Future of Optometry: Preparing for Change and Regulatory Developments

Historical Context and Recent Developments in Optometry (2017–2019)

• College of Optometrists (2017–2019):

  • 2017: Launch of a new website alongside a refreshed logo and motto.
  • 2018: Publication of the Scheme for Registration report and the introduction of 'SAFE'.
  • 2019: Launch of an updated patient-facing website and research conducted on posterior cortical atrophy.

• General Optical Council (GOC) (2017–2019):

  • 2017: Issued guidance on candour, updated registration declarations, and developed a strategic plan that included an education review.
  • 2018: Called for collaboration with health system leaders; conducted a consultation on standards for optical businesses; introduced requirements for additional renewal information.
  • 2019: Appointment of a new Registrar; publication of Business Standards; consultation on the disclosure of confidential information.

• Association of Optometrists (AOP) (2017–2019):

  • 2017: Launched a peer support line.
  • 2018: Focused on creating low-stress optical practices and providing advice on new data protection laws.
  • 2019: Offered professional development courses; addressed the gender pay gap; supported an IT campaign to improve direct practice connectivity with the NHS.

• Policy and Legal Reviews:

  • 2018: Review of gross negligence manslaughter policy within healthcare. Contributions were made by the AOP, the College of Optometrists, the BMA, and the GMC.
  • Reflective Statements: Robust calls were made for the protection of reflective statements from being used against practitioners in legal proceedings.

Public Perception and Sector Confidence Surveys

• General Satisfaction: As of April $2021$, surveys indicate that $96\%$ of respondents reported overall satisfaction with their last visit to an optician.
• Relative Confidence: $94\%$ of respondents are confident that the standard of care provided by opticians remains high. Notably, this level of confidence is perceived as higher than that which the public has for doctors, dentists, and pharmacists.
• COVID-19 Safety: $97\%$ of respondents expressed satisfaction with the coronavirus protection measures implemented during their optician visits.
• First Point of Contact: A record high of $30\%$ of respondents stated they would speak to an optician first if they woke up with an eye problem, representing an $11\%$ increase since $2015$.
• Healthcare Perception: More than one-third ($35\%$—a $4\%$ increase since $2019$) perceive opticians solely as a healthcare service rather than a retail/commercial service.

The General Optical Council (GOC) Strategic Plan: 'Fit for the Future'

• Strategic Period: April $2020$ to $2025$.
• Primary Priorities:
  1. Delivering world-class regulatory practice: High-level standards for both practitioners and businesses.
  2. Transforming customer service: Focusing on the experience of registrants and the public during GOC interactions.
  3. Building a culture of continuous improvement: Enhancing internal processes and external standards based on data and feedback.     
• GOC Engagement Activities: Between $2014$ and $2020$, the GOC has consistently increased news releases covering fitness to practise decisions, staff changes, strategic plans (such as the five-year plan from April $2020$), consultations, review outcomes, and statements on emerging topics.

Strategic Work Programme and Implementation Timelines

• Policy Guidance on 'Speaking Up': Scheduled for publication and implementation between April–June $2021$ and Jan–Mar $2022$.
• Standards of Practice for Individuals: Development and consultation set for April–June $2021$ through Oct–Dec $2022$.
• Education Delivery and Quality Assurance: Implementing outcomes and new quality assurance schemes between Oct–Dec $2020$ and April–June $2022$.
• CPD (Continuing Professional Development) Scheme:
  • Legislative underpinning: April–June $2020$ to Oct–Dec $2021$.
  • Implementation: Jan–Mar $2021$ to Oct–Dec $2021$.
  • Launch: Jan–Mar $2022$ to Oct–Dec $2024$.
• Government Reforms: Implementation of reforms to GOC governance and fitness to practise (FtP) processes scheduled from April–June $2020$ to Jan–Mar $2022$.
• Registration Outcomes: Developing 'Outcomes for Registration' and 'Standards for Approved Qualifications' between April $2021$ and $2024/25$, with longitudinal research continuing to $2030$.

Fitness to Practise (FtP) and Regulatory Oversight

• FtP Focus Bulletin: A learning bulletin launched in December $2020$ to provide registrants with insight into concerns received and the assessment process at various investigation stages. Issue $1$ covered 'Triage' and Issue $2$ covered 'Investigation'.
• Case Study (Student Misconduct): On $2$ February $2021$, student optometrist Lukshana Jeyaruban (London) was suspended from the register for $6$ months. The FtP Committee found her fitness to practise impaired by misconduct involving dishonesty and plagiarism for submitting a dissertation drafted by another person.
• Professional Standards Authority (PSA) Appeals: On $26$ Jan $2021$, the GOC acknowledged that the PSA referred the case of Honey Rose back to the High Court under the NHS Reform and Health Care Professions Act $2002$. This case involved intensive scrutiny of professional responsibility and liability.

Sector Criticism and Performance Reviews

• Ophthalmic Practitioners' Group (OPG) Petition: A petition on Change.org titled "Accept our vote of no confidence in the GOC's ability to protect the public" garnered over $794$ signatures by early $2021$. Concerns cited included failure to listen to stakeholders and failure to maintain education standards.
• Conflict of Interest Investigation: A separate petition in June $2020$ requested an investigation into the GOC for potential conflicts of interest. The PSA announced awareness and investigation into these concerns on $26$ June $2020$.
• PSA Performance Review ($2019/20$): Published $31$ March $2021$ (covering Oct $2019$ to Sept $2020$).
  • The GOC met $16$ out of $18$ Standards of Good Regulation.
  • Failings: Standard $10$ (Register robustness was insufficient to ensure only qualified individuals were added) and Standard $15$ (Fitness to practise cases took too long to resolve).

Professional Guidance: Clinical and Legal Compliance

• Disclosing Confidential Information: New guidance issued on $24$ February $2020$ after a consultation period. Key areas include:
  • Assessing if a patient's vision makes them unfit to drive.
  • Public interest disclosures.
  • DVLA/DVA Notification Process: Practitioners must advise patients to self-report vision problems. If the patient is unable/unwilling and there is a concern for road safety, the practitioner may contact the DVLA/DVA directly with clinical details.

COVID-19 Professional Adjustments (2021)

• NHS England Eye Care Planning: Published guidance for Eye Care Planning and Implementation for $2021-22$.
• IP Qualifications: Virtual clinics are now formally included in Independent Prescribing (IP) qualification workplace session requirements as of April $2021$.
• Infection Control: A joint statement on maintaining high standards of infection control was released on $21$ April $2021$.
• AOP Infection Control Certificate: A $45$-minute online lecture followed by Multiple Choice Questions (MCQs). Successful completion earns qualified optometrists and dispensing opticians $1$ CET point.

National Outpatient Transformation and Integrated Pathways

• LOCSU (Local Optical Committee Support Unit): Provides support for LOCs in England for service recovery and reform.
• National Optical Conference (NOC) 2020: A virtual event covering outpatient transformation, COVID-19 response, and future LOC structures.
• Five Integrated Eye Care Pathways: Developed through clinical consensus to reduce hospital attendances:
  1. Cataract Care Pathway.
  2. Glaucoma New Patients Pathway.
  3. Glaucoma Long Term Care Pathway.
  4. Maculopathy Pathway.
  5. Diabetic Macular Oedema (DMO) Pathway.
• CUES (COVID-19 Urgent Eyecare Service): A model for collaborative leadership and integrated pathways designed to maintain/restore urgent eye services while staying outside hospital environments.