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Our response to the GOC consultation on standards

Our response to the consultation, June 2024

Optometrist with patient at practice

Executive summary

The GOC consultation on their revision to the standards for optometrists and dispensing optician and standards for students concluded on 8 May. To inform and guide our response, we drew upon the expertise the AOP clinical, legal and policy teams, and reached out to the wider membership for their views. In addition, we engaged with the other sector bodies to coordinate a unified voice on the key points.

The revisions to the standards were very much focussed on incorporating key principles from the Equality Act, with further emphasis on caring for patients with vulnerabilities to ensure that mode of practice is accessible to all who need it.

In addition, they have expanded the section “Your role as a professional” with a greater emphasis on leadership and professionalism. We agreed with general tone and principles of the revisions, welcoming the focus on caring for all patients, no matter what their needs.

However, we did assert to the GOC that registrants must be fully enabled to demonstrate these skills, attributes and behaviours that help them to provide optimum eyecare to all.

To this end, we suggested additional guidance and clearer wording on many of the revised standards to ensure that practitioners fully understand their responsibilities and positioning to be able to comply.

Proposed changes to the standards

Changes to the standards fall in the following key areas:

  • Leadership and professionalism
  • Care of patients in vulnerable circumstances
  • Effective communication
  • Use of digital technologies, including AI*
  • Supervision and delegation
  • Equality, diversity, and inclusion
  • Social media, online conduct, and consent
  • Maintaining appropriate professional boundaries
  • Registrant health
  • A small number of minor changes.

How the GOC refer to standards

The GOC states:

“Throughout this document we will refer to specific standards that have been revised using the standard number, for example, standard 6.1. We recognise that the numbering in the Standards of Practice for Optometrists and Dispensing Opticians differs from the numbering within the Standards for Optical Students.

“To address this, we refer to the number within the Standards of Practice for Optometrists and Dispensing Opticians first, and then the number within the Standards for Optical Students in brackets afterwards. For example, we have proposed a revision to standard 6.1 (5.1).

“When referring to the Standards for Optical Businesses we will simply refer to the relevant standard, for example, standard 1.1.4. *For the purposes of this document, where we refer to ‘digital technology’ or ‘digital technologies’, this includes AI.

Our response

2.1 General questions

Q1. Do you think there should be any difference in our expectations of students and fully qualified registrants?

AOP response: Yes

On a fundamental level, the standards harbour an assumption that student registrants understand what it means to be “professional”. Grasping the concept of being a professional is often only afforded following a level of lived experience in working for an organisation or in operating a direct business. As such, we are concerned that the student registrants may be set up to fail – particularly around the “Your Role as a Professional” section. We suggest that a softening of the language be used in the students’ standards to better reflect the role of the supervisors in terms of their essential role as mentor in the initial stages of training.

Additionally, we wish to note that many other regulators do not have students as registrants at all. While it can and does provide an advantage for a small number of students when FTP issues arise, we feel that this should kept open for wider debate. Especially considering that optometry is a comparatively low-risk health profession.

Q2. Do you think any of the proposed changes could affect any individuals or groups with one or more of the protected characteristics defined in the Equality Act 2010?

AOP response: No

Q3. Do you think any of the proposed changes could affect any other individuals or groups, either positively or negatively?

AOP response: No

Q7. Is there anything else you think we should consider as part of the proposed changes

AOP response:

Our general opinion is that most of the proposed revisions to the existing standards are uncontentious. They mainly serve as a welcome culturally sensitive update to both patient needs, and to wider principles of Equality, Diversity and Inclusion (EDI). There is a clear enhancement of a professionals’ duty to care for more vulnerable patients and to ensure that mode of practice is accessible to all who need it.

Further comment on small suggestions to definitions, clarity of wording and finer detail of interpretation are featured in the subsequent sections of this survey.

Q8. Do you think there should be a short implementation period after the new standards are published and before they come into effect?

The purpose of an implementation period would be to give registrants time to adapt, to adjust their conduct and enable stakeholders to review the standards and make any necessary amendments to practice, policy, guidance, or training material.

Please explain your reasoning. If you consider a short implementation period is necessary, please say how long this should be for, and why.

AOP response:

As most revisions are light touch enough that they do not require any substantial systemic adjustments, we are not certain that an implementation period is necessary. Perhaps rather than a formal implementation period, you could publish the revised standards, and schedule them to take effect three months following that date?

2.2 Leadership and professionalism

Background: Our Standards for Optical Businesses set expectations around the leadership and management of businesses themselves, but not for the registrants working within the business, which creates a gap. Other healthcare regulators have produced guidance for leaders and managers, as well as standards on leadership, regardless of role. 

We received feedback through our stakeholder conversations that the existing Standards of Practice for Optometrists and Dispensing Opticians, and the Standards for Optical Students, do include skills, attributes and behaviours associated with leadership, but that registrants may not recognise them as being “leadership” skills, attributes, and behaviours.

Stakeholders were of the view that expectations around leadership should also apply to optical students. We also heard views that leadership skills should include supporting the next generation of optical professionals.

We heard about the challenges in differentiating between leadership and professionalism. Stakeholders broadly agreed that professionalism relates to ‘internal’ behaviours, whereas leadership relates to ‘external’ behaviours.

