FAQs for members on the GOC’s review of the Opticians Act

The GOC launched its call for evidence on the Opticians Act and consultation on associated policies on 28 March. This could eventually result in some of the most significant changes to regulation for the optical sector in years. The key areas it covers include:

• Delegation of refraction in the sight test  
• Sight testing duties  
• Protection of title, restricted activities and registers 
• Regulation of businesses 
• Fitting of contact lenses 
• Sale and supply of optical appliances 
• Delivery of remote care and technology

The GOC has said the call for evidence will run for 16 weeks and will close on 18 July.

In its statement online, the GOC has said that the “catalyst [for this work] is planned reforms to health and social care regulators’ legislation by the Department of Health and Social Care (DHSC).” The GOC says it wants to “consider what changes are needed for the aspects of the Act that are specific to the GOC or the practice of optometry and dispensing optics.” We understand that other healthcare regulators are undertaking similar work for the professions they regulate.

Running alongside this project, the Regulating healthcare professionals, protecting the public¹ consultation work is also taking place, which the DHSC is undertaking in order to make powers across regulators more consistent in the core functions of registration, education, fitness to practise, standards and overall governance.

Reference

1. AOP response to this consultation, June 2021

The Opticians Act 1989 contains legislation about optical registers, training, fitness to practise procedures, the GOC’s governance, restrictions on sale and supply of optical appliances, and definitions and restrictions on duties relating to the sight test and contact lens fitting. Over time the Act has had important statutory rules added to it through secondary legislation. These include rules about completion of Continuing Education and Training (CET) in 2005, and the introduction of therapeutic specialties in 2008.

You can find more insights about the importance of the Act and its features in this Optometry Today article.

A call for evidence is similar to a consultation – it is a formal engagement exercise that is designed to gather information. A call for evidence is likely to be targeted at assessing the impacts of a proposed action or to assess the need for change, and are often carried out by public bodies. In this case the GOC wants to consider both the need for and impacts of (or changes to) the Opticians Act. The call for evidence provides, an opportunity to gather evidence on how the members of the profession are affected or likely to be affected. This exercise will enable the GOC to collect factual evidence, views, or information to inform its decisions.

A call for evidence should contain questions and request information from anyone with relevant knowledge,  or experience to contribute. The call for evidence should have a specified timescale for responses and can also be directly issued to external stakeholders, representative groups and members of the public. It is common practice to publish responses which illustrate the findings of the call for evidence.

The GOC has said that it is asking for views, information and evidence to help it to decide whether pieces of legislation in the Opticians Act should remain as they are, be updated, or be removed. The GOC has said that a strong case will be needed for any changes to the Act. This could include evidence which identifies risks of harm to patients, impacts on public protection, or delivery of clinical care.

The GOC has not put forward any specific proposals for revisions to the Act, but the call for evidence document and its questions may provide some indication about areas the GOC may seek to change. One area where the GOC has proposed specific changes without the need for changes to the law is on the possibility of delegating refraction to dispensing opticians as part of the sight test.

Sight testing is a legally restricted function. This is why the GOC published a statement in 2013 saying that refraction is an essential part of the sight test which can only be conducted by a registered optometrist, a registered medical practitioner or a student optometrist under supervision. And, that no part of the sight test can be delegated to a dispensing optician or contact lens optician, even under supervision.

However, the GOC is now asking if dispensing opticians should be allowed to undertake refraction as a delegated function within the sight test. The GOC is referring to this question as a consultation because it takes the view that refraction may be delegated to dispensing opticians by removing or changing its 2013 regulatory statement, and without the need for changes to the Opticians Act.

The Opticians Act makes the sight test a restricted function which can only be conducted by a registered optometrist, a registered medical practitioner or a student optometrist under supervision. The section in the Opticians Act which deals with interpretation says the following about sight testing:

“References in this Act to testing sight are references to testing sight with the object of determining whether there is any and, if so, what defect of sight and of correcting, remedying or relieving any such defect of an anatomical or physiological nature by means of an optical appliance prescribed on the basis of the determination.”

In effect, the Act defines sight testing as refraction with the intention to prescribe.

