Business registration has been a troublesome topic in recent years for the General Optical Council. In 2013, the regulator told Specsavers it had to register all its practices after a story in Private Eye found that many were operating without registration. Unregistered, often overseas, online retailers falling outside of the Council’s jurisdiction has also been a point of contention for many within the profession.
A draft presented to Council members at a meeting last week sought to address concerns relating to business registration and to introduce positive behavioural change within the optical profession. The draft will form the basis of a public consultation scheduled for launch later this year and will be implemented in early 2019.
The Council said new Standards for Business Registrants would replace the Code of Conduct for business registrants and complement the Standards of Practice and Standards for Optical Students, which came in effect in April 2016.
The changing face of high street optometry, where practices are increasingly delivering the types of services previously performed in hospital settings, meant that the risk profile of optical businesses had changed. In addition, new standards will also look to address the increasing scope of telemedicine and those that do business outside of the traditional bricks and mortar model.
‘As a result, we consider that compulsory registration for optical businesses that carry out specified functions is necessary and would benefit patients. We shall be following up this consultation response with a series of urgent requests for legislative change of which this will be one,’ said the GOC.
The new draft standards were the result of internal research that considered the positions of other regulators, healthcare reviews, stipulations under GOS and requirements set by the Care Quality Commission (CQC) and the NHS. The key risks outlined by the GOC included reduced patient safety through ineffective standards and the lack of a level playing field being created without all businesses being registered.
The areas covered by the new standards have been split into three sections: patients; governance and staff. Issues focusing on the patient include making sure they are treated in a suitable environment with appropriate equipment, an expectation from the patient that they are safe in the practitioner’s care and providing clear, effective communications with informed consent.
Post Mid-Staffs and Francis inquiry, transparency and openness in all healthcare settings has been a critical issue and features in the governance set of draft standards. Compliance with relevant legislation, clinical governance systems and confidentiality are also key aspects of the proposed rules.
Staff standards
New proposed standards on staff were far-reaching. Suitable training and registration, correct supervision and staff collaboration were all core areas covered within the draft measures. Businesses allowing staff to exercise their professional judgement was another area in which the GOC wants to strengthen. This issue came to the fore last year when Boots Opticians introduced optometrist-only recommendation for its blue light filtering ophthalmic lenses, making dispensing opticians seek approval from the optometrist. The multiple clarified that its DOs were free to recommend what products they felt appropriate and no action was taken.
The draft standards document stated: ‘Staff being able to exercise their professional judgement is of importance in fulfilling their duties to patients and to their regulator. A flexible approach to care means that each patient’s individual needs can be taken into account, and appropriate care provided.’
Unregistered optical businesses have been in the GOC’s sights for several years now, but current legislation means it cannot compel all businesses to register, just those companies using protected titles.
‘As an organisation we are pushing for legislative change to require all optical businesses to register with us, but this falls within our Legislative Reform project rather than this one. We are also exploring the possibility of compelling business registration by way of the GOS contract,’ said the Council.
Fitness to practise
‘No healthcare regulator covers itself in glory in this area,’ said GOC chair Gareth Hadley (pictured). ‘But with this project, we are in good shape.’
The project Hadley referred to was improving of end-to-end case progression times for FTP cases, which was part of the organisational transformation section of the GOC’s 2017-20 strategic plan.
As well as providing an update on case times, GOC head of case progression Keith Watts said there were still several myths surrounding fitness to practise cases and work needed to be done to make sure registrants had a clear understanding of what types of case could lead to erasure.
Watts said despite what some registrants believed, cases involving lapses of clinical standards rarely resulted in being struck off Council registers. Instead, convictions and personal conduct issues were generally what constituted issues of erasure.
Watts showed the Council a four-stage breakdown of the FTP process to make it easier for members to understand where the main challenges were within the end-to-end process and how the work the FTP committees did at each stage that could influence timescales at later stages of the process. The GOC aims to reduce the time taken from first receiving a complaint to decision down to 78 weeks. The year-to-date average is 124 weeks.
The four stages of the FTP process were: triage; investigation; GOC hearing preparation and registrant hearing preparation.
The FTP stages
Once a referral is received by the GOC, it is placed into triage for assessment, where three tenets will be established: sufficient consent from the referrer, that the complaint relates to a GOC registrant and whether the registrar considers the referral to amount to an allegation that fitness to practice is impaired.
The median age of cases in the triage stage is 15 weeks, but Watts pointed out that this statistic had been impacted by a small group of cases that had remained in triage for some time, for reasons such as third-party investigations and complex cases.
For the investigation stage, the median age of complaints was 39 weeks, but it was here much of the time reduction could be found, said Watts, through improvements in ‘front loading’ cases. The process of front loading involved getting cases ready for hearing at the investigation stage, which would eventually replace the current third stage, GOC hearing preparation. However, front loading remains a relatively new concept for fitness to practise committees and according to Watts, was resource intensive. The newness of front loading has resulted in some inconsistencies in the quality of cases reviewed, but Watts said this would improve over time and was still being fine-tuned.
At the GOC hearing preparation stage, the median age of complaints was 92 weeks, but Watts pointed out the majority of complaints at this stage had come through using old methods, something that also affected the final stage of process, registrant hearing preparation and hearing, where the median age of complaints was 112 weeks.