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The General Optical Council ‘Standards of Practice for Optometrists and Dispensing Opticians’ is effective from this month, replacing the current Code of Conduct. The intention of this article is to make the reader fully aware of and give a basic understanding of the new standards, which will have a profound implication on the practice of optometrist and dispensing optician registrants.

The Code of Conduct

The General Optical Council (GOC) regulate the practice of optometry and dispensing optics in the UK through overseeing the Opticians Act. The main functions of the GOC are to:

  • Set standards for optical education and training, performance and conduct

  • Approve qualifications

  • Maintain the register

  • Investigate and act where a registrant’s fitness to practice, train or carry on business is impaired.

In addition to setting standards for the knowledge and skills that a registrant should maintain, the GOC sets standards for good practice and professional conduct to which registrants must adhere.

The standards of conduct were contained within two separate codes of conduct for individuals and business registrants. All optometrists, dispensing opticians, and trainees had to abide by the code as illustrated in the foreword to the code that stated: ‘If a registrant fails to comply with the duties and responsibilities set out in the Code of Conduct they are putting their registration at risk’.

There was a list of 19 short statements with no supporting information or detail. Examples included: give patients information in a way they can understand and make them aware of options available; and ensure your conduct, whether or not connected to your professional practice, does not damage confidence in you or your profession.

The code reminded registrants that detailed guidance and standards are produced by other bodies, such as the College of Optometrists, the Association of British Dispensing Opticians and NHS bodies. It was expected that registrants be familiar with these and also complied with local and national standards. The GOC further maked the point that reference may be made to the guidance and advice of other bodies in the exercise of GOC functions, such as determining fitness to practise.

Despite the current code being in place since 2010 and the previous incarnation since 2005, it still remained the case that many registrants were not fully aware of the content of the code or the implication of failure to abide by its content. Many registrants think about and are aware of their clinical behaviours. However, the code also targeted our personal behaviours, both in our professional and private lives. There have been many recent examples where registrants have been erased, not due to clinical error, but from issues within their private lives which infringed the Code of Conduct. An obvious example was where a registrant had been dishonest, and in a profession this may be viewed more seriously than a clinical error. Dishonesty would be reported to the GOC and very likely lead to erasure; and while there may have been mitigating circumstances, to quote a Law Lords ruling – where ‘a professional is found to be dishonest – you will be erased.’

Why New Standards?

The GOC considered that the existing Code of Conduct lacked detail and, as it was five-years-old, it did not meet the current needs of the profession. As a result, the GOC undertook a standards strategic review and consultation exercise, with three key objectives:

It was thought important to clarify, and ensure, that the statutory role of promoting high standards, including the role of providing guidance was fulfilled.

Standards of ethics and performance would focus on outcomes, would meet the public’s expectations, and would be clear to registrants and reflect good practice, including the recommendations of recent inquiries, notably the Francis Inquiry.

It would ensure that the standards of competence, and the system of regulation more generally, enabled positive developments in optical practice, thereby benefiting patients and the public.

Initial development of the standards began some time ago through a ‘call for evidence’ consultation to ask stakeholders to consider how the scope of practise of optometrists and dispensing opticians may evolve in the future, and how standards should therefore adapt to ensure continuing patient safety. Research was carried out into patient expectations and summaries of responses can be found through the GOC website. More recently a consultation took place over 12 weeks March-June 2015) and focused on the development of the standards framework and standards for optometrists, dispensing opticians and optical students. The outcome of the consultation was for the GOC to take forward publication of Standards of Practice for Optometrists and Dispensing Opticians and separate Standards of Practice for Optical Students.

Consultation on standards for business registrants will be undertaken in the foreseeable future, date to be confirmed; however the existing Code of conduct for business registrants will be updated to reference the new standards and require business registrants to continue to support individual registrants in meeting the standards which apply to them.

Understanding that communication of the new standards would be essential, the GOC wanted to have a programme of implementation to support registrants in understanding and applying standards in practice.

Timetable

These new standards were first published in October 2015 and circulated to all registrants in early 2016. The GOC have gone to great efforts to ensure the introduction of the new standards has a high profile within the professions, so that no one can be unaware of the content and their responsibilities. As part of their retention declaration for 2016-17, all optometrists and dispensing opticians have had to confirm they have read and will abide by the standards, which came into effect on April 1 2016, together with the revised Code of Conduct for business registrants.

