, but there are some places where the language is not clear. We have provided the GOC with an annotated copy of the draft guidance highlighting suggested drafting changes to address this.

Clarity could also be improved by some re-ordering of the content. For example paragraphs 14-16 could usefully be moved to the introduction, which would allow Part 1 to focus more on the actions registrants should consider. Paragraph 17 could be deleted altogether. Paragraph 21 could come straight after paragraph 18. At the moment the draft shifts between background information and process. For example Section E, on protected disclosures, should be earlier in the document, possibly in the introduction, because it describes the legal background.

More fundamentally, we don’t think that the guidance describes a clear pathway for registrants to know what to do if they see something that they think might be putting patients at risk. By that we mean that there needs to be a clear pathway about what to do, in what order. There is no harm in making this very clear in a list such as:

  • Raise “at source” with the colleague concerned
  • Discussion with store manager
  • Elevation to head office
  • Escalation to General Optical Council

It should also include advice on how to best document your concern, and the complaints process.

We think that diagrams or flowcharts would help in making the guidance clearer for registrants.

Q2. Would the guidance give you more confidence in knowing what to do if you encounter a patient/public safety concern?

The duty to speak up is explained well. This could help registrants feel more confident in knowing what they should do.

Paragraph 19 should include a mention that a patient safety concern could arise from a lack of action, such as a failure to send a referral that the optometrist has initiated, as well as from actions.

We are also conscious that when members have a concern they may not immediately know how to define it, or distinguish a patient safety concern from a grievance or poor relationships within a practice that have not affected patients (but potentially could). We believe it is the role of representative bodies to help their members through that thinking, but it might be valuable for the GOC guidance to recognise that this confusion might exist at the outset of a registrant’s thinking about the issue they have identified.

Q3. Would the guidance give you confidence to speak up if you identify patient safety concerns?

Guidance alone cannot give confidence. What gives confidence is knowing that you will be taken seriously and supported and, conversely, won’t be victimised or ignored. This cannot be assured by a document alone.

The document does recognise that speaking up can be daunting, but we wonder if the GOC understands the level of anxiety that it invokes. One of our members put it like this:

"There are various legal protections in place for employees who whistleblow against employers. There is also the opportunity to follow up on a clinical complaint as you are there at all times. 

As a locum optometrist, I would be terrified that I would (for lack of a better phrase) become unemployable. No practise manager/owner is going to bring in a locum who is a known ‘trouble maker’. Why would they want to risk bringing in a locum who will raise a clinical complaint?

It is a hard area to legislate for (ie being a contractor, not an employee), but seeing as nearly 3rd of optometrists now work as locums, this is very important."

It will always be difficult for the GOC to balance the need to encourage speaking up on the one hand, and its over-riding objective of protecting the public on the other. Registrants understand that the GOC’s primary responsibility is to the public and many will be deterred from speaking up if they think the route to do it is the GOC, especially if there is potential for them to be deemed culpable in the act or omission that they are now speaking up about. This should be addressed in the section on the GOC Speaking Up Team (paragraphs 41 and 42) It would be better for the GOC’s guidance to encourage people to contact their representative body before the GOC if they have a concern or want to speak up.

It is necessary to give clear guidance on when speaking up is and isn’t protected by law (eg in para 49) but of course this may in itself deter speaking up. This is another reason why it would be better for the GOC to steer people to seek advice from their representative body.

We expect that any AOP member who was thinking about taking such a difficult step will want to ask our advice and seek our support. We note that professional/representative bodies are mentioned in paragraph 9, but we think they should be mentioned again/more often, for example in paragraphs 23 and 38. Another example is section G, where professional/representative bodies are currently listed in the fourth paragraph. We think that paragraph should be first in that section.

Q4. Is anything missing, incorrect or unclear in the guidance?

We haven’t identified any inaccuracy. We do think, as above, that there ought to be greater prominence given to the other sources of advice and support available to registrants, such as AOP.

We do think that the guidance underplays or discourages sharing concerns publicly. Not that we would recommend going public before other routes have been exhausted, but we feel that the GOC could do more to reinforce the principle of a public interest disclosure and the fact that such a disclosure may have to be made outside the “normal” channels of one’s own organisation.

We also think that the guidance is unbalanced between the material aimed at employers and the material aimed at employees, not just in terms of the amount of guidance but also the type of guidance. As a particular example we would draw your attention to paragraph 68 where the GOC effectively gives employment advice to businesses if they suspect an employee is being disingenuous. There is no similar advice given to employees. We think this section should be removed, unless an equivalent section is written for employees.

Q5. Is the guidance sufficiently flexible to accommodate differences in policy and practice across the nations of the UK?

No. The term “speaking up” is used in England but not in the other UK nations. The guidance needs to make that clear in paragraph 4 and to include the relevant terminology for the other nations. It also needs to be made clear that the National Guardian’s Office only covers England.

Impact of draft guidance

Q1. Do you think the guidance will help to protect patient and public safety?

It’s very hard to predict the effect, although one could assume it won’t act against safety.

Q2. Are there any specific issues or barriers which might prevent registrants from using the guidance?

As discussed above, people’s confidence in using the guidance will depend largely on how supported they feel in speaking up. Most registrants understandably do not think of the GOC as primarily there to support them. This fact could prevent them from using the guidance or even from speaking up. It will be important for other sector bodies to offer their members guidance and support on speaking up and related issues.

Q3. Are there any aspects of the guidance that could have an adverse or negative impact on patients and the public, individual registrants, businesses or others?

If the guidance does not build confidence in speaking up, as we suggest, then this could have a negative effect on patients.

Q4. Are there any aspects of the guidance that could discriminate against stakeholders with specific characteristics? (Please consider age, sex, race, religion or belief, disability, sexual orientation, gender reassignment, pregnancy or maternity, caring responsibilities or any other characteristics)


Q5. Overall, do you expect that the guidance will have a positive impact on: patients and the public; individual registrants; businesses or others?

The guidance should have at least some positive impact, particularly if it increases knowledge among registrants. However, as we have said, we do not think it will make registrants confident to speak up to the GOC, and so that impact could be limited.

Support for speaking up

Q1. Would any specific supporting activities be beneficial to registrants in implementing the guidance?

The GOC (rightly) won’t seem to registrants like the right channel to use for initial advice and support with regards to speaking up. The GOC should encourage registrants to seek advice and support from their membership bodies and from their LOCs/ROCs etc.

Q2. Is there anything further we could do to promote speaking up and a culture of openness and honesty within optical care?

The GOC could publish case studies alongside the guidance, showing how speaking up can benefit patient care, and that it does not involve negative consequences for the person who spoke up.