Additional rules to the Opticians Act, the Sight Testing (Examination and Prescription), go on to describe the duties that should be undertaken when a sight test is performed, including an external and internal examination of the eye.

We have published information here explaining the use of the term sight test.

We agree that it is right for the GOC to launch a call for evidence before it develops any proposals about the Opticians Act for DHSC. Our view is that the GOC must ensure that it gathers extensive evidence and views from the optical sector, and only proposes changes to the Act where there is a strong case that it will prevent the risk of harm to patients and the public, and does so without introducing additional risks.

We believe that the Opticians Act already succeeds in its stated aim of protecting patients and safeguarding professional delivery of care. The GOC should therefore seek to retain all legal restrictions and protections in the Act unless there is a clear case for revision based on risk to the public. Maintaining appropriate legal restrictions on sight testing are vital to ensure eye disease is detected and referred appropriately. There are areas where the Act may need updating in response to possible risks to patients from new ways of delivering eye care, so we welcome the fact that the GOC has asked for views about regulating remote care, emerging technology and online services and products.

The Opticians Act provides the basis for legal protections and regulation in the optical sector. The primary care optical model is underpinned by the legislation about the sight test and contact lens fitting. This call for evidence could change or remove many key legal protections in the Opticians Act and therefore carries significant risks, as well as opportunities. In time it could have a profound impact on the way that optical professions are regulated and practice in the future. This is why we need to ensure that our members are aware of the importance of the call for evidence, what it means, and how they put their views forward.

The most immediate change would be for the GOC to allow dispensing opticians to carry out refraction as part of the sight test soon after the close of the call for evidence. We understand that the GOC takes the view that this can be done without changes to the Opticians Act. In our opinion, however, the current legislation states that sight testing is defined as refraction with the intention to prescribe – and can, therefore, only be carried out by optometrists, medical practitioners or students under supervision.

All other potential changes from the call for evidence will require changes to the Opticians Act and therefore will take longer to implement.

The timeline is uncertain but it is likely to take a few years to happen. Exactly when and how changes to the Act take place could be affected by DHSC and Government priorities in the future. Following the call for evidence, the GOC will need to use the responses to assess the case for changing the Act and develop proposals for legislative change for the DHSC.

It is imperative that the GOC commits to carrying out a full public consultation on any legislative proposals it develops and listens carefully to the optical professions before submitting these to the DHSC.

The AOP will have a vital role in representing the interests of our members and leading and shaping discussion in the sector about the call for evidence. This will include:

• Helping our members understand what the call for evidence is and its significance for their future practice
• Identifying and responding to risks and opportunities
• Reflecting the interests of individuals across our membership
• Protecting the professional interests of our members
• Seeking feedback from our members to help shape our response across key areas
• Leading discussions within the sector

We have reviewed the call for evidence and prioritised our work in order to focus on the greatest risks or opportunities for our members and their future practice. To develop our response, we will:

• Inform our response using existing AOP position statements and consultation responses
• Seek views and evidence from members on key topics
• Identify evidence and views to help maintain professional protection that will support our member’s future practice and clinical care to patients
• Consult with our Policy Committee and Council, which constitutes representatives from across membership, to help shape our response

AOP members will have a critical role to play in the process of informing our response to the GOC call for evidence. We want to support our members to understand the key issues and help shape our response. As such, we encourage members to:

• Read the full GOC’s call for evidence document
• Let us know what questions you want answers to in order to help you understand this work. To get in touch with us, email [email protected]
• Read the information we send out about the call for evidence, via email and other channels
• Respond to our call for comments, evidence and feedback in the coming weeks

On 22 April the AOP hosted a roundtable meeting with sector colleagues from ABDO, the College of Optometrists and FODO about the call for evidence. We believe it is important to understand the views and position of different sector bodies to help inform how we represent the key interests of our members in our response to the call for evidence. We will continue these discussion, and will take complementary actions, such as sharing evidence, where it’s in the interests of our members to do so. We will also liaise with organisations outside optics to identify evidence and support on key topics such as legislation to protect the sight test.