As part of continuing education and training from January 1 2016, each registrant will have to undertake one CET activity relating to the new standards.

What Are the New Standards?

The new Standards of Practice for Optometrists and Dispensing Opticians define the standards of behaviour and performance expected of all registered optometrists and dispensing opticians and are designed to make clear to professionals and patients what is expected. The GOC also consider that the standards give room for registrants to use their professional judgement in deciding how to apply them in any given situation.

There are 19 separate standards, (18 for students – minus continuing education), not listed in order of priority, each with a summary statement heading, further clarified by a series of more detailed bullet points. These standards are listed in Table 1.

Table 1

  • Listen to patients and ensure they are at the heart of the decisions made about their care

  • Communicate effectively with your patients

  • Obtain valid consent

  • Show care and compassion for your patients

  • Keep your knowledge and skills up to date

  • Recognise, and work within, your limits of competence

  • Conduct appropriate assessments, examinations, treatments and referrals

  • Maintain adequate patient records

  • Ensure that supervision is undertaken appropriately and complies with the law

  • Work collaboratively with colleagues in the interests of patients

  • Protect and safeguard patients, colleagues and others from harm

  • Ensure a safe environment for your patients

  • Show respect and fairness to others and do not discriminate

  • Maintain confidentiality and respect your patients’ privacy

  • Maintain appropriate boundaries with others

  • Be honest and trustworthy

  • Do not damage the reputation of your profession through your conduct

  • Respond to complaints effectively

  • Be candid when things have gone wrong

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The foreword to the Standards makes it clear that each registrant is professionally accountable and personally responsible for their practice and for what they do or do not do. This is irrespective of any direction or guidance that is given by an employer or colleague. If anyone raises a question about a registrant’s fitness to practice, the GOC will refer to the standards when deciding whether to take action and the registrant would then need to demonstrate their decision making was informed by the standards and that actions were taken in the best interest of the patient.

If the new standards are compared to the old Code of Conduct there are many that are familiar such as communication, consent and honesty and trustworthiness. Others are certainly more detailed, for instance with regard to supervision, safeguarding and consent. There are then new standards concerned with candour and care, and compassion.

What Should Registrants Consider?

In order to comply with the new standards both within and outside the workplace, there are a number of points a registrant should consider. It is not the intention to go through all 19 standards in detail, but to attempt to set out a logical approach each registrant may take to ensure they are compliant in the future. All registrants should now have their own copy of the standards, hence they should already be familiar with them and the standards are also always available on the GOC website.

Clearly, it will be essential for each registrant to read and understand each of the 19 standards, consider how they relate to their practice and how they will comply. For some issues it will be common sense as to what is required. As an example, acting illegally within one’s professional or private life would clearly be contrary to standard 16.2: act with honesty and integrity to maintain public trust and confidence in your profession, and is something I would hope any professional would be aware of. You may find it helpful to have discussions with colleagues and other registrants and learn from what others are thinking and doing. Peer review and discussion will be an ideal format for this, to learn and adopt new ideas.

The GOC have stated that The College of Optometrists and Association of British Dispensing Opticians guidance can inform the registrant’s view and these documents, representing the peer view, will be an invaluable source of information to help registrants use their professional judgement in applying the standards.

As an example, standard 8.2.2 states: you should record patient’s personal details, and 8.2.4: the details and finding of any assessment or examination conducted. The College guidance gives greater detail on record card completion and will be a useful reference source. Quality in Optometry developed jointly by ABDO, Association of Optical Practitioners, the College, Federation of Ophthalmic and Dispensing Opticians and the LOC support unit, will also be a good reference document. Your continuing education personal development plan, (to be found on the GOC website at myCET), will be a useful tool to target specific topics where you feel you need to fill in gaps in your knowledge and to then find information online and through the journals.

Over time the GOC will give further support to registrants, through the production of supporting guidance for standards relating to consent, care and compassion, and candour and the legal requirements that registrants must meet. They will also consider other support measures for standards related to record keeping, safeguarding, whistleblowing and equality and diversity. They may also produce material to explain complex legal requirements, address issues arising persistently in Fitness to Practice cases and provide clarity where third party guidance conflicts.