Stakeholders advised that they were content with leadership skills, attributes and behaviours being interwoven throughout the Standards of Practice for Optometrists and Dispensing Opticians, and the Standards for Optical Students, however, we need to be more explicit about our expectations.

Proposed amendments: We believe that it is important for all registrants - students and fully qualified - to demonstrate leadership skills, attributes, and behaviours in their practice. Demonstrating leadership means demonstrating skills, attributes and behaviours that are essential to protect the public, such as speaking up in situations where something has gone wrong, as well as role modelling professional behaviours.

To address the issues discussed at paragraph 30 and feedback at paragraphs 31 to 34, we have proposed that a statement is added to the introductory text of the Standards of Practice for Optometrists and Dispensing Opticians, and the Standards for Optical Students. The statement would make clear that all registrants are expected to demonstrate leadership skills, attributes, and behaviours relevant to their scope of practice, and that leadership skills should be applied to all aspects of a registrant’s work. We have given some non-exhaustive examples of when registrants can demonstrate leadership.

We recognise that business owners and employers have a role in creating a culture and environment in which registrants feel comfortable to “step up” and lead. The scope of this review is to make changes to the standards for individuals, with consequential changes made to the business standards. We believe that a change to the Standards for Optical Businesses on this point would be a substantive change, therefore we will seek to address this issue when we undertake a full review of those standards.

This is a new proposed statement to be added to the introductory wording under the heading ‘Your role as a professional’, Standards of Practice for Optometrists and Dispensing Opticians:

This is a new proposed statement to be added to the introductory wording under the heading ‘Your role as a professional’, Standards for Optical Students:

Q9. To what extent do you agree that the addition to the introduction on leadership is clear?

AOP response: Somewhat agree

As a principle, there is no quibble with embedding the concept of leadership into everyday practice, but there is potential for ambiguity without clear elaboration on the traits and attributes of leadership.

See our response to Q1 which outlays our concerns around the expectation of students to adhere to the same standards around professionalism and leadership. We would urge that specific learning outcomes around the whole concept of professionalism are prioritised for students, and that some advance provision is made for standards that are relevant to the introduction of the Clinical Learning in Practice (CLiP) scheme.

Q10. To what extent do you agree that the addition to the introduction on leadership sets appropriate minimum expectations of registrants?

AOP response:

Somewhat agree - See answer above, the behavioural traits around leadership may need to be more explicitly conveyed.

2.3 Care of patients in vulnerable circumstances

The GOC state:

“Registrants are likely to interact with patients in vulnerable circumstances regularly as part of their practice. Vulnerability should not be restricted to considerations such as ill health or disability and nor does a person’s level of vulnerability remain the same in all contexts. We can all be vulnerable at different points in our life, perhaps because we are in a moment of crisis or because we are handling a difficult set of life circumstances. Inherent features of markets and the actions of providers can also contribute to vulnerability.

“In our latest public perceptions research, 7.9 per cent of ethnic minority respondents had never had their sight tested compared to 2.6 per cent of white respondents. The data also suggests ethnic minority respondents are more likely to feel uncomfortable when visiting an opticians / optometrist practice than white respondents. The survey data indicates other markers of vulnerability, for example, respondents with a disability are less satisfied with the service they receive – this was also the case in the previous year’s data.

“The patient and public research commissioned to support the review of standards highlighted the importance of registrants maintaining appropriate boundaries, to avoid putting patients in a vulnerable position. The research also found that vulnerable respondents did not generally view online consultations favourably, as the nature of their health conditions meant that personal interactions made them feel more comfortable.

“Proposed amendments: As registrants are likely to interact with patients in vulnerable circumstances regularly as part of their practice, it is vital that they can identify, support and treat these patients appropriately. Other regulators have developed their thinking on vulnerability, and it is important that we update our standards to follow best practice in this area.

“We have proposed a statement to be added to the introductory text of the Standards of Practice for Optometrists and Dispensing Opticians, and the Standards for Optical Students. The statement sets out our interpretation of ‘vulnerability’, and our overarching expectations of registrants when providing care to patients in vulnerable circumstances. Vulnerability can be visible or non-visible and relate to clinical and non-clinical factors. We expect registrants to be aware of the possibility that people may be vulnerable for a number of reasons, including difficult life events. Whereas we would expect registrants to proactively seek to identify relevant clinical factors, we recognise that not all patients will feel comfortable sharing other types of information and that signs of vulnerability may be less easy to spot. The statement therefore says that registrants should consider vulnerabilities as part of each consultation and our interpretation of the statement in practice will consider all these factors.

“This is a new proposed statement to be added to the introductory wording under the heading ‘Making the care of your patients your first and overriding concern’. This proposed statement will be added to both the Standards of Practice for Optometrists and Dispensing Opticians and the Standards for Optical Students:

“To further support this and address points raised in the patient and public research at paragraph 40, we have proposed revisions to standards 7.1 (6.1), 13.8 (12.6), 15.1 (14.1), and 15.2 (14.2) to include reference to ‘patients in vulnerable circumstances’. These revisions would require registrants to take account of a patient’s vulnerabilities when conducting an adequate clinical assessment, to respond to the needs of patients in vulnerable circumstances and adapt their practice accordingly. It will also remind them of the importance of maintaining appropriate boundaries and not using their position to influence patients or the public in vulnerable circumstances. 

Proposed revision to standard 7.1 (6.1):

Proposed revision to standard 13.8 (12.6):

Proposed revision to standards 15.1 (14.1), and 15.2 (14.2):

Q11. To what extent do you agree that the addition to the introduction on providing care for patients in vulnerable circumstances is clear?

AOP response: Somewhat agree

Potentially, there is some degree of ambiguity for practitioners that could arise with the prevalence of the term “vulnerable” which is used throughout the revised standards. The Office for Health Improvements and Disparities (OHID), defines the term ‘vulnerable’ as being ‘in need of special care, support, or protection because of age, disability, risk of abuse or neglect.’ However, there are further definitions dependent on whether a patient is a child or an adult as well as risk of vulnerability. We feel that the changes are a positive step towards being more inclusive for patients who may need extra care - ensuring that optometry is accessible to all. Further, the proposals offer clearer guidance for how to operate humanely and safely within the confines of the Equality Act.

The GOC taking these positive steps to protect registrants in accommodating all their patients, whatever their needs, is welcome. However, the concept of vulnerability as it relates to humans is often subjective (except maybe in more extreme circumstances). People may not identify with other people’s opinions on their own level of vulnerability, either to the positive or the negative and this may cause a practitioner to inadvertently cause offence. For example, the professional assuming a person is vulnerable and acting accordingly when they do not view themselves as such.

When considering protected characteristics and unconscious bias, the potential for assumptions could be litigiously dangerous. We appreciate that the standards do try to spell out what is meant by “vulnerable” and who could potentially fall into that category, but this could be strengthened by directly referencing standard 13.2. Further, we suggest offering more training for practitioners to build their confidence in recognising patients who are considered vulnerable. Also, an additional line to the newly suggested standard on adherence to legal responsibility that includes the protected characteristics of the Equality Act could be helpful for even more clarity.

In this same context, while the standard itself is not up for express review - we do have some concerns around the second sentence in standard 13.3 “Ensure that your own religious, moral, political or personal beliefs and values do not prejudice patients’ care. If these prevent you from providing a service, ensure that you refer patients to other appropriate providers”. As written, this standard suggests that prejudice is acceptable as long as the practitioner recommends an alternative practitioner – contravening the core EDI ethos. As in other areas of the proposed revisions, we would urge guidance for registrants in this area to provide clarity.

Additionally, for standard 7.1, the term “adequate assessment” is open to differing interpretation and should be elaborated on in guidance materials.

Q12. To what extent do you agree that the addition to the introduction on providing care for patients in vulnerable circumstances sets appropriate minimum expectations of registrants?

AOP response: Somewhat agree

Q13. To what extent do you agree that the revised standards are clear

AOP response: Somewhat agree

Q14. To what extent do you agree that the revised standards set appropriate minimum expectations of registrants?

AOP response: Somewhat agree

2.3 Effective communication

The GOC state:

“The proposed changes in this section cover three different aspects of effective communication: making patients aware of who is providing their care; helping patients understand options available to them including declining treatment; and communications relating to use of digital technologies.

“In relation to the first aspect, our stakeholder research, our research on refraction, and our standards queries, suggest that patients may be unaware of the different staff roles within optical practices, and don’t always know who is providing their care.

“The joint regulatory statement titled High level principles for good practice in remote consultations and prescribing sets out the following key principle, “Tell patients their name, role and (if online) professional registration details, establish a dialogue and make sure the patient understands how the remote consultation is going to work.”

“Our patient and public research found, “Respondents felt that effective communication included letting patients know when the optometrist completing a patient’s eye examinations would be a student or when a task had been delegated to another role.”

“In relation to the second aspect, the High level principles for good practice in remote consultations and prescribing set out another key principle which we see merit in replicating in the standards: “Give patients information about all the options available to them, including declining treatment, in a way they can understand.” We heard through our stakeholder conversations that increased use of digital technologies could result in registrants identifying disease at an earlier stage, including non-eye related diseases. Therefore, registrants are more likely to need to effectively communicate a range of clinical outcomes, to their patients, which could include bad news about a non-eye related disease.

49. In relation to the third aspect, we heard through our stakeholder conversations that registrants should be able to understand and communicate the potential benefits and risks associated with the use of digital technologies, to allow patients to make informed decisions about their care.

Proposed amendments: It is important that registrants can communicate effectively and empathetically with their patients, so that patients can give their informed consent, understand their treatment, and play an active role in maintaining their eye health.

To address the issues discussed at paragraphs 45 to 47, we have proposed an amendment to standard 2.2 that would require registrants to identify themselves and their role and advise patients who will be involved in providing their care.

Proposed revision to standard 2.2, Standards of Practice for Optometrists and Dispensing Opticians and Standards for Optical Students:

“To address the issues discussed at paragraphs 48 and 49, we have proposed an amendment to standard 7.6 (6.6) that mirrors the wording from the ‘High level principles for good practice in remote consultations and prescribing’ around giving patients information about all the options available to them, including declining treatment, in a way they can understand.

Proposed revision to standard 7.6 (6.6)

”We have also proposed an amendment to standard 4.2 that reminds registrants of the need to demonstrate humanity and kindness when communicating bad news.

Proposed revision to standard 4.2, Standards of Practice for Optometrists and Dispensing Opticians and Standards for Optical Students:

Q15. To what extent do you agree that the revised standards are clear?

AOP response: Strongly agree

Q16. To what extent do you agree that the revised standards set appropriate minimum expectations of registrants?

AOP response: Strongly agree

2.4 Use of digital technologies including artificial intelligence (AI)

The GOC state:

“Digital technologies are increasingly central to the delivery of patient care and assessment of clinical conditions. We recognise that many digital technologies are classified as medical devices and are therefore regulated by the Medicines and Healthcare products Regulatory Agency (MHRA).

“Registrants must be able to apply their professional judgement to all aspects of their practice. Our role is to set standards in relation to the safe and effective use of digital technologies by registrants. They need to be competent in the use of digital technologies, understand their limitations and exercise professional judgement, for example, when interpreting data.

“Digital technologies are one form of innovation in optical care. We focussed on digital technologies because we believe that this is where change creates a need to revise our standards.

“We heard that stakeholders are generally positive about the benefits that digital technologies could offer in terms of delivering patient care. However, there is a need to ensure that registrants can understand and use digital technologies safely and effectively.

“Digital technologies are usually developed for specific purposes and are developed using data sets which may not be representative of the population. Registrants need to be aware of the limitations of digital technologies and apply their professional judgement, for example, when using data to inform decision-making.

“We also heard about the important role that employers and business owners play in ensuring that digital technologies are procured, implemented and maintained appropriately, and that staff are suitably trained in their use.

“Our patient and public research highlighted that patients expect registrants to be able to “step in” if machines break down, to offer patients a similar standard of care without relying on machines. It is likely that they would expect the same when registrants use digital technologies. The research also found that patients and the public felt that the standards may need adapting or extending, to explicitly cover the use of digital technology or remote consultations.

Proposed amendments: Our starting point is to support responsible innovation while protecting patients. Our standards must support registrants to use digital technologies effectively to support effective patient care. This includes not just understanding digital technology and its uses, but also being able to help patients to understand how digital technologies will be used when providing their care.

“Standard 5.1 already requires registrants to be competent in all aspects of work, including their clinical practice. This would include the need to be competent in the use of digital technologies, appropriate to their scope of practice.

“However, we believe it is important to address the concerns that registrants stay up to date with digital technologies and aware of their benefits and limitations. In response to the stakeholder feedback at paragraph 57 and feedback from the patient and public research at paragraph 60, we have proposed a revision to standard 5.3, to set clear expectations around keeping up to date with digital developments, to inform the care provided. Note: These amendments will apply to optometrists and dispensing opticians only. The Standards for Optical Students do not have a standard titled ‘Keep your knowledge and skills up to date’ as students are learning and developing their practice.

Proposed revision to standard 5.3, Standards of Practice for Optometrists and Dispensing Opticians:

“To address the issues raised and feedback received at paragraph 58, we have proposed an additional sub-standard under standard 7 (6), to set expectations around applying professional judgement when using data generated by digital technologies, to inform decision-making.

Proposed additional sub-standard under standard 7 (6):

“In response to the feedback at paragraph 59, we recognise that the Standards for Optical Businesses could be strengthened in this area. However, the scope of this review is to make changes to the standards for individuals, with consequential changes made to the standards for businesses. We believe that a change to the business standards on this point would be a substantive change and will seek to address this when we undertake a full review of those standards.

Q17. To what extent do you agree that the revised standards are clear?

AOP response: Neither agree nor disagree

As you state, the substantive changes will be addressed in the forthcoming review of the Business Standards – so it is difficult to respond to the adequacy of these standards for the individual when the use and implementation will in many regards be made at a head office level.

Q18. To what extent do you agree that the revised standards set appropriate minimum expectations of registrants?

AOP response: Neither agree nor disagree

The use and implementation of digital technologies will in many instances be taken at a head office level and will therefore be outside of the control of individual registrants. However, where new technology is implemented, we think it is reasonable to expect registrants to maintain their competence by undertaking targeted training when it is appropriate to do so.

More widely, there are still significant basic connectivity challenges within the sector and the use of advice and guidance, either with a person, or an AI is hamstrung by these limitations. Although it cannot sit within the standards, it is our view that all registrants should have access to real-time information and be able to communicate easily and effectively with other eye care providers. Without NHS email addresses or electronic referral systems in place across all areas of the UK, many optometrists must rely on bespoke local arrangements and relationships to communicate effectively for the benefit of the patient. This lack of standardisation introduces unnecessary variation and risk.

Additionally, the duty to discuss and explain the implications of digital technologies may not be realistic as their fast pace of progress can be difficult to keep track of, in the engagement sessions we spoke of the challenge of the black box, where technology and the algorithms that underpin it may be beyond challenge for normal clinicians. We note the GOC reference to digital technologies as medical devices but reiterate our concerns in this regard. We would suggest that to attempt to tackle this, consideration should be given to guidance or learning and support hubs to aid busy clinicians in this time of significant change.

2.5 Equality, diversity, and inclusion (EDI)

The GOC state:

“We identified three key areas that we should consider for the review of our standards in relation to EDI. These are discrimination, inclusion, and equity. 

“Discrimination: The results of our 2023 registrant survey highlight that a quarter of respondents had experienced discrimination in their role at work or place of study in the last 12 months, most notably from patients, service users, their relatives, or other members of the public. Smaller but still significant proportions indicated that they had experienced discrimination from managers (11%), other colleagues (8%), or tutors/lecturers/supervisors (8%). Discrimination is more likely to be experienced by student registrants, registrants aged 35 and under, female registrants, those from ethnic minority backgrounds, and those with a disability.

“Inclusion: Inclusion is often used to mean the practice or policy of providing equal access to opportunities and resources for people who might otherwise be excluded or marginalised. People belonging to excluded or marginalised groups tend to have very poor health outcomes, often much worse than the general population, and a lower average age of death.

“Our recent public perceptions survey highlights that some groups may find it more difficult to access eye care than others. In our latest data, 7.9% of ethnic minority respondents have never had their sight tested compared to 2.6% of white respondents. When we ask about factors that make people feel uncomfortable visiting an opticians or optometrist practice, 28.6% of ethnic minority respondents cite the cost of the sight test compared to 14.8% of white respondents. While the reasons for these differences may reflect many varied factors, there may be more that the sector can do to reduce barriers to access.

“Equity of access: Access to services is discussed above, in relation to inclusion. However, in healthcare the conversation about equity touches on the need to address health inequalities, which can include reducing geographical inequalities (variations) in health outcomes and provision, as well as inequalities relating to different groups within society. Our standards do not currently touch on the issue of health inequalities directly but do require registrants to listen to their patients and modify care based on the patient’s needs (standard 1), which could include exploring and reflecting on the patient’s health history.

“Proposed amendments: Delivering safe optical care to all patients means ensuring that there are no barriers to access, and that patients are not discriminated against. It is also important that we address concerns about registrants experiencing discrimination, so that they are supported to provide safe and effective care.

“We have proposed a revision to standard 13.4 (12.4) that incorporates standard 13.6 (12.5) and makes clear that registrants should not make unnecessary or disparaging remarks about colleagues online.

Proposed revision to standard 13.4 that incorporates standard 13.6, Standards of Practice for Optometrists and Dispensing Opticians:

Proposed revision to standard 12.4 that incorporates standard 12.5, Standards for Optical Students:

“We have proposed a consequential revision to standard 2.2.5 of the Standards for Optical Businesses, to update the language used in relation to protected characteristics to align it with the Equality Act for the reasons outlined in paragraph 81.

Proposed revision to standard 2.2.5 of the Standards for Optical Businesses: “To further address the issues discussed at paragraph 76, we have proposed an additional standard under standard 3.3 of the Standards for Optical Businesses. This would require businesses to provide support for staff who have experienced discrimination, bullying and/or harassment in the workplace. We also propose that the title of the standard is updated as follows, ‘Staff are adequately supervised and supported’.

“To further address the issues discussed at paragraph 76, we have proposed an additional standard under standard 3.3 of the Standards for Optical Businesses. This would require businesses to provide support for staff who have experienced discrimination, bullying and/or harassment in the workplace. We also propose that the title of the standard is updated as follows, ‘Staff are adequately supervised and supported’.

Q19. To what extent do you agree that the revised standards are clear?

AOP response: Strongly agree

Q20. To what extent do you agree that the revised standards set appropriate minimum expectations of registrants?

AOP response: Strongly agree

Q21. To what extent do you agree that the addition to the business standard is clear?

AOP response: Strongly agree

Q22. To what extent do you agree that the addition to the business standards sets appropriate minimum expectations of business registrants?

AOP response: Strongly agree

2.6 Social media and online conduct and consent

The GOC state:

“Social media is used widely for personal and professional purposes, and while offering many benefits, may also present risks such as disclosure of confidential information (deliberately or inadvertently), boundary crossing, poor communication, and potential damage to the reputation of the profession.

“Recently we have seen a slight increase in fitness to practise cases involving social media and online conduct, and we have also received a small number of standards queries in relation to registrants and/or businesses sharing allegedly inaccurate, misleading or false information online. The issue of sharing ‘misinformation’ was also raised during a stakeholder conversation “with registrants.

Through our stakeholder conversations we heard that registrants are using social media for many purposes including but not limited to: business promotion, research, learning and development; peer to peer support; interacting with communities of practice; and sharing clinical advice. We heard that some registrants use WhatsApp groups to share information, including patients’ retinal images, for educational purposes and/or to seek peer advice and guidance. Some stakeholders felt that patient consent should be obtained before retinal images were shared, whereas other stakeholders felt it was not necessary to obtain consent if the image was anonymised.

“Feedback from the GOC’s Standards Committee questioned whether sharing retinal images via WhatsApp groups or similar was compliant with the General Data Protection Regulation (GDPR). The Committee also raised the issue of patient consent. It is our understanding that if the data is properly anonymised so that you cannot identify an individual from the image, then it would not be considered personal data and would not be subject to UK GDPR. The Standards Committee also suggested that we could include a positive duty for registrants to act where they see concerning behaviour by other registrants online. Having considered this, we feel the duty to report is adequately addressed by standard 11.3 (10.2), whilst acknowledging that further guidance could be used to make this explicit. 

“Our patient and public research highlighted that, “Respondents felt that appropriate online behaviour was particularly necessary in public professions requiring public trust, with good online conduct seen as essential for protecting the reputation of the optical professionals and their practices. Many felt there should be a clear separation between what was posted on personal and professional social media accounts.” It also found that respondents, “recognised that the degree of privacy of different platforms mattered here, with posting to a more public platform, such as Twitter, being seen as markedly different to private messages on a service like WhatsApp.”

“On the specific issue of sharing retinal images via WhatsApp, our patient and public research found that there were mixed views. “The majority felt WhatsApp was an unprofessional platform for this purpose, particularly as it would be via a mobile device. A practice’s own system or e-mail were considered more professional and secure.” In relation to patient consent the research found that, “Respondents largely felt patient consent should be obtained, to ensure they have a say. This was particularly key for those with eye conditions and vulnerable service users.” On the issue on anonymity, “There were mixed perceptions of whether this activity involved identifying information. Some felt that if the retinal image didn’t have other personal details, this was not identifying, whereas others felt the retinal image itself could be identifying.”

“Proposed amendments: In an increasingly online world, we know that registrants will use social media and engage online and that the boundaries between the private and the professional will continue to blur. Our standards must set clear expectations of registrants in this area.

“In response to feedback received at paragraphs 87 and 88, we have proposed a revision to standard 14.3 (13.2) to clarify that patient confidentiality must be maintained when sharing patient images online or via social media.

Proposed revision to standard 14.3 (13.2):

“In response to the issues raised at paragraph 86, we have proposed a revision to standard 16.6 (15.6) to clarify that registrants should not make misleading, confusing, or unlawful statements in their communications, as well as when advertising.

Proposed revision to standard 16.6 (15.6):

“In response to the patient and public feedback at paragraph 90, we have proposed a revision to standard 3.3 to clarify that patients’ consent must remain valid when sharing patient data with others.

Proposed revision to standard 3.3, Standards of Practice for Optometrists and Dispensing Opticians and Standards for Optical Students:

2.7 Other actions: We heard that stakeholders would benefit from further guidance on the use of social media and online conduct, and we will consider publishing guidance on this topic after we finish the review of our standards for individuals.

Q23. To what extent do you agree the revised standards are clear?

AOP response: Somewhat disagree

The standard as drafted could lead to confusion, as it appears to conflate the consent process and the data sharing process. Generally, within healthcare, processing of patient data will be conducted under the remit of “legitimate interest” or as special category data with regard to health and social care or public health. It is our view that if this standard is to include data-sharing then it should make it clear that consent only applies when you wish to share the data for reasons other than in relation to the patient’s care. It should also only apply where data is defined as personal data, and we would draw attention to the ICO definition in that regard.

We agree that patient confidentiality must be maintained when sharing patient images online or via social media and welcome the suggestion of further GOC guidance to help registrants understand what is safe.

Q24. To what extent do you agree that the revised standards set appropriate minimum expectations of registrants?

AOP response: Somewhat agree

With the clarifications as suggested above and with subsequent GOC guidance, the appropriate expectations of registrants will be better understood.

2.7 Maintaining appropriate professional boundaries

The GOC state:

“Through our stakeholder conversations we heard that registrants were very clear on the need to maintain appropriate boundaries with patients, particularly patients in vulnerable circumstances, such as those receiving domiciliary care.

“However, stakeholders felt that registrants are less clear on the need to maintain appropriate boundaries with colleagues. We also heard that maintaining boundaries relates to what is said, as well as behaviours and actions, that it applies to conduct both in and out of the workplace, and that social media can blur boundaries with colleagues.

“In general, stakeholders felt that the standards could benefit from being more explicit about our expectations on maintaining boundaries with colleagues, and that registrants would also benefit from further guidance on this issue.

“Stakeholders also fed back that sometimes patients can cross boundaries and this can be particularly challenging for registrants to deal with.

“Our patient and public research found, “...that the close and intimate nature of eye care may require particular sensitivity around maintaining appropriate boundaries. Respondents discussed how a compassionate, friendly, and respectful nature contributed towards a positive and less stressful experience, but that maintaining boundaries – both during and outside appointments – was still key for patient well-being.”

“The research highlighted that, “Some boundaries (physical, sexual, or sensitive, and with colleagues) were seen as non-negotiable. However, others (conversation, relationship and commercial) were perhaps more flexible depending on the context and relationship with an optical professional.”

“Further detail on each boundary is listed below.

  • “Physical: This was felt to be important due to the fairly intimate nature of eye examinations”
  • “Sexual or sensitive: There was strong feeling that unwelcome personal interactions, in person or otherwise, crossed a boundary”
  • “Colleagues: Respondents felt strongly about showing respect to colleagues”
  • “Conversation: Some level of small talk was seen as appropriate, but overly personal topics should be avoided”
  • “Relationship: Anything that may lead to one patient being treated more favourably to others was viewed as crossing a boundary”
  • “Commercial: Some [respondents] discussed the balance between the functions of patient care and sales.”

“Patients and the public felt that, “An area may be worth exploring is the balance between the commercial and patient-care functions of the optical professions.”

“Proposed amendments: Maintaining appropriate boundaries with patients, colleagues and others is vital for protecting both the patient and the registrant. A failure to maintain boundaries can affect patient trust in the professional or can affect a professional’s ability to practise safely and effectively, or their desire to remain in the profession. 

“In response to the feedback received at paragraphs 97 and 98, we have proposed a revision to standard 15.1 (14.1) that a) sets clear expectations around maintaining boundaries with colleagues and others with whom registrants have a professional relationship, b) clarifies that maintaining appropriate boundaries applies to behaviours, actions and communications, and c) expresses the need to take special care when dealing with patients in vulnerable circumstances. 

Proposed revision to standard 15.1 (14.1):

“In response to the issues raised at paragraph 99, we recognise the difficulties faced by registrants when patients and the public cross boundaries, whilst acknowledging that our regulatory remit does not extend to patients and the public. Under the section titled ‘Equality, diversity and inclusion (EDI)’ we have proposed a consequential revision to the Standards for Optical Businesses that would require business owners and employers to provide support for staff who have experienced discrimination, bullying and/or harassment in the workplace. We would interpret this to include where boundaries have been crossed by patients or the public.

Proposed additional sub-standard under standard 3.3 of the Standards for Optical Businesses:

Q25. To what extent do you agree that the revised standards are clear?

AOP response: Strongly agree

All of these boundaries should be inherently understood by the basic practice of being a “professional”, but the more explicit additions to the standards remove any scope for grey areas and are welcomed.

Q26. To what extent do you agree the revised standards set appropriate minimum expectations of registrants?

AOP response: Strongly agree

The GOC state:

“Preventing sexual harassment: Our scoping research identified that the issue of sexual misconduct has become a focus for regulators and the Professional Standards Authority (PSA) in recent years, and the number of fitness to practise cases received by regulators relating to sexual misconduct have increased. The research highlighted that numerous regulatory bodies have incorporated sexual misconduct into their professional standards and guidance.

“Proposed amendments: In response to the issues raised at paragraph 107, we have proposed an additional standard under standard 15 (14), that is specific to sexual harassment. This would set clear expectations for the way in which registrants conduct themselves with patients, students, colleagues, and others with whom they have a professional relationship. The existing standards do not explicitly reference sexual harassment between colleagues; while the absence of an explicit reference does not currently prevent the GOC from bringing a fitness to practise case, the proposed new standard would bring greater clarity.

Proposed additional sub-standard under standard 15 (14):

“The new standard makes clear that registrants must not act in a sexual way towards patients, students, colleagues, or others with whom they have a professional relationship, with the effect or purpose of causing offence, embarrassment, humiliation or distress. We have used the phrase ‘effect or purpose of causing offence’ because we want to set clear expectations of registrants that they must not act in this way. This mirrors the language used by the General Medical Council (GMC) which has recently strengthened its standards in this area. However, we recognise that some registrants are already in relationships with their colleagues or others with whom they have a professional relationship, and the proposed revised standard would not prevent appropriate relationships.

2.8 Other actions

The GOC state:

“We heard that stakeholders would benefit from further guidance on maintaining appropriate boundaries, and we will consider publishing guidance on this topic after we finish the review of the individual standards.

“We recognise the challenges faced by optical professionals when balancing patient care and commercial interests. Standard 16.3 (15.3) says, “Ensure that incentives, targets, and similar factors do not affect your professional judgement. Do not allow personal or commercial interests and gains to compromise patient safety.” We believe that this adequately addresses the issues raised by the public and patients in relation to commercial and patient functions at an individual level.

“Standard 1.1.10 of the Standards for Optical Businesses states that businesses must, “Ensure that any operational or commercial targets do not have an adverse effect on patient care.” We will look at this standard again when we review the business standards to consider whether the standards need to be strengthened in this area.

Q27. To what extent do you agree with the inclusion of an additional standard that specifically addresses the issue of sexual harassment?

AOP response: Strongly agree

The inclusion of such a standard could offer a better mechanism of protection for victims of sexual harassment or abuse, no matter what form it presents itself.

Q28. To what extent do you agree that the additional standard is clear?

AOP response: Somewhat disagree

The wording of the new standard is not particularly clear, and we would urge that the GOC mirror the existing UK legal definitions of sexual harassment. Again, the suggestion of GOC guidance on this potentially fraught area is welcomed.

2.9 Registrant health

The GOC state:

“Managing the impact of health on fitness to practise: The Government has set out proposals to remove health as a specific ground of impairment. Instead, health issues will be dealt with under the two new grounds of impairment: ‘inability to provide care to a sufficient standard’ or ’misconduct’. Part of being a professional is the ability to understand and manage the impact of a health condition on the ability to practise safely and effectively. In recognition of this, we have strengthened the standards in relation to health.

“We note that in the recently revised Good Medical Practice guidance the GMC has included the following standard, “You must consult a suitably qualified professional and follow their advice about any changes to your practice they consider necessary if a) you know or suspect that you have a serious condition that you could pass on to patients b) your judgement or performance could be affected by a condition or its treatment. You must not rely on your own assessment of the risk to patients.”

“Proposed amendments: We have proposed a revision to standard 11.4 (10.3) that would require registrants to consider whether concerns relating to their fitness to practise could compromise patient safety, as well as whether they could damage the reputation of the profession.

Proposed revision to standard 11.4, Standards of Practice for Optometrists and Dispensing Opticians:

Proposed revision to standard 10.3, Standards for Optical Students:

Q29. To what extent do you agree that the revised standards are clear

AOP response: Strongly agree

Q30. To what extent do you agree that the revised standards set appropriate minimum expectations of registrants?

AOP response: Strongly agree

The additional patient focus is welcome and clear.

The GOC state:

“We have proposed an additional standard under standard 11 (10) that would set out clear expectations of registrants who are carriers of, or have been exposed to, a serious communicable disease.

Proposed additional sub-standard under Standard 11 (10):

“We consider an additional standard on the issue of serious communicable diseases is necessary to set clear expectations around the management of such situations, reflecting on learning from the COVID-19 pandemic.

“We have not defined the term ‘serious communicable disease’ as this could change in response to emerging public health diseases. We reviewed the Government’s definition of High Consequence Infectious Disease but consider this is not broad enough to capture all the diseases to which we would want this standard to apply. We propose that registrants follow public health guidance available at the time and apply their professional judgment in deciding whether their health condition meets the threshold for a ‘serious communicable disease’. Where necessary, the GOC may issue supplementary or emergency guidance to address specific circumstances.

Q31. To what extent do you agree with the inclusion of an additional standard that specifically addresses the issue of serious communicable diseases?

AOP response: Neither agree nor disagree

While the necessity for more plainly stated measures in a post-COVID world is understandable, the inclusion of this standard feels arguably superfluous for individual registrants. These measures should be basic common sense, be a part of wider public health measures, or the responsibility for optical businesses to enforce. The forthcoming larger review of GOC Business Standards would be the more sensible place to fully address this.

3.0 Other changes and areas for consideration

The GOC state:

“Compliance with legislation: The GOC’s Advisory Panel fed back that although there was reference to legislation in the existing standards, there was scope for its application in a clinical setting to be strengthened.

“To address this, we have proposed that a statement is added to the introductory text of the Standards of Practice for Optometrists and Dispensing Opticians, and the Standards for Optical Students. The statement would make clear that all registrants are expected to comply with all legal requirements that apply to them and their practice, as well as other regulatory requirements, for example, relating to provision of NHS services.

“This is a new proposed statement to be added to the introductory wording under the heading ‘Your role as a professional’ - Standards of Practice for Optometrists and Dispensing Opticians and Standards for Optical Students:

Q33. To what extent do you agree that the addition to the introduction on compliance with legislation is clear?

AOP response: Somewhat agree

Considering the added focus of EDI matters on this review of the standards, we feel that specific mention of the legal requirements from the Equality Act (protected characteristics) would help to protect registrants further.

Q34. To what extent do you agree that the addition to the introduction on compliance with legislation sets appropriate minimum expectations of registrants?

AOP response: Somewhat agree - See answer above.

3.1 Continuing professional development

The GOC state:

“We have proposed a revision to standard 5.2 of the Standards of Practice for Optometrists and Dispensing Opticians and standard 3.2.7 of the Standards for Optical Businesses to update wording from ‘continuing education and training (CET) requirements’ to ‘continuing professional development (CPD)’. Note: This amendment will apply to optometrists and dispensing opticians only. The standards for Optical Students do not have a standard titled ‘Keep your knowledge and skills up to date’ as students are learning and developing their practice. 

Proposed revision to standard 5.2, Standards of Practice for Optometrists and Dispensing Opticians

Proposed revision to standard 3.2.7 of the Standards for Optical Businesses:

“Minor amendments: We have amended standard 14.6 (13.5) “Only use the patient information you collect for the purposes it was given, or where you are required to share it by law” to incorporate situations where registrants are required to share information in the public interest. For example, if a registrant notifies the Driver and Vehicle Licensing Agency (DVLA) or Driver and Vehicle Agency (DVA) if a patient will continue to drive despite advice not to. We have made this change to the standard so that it aligns with our guidance for registrants on disclosing confidential information.

Proposed revision to standard 14.6 (13.5):

“We have made a minor amendment to standard 13.8 (12.6) to amend the term ‘disabled patients’ to ‘patients with a disability’.

Proposed revision to standard 13.8 (12.6):

“We have made minor amendments to the standards to ensure that they are consistent with the Sale of Optical Appliances Order 1984 and to include zero powered contact lenses. These changes are largely to update existing references to ‘optical devices’ to ‘optical appliances’ or ‘appliances’.

Q35. Do you have any other comments about the proposed revisions or additions to the standards?

One area where we harbour mild concern is with how this revision of the standards will apply as the CLiP scheme is implemented over the coming months. Will the standards be flexible enough to evolve with the scheme, or is the intention to conduct a greater overhaul as the new education requirements bed in? Will those people who are undertaking their training through CLiP be measured against a standard that is appropriate to the stage of their training?

As training and experience will be staggered and vary between universities, we must be sure that the student standards will be suitable for the new mix of training. If a practice were to take students from two separate universities where the training differs, how will variations in knowledge be assessed against the standards? Currently pre-reg students have all completed an optometry degree before they see patients, but the new system will introduce a level of variation on acquired knowledge, and it will be important to manage expectations and be sure that all students are protected and guided by the standards.