It would be useful to consider some examples of issues that arise from the new standards and how a registrant may consider how they comply.

Reporting Concerns –'Whistleblowing'

Standard 11: protect and safeguard patients, colleagues and others from harm, deals with raising concerns about your patients, colleagues, employer or others if patient or public safety may be at risk. The GOC are co-signatories to a general statement regarding reporting concerns on behalf of a number of regulators and this gives helpful advice to registrants. It reminds registrants that all health professionals have a responsibility to respond if they think that a colleague is acting unsafely or unprofessionally through their conduct or performance, or if they believe that the healthcare environment management or other system-related matter is putting patients at risk. The healthcare professional is advised to keep written records about what is happening, and when, and should express their concerns to the employer or relevant regulatory body, having first exhausted all possible local procedures for expressing concerns. If patient safety is still at risk, advice should be sought from a senior and trusted colleague, a professional organisation, a defence organisation, the appropriate regulatory body and/or Public Concern at Work.

For registrants in management positions, they have particular responsibilities for the teams and environments they manage to create a culture of openness and transparency which supports staff who make known any concerns about patient safety.

The College of Optometrists guidelines give examples of what should be reported, such as; very poor treatment, failure to gain consent, fraud or theft, and practising under the influence of drink or drugs.

Duty of Candour

The new standard 19 relates to duty of candour: be candid when things go wrong. This of course arises from recommendations in the Francis Report which stated; unless steps are taken to evidence the importance of candour by the creation of some uniform duty with serious sanctions available for non-observance, a culture of denial, secrecy and concealment of issues of concern will be able to survive in the healthcare system.

Again, the GOC are co-signatories with other regulators to a statement on duty of candour. This states that registrants must be open and honest with patients when things go wrong, when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress. The registrant should tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong, apologise to the patient, offer an appropriate remedy or support to put matters right and explain fully to the patient the short and long term effects of what has happened. Duty of candour is also about having a culture where ‘near misses’ are reviewed and everyone learns from what went wrong.

Perhaps the question for the optical professions will be: what constitutes an incident when we should impose our duty of candour policy?

In medical terms this is defined in the Health and Social Care Act as ‘an incident that could result in the death of a person or severe harm, moderate harm or prolonged psychological harm’, of which there are not many in optical practice.

The General Medical Council guidance gives examples such as surgery going wrong and incorrect treatment by a GP prolonging the issue when they should have been in hospital. Over the coming months and years our understanding of when to impose duty of candour will become clearer with the publication of further GOC guidance and as FTP cases are heard.

Confidentiality

One example of an issue covered in both the old code and the new standards is that of confidentiality. The old code point 12 simply states; Respect and protect confidential information, while the new standards 14 is: Maintain confidentiality and respect your patients’ privacy, gives detail as to what this means through a further eight bullet points.

These include, 14.2: ensure that all staff you employ or are responsible for, are aware of their obligations in relation to maintaining confidentiality, and 14.6: only use the patient information you collect for the purposes it was given, or where you are required to share it by law.

These bullet points give more helpful guidance for what is expected of the registrant and may also still raise some further questions. For instance, to make sure all staff are aware of their obligations it would be advisable to implement a standard operating procedure that all staff are required to read and sign to confirm understanding. To ensure you are using data appropriately it would be advisable to consider the Data Protection Act 1998, which states that practices should have a data handling policy. Further detail is available through Quality in Optometry.

Consent

Standard 3: obtain valid consent, lists a further three bullet points, which includes 3.2: be aware of your legal obligations in relation to consent, including the differences in the provision of consent for children, young people and vulnerable adults.

When working in a nation of the UK other than where you normally practise, be aware of any differences in consent law and apply these to your practice. This raises a whole set of questions that require further reference to the professional bodies guidance, which covers the issues in greater detail.

Indemnity

The new standard 12: ‘ensure a safe environment for your patients’, covering the requirements for indemnity insurance gives a helpful reminder in bullet 12.2.4: your professional indemnity insurance must cover complaints that are received after you stop practising, as these might be received years later – this is sometimes referred to as ‘run-off’ cover.

This is something that has at times caused practitioners problems as they have not paid for indemnity cover due to leaving the profession or ceasing practice for a short while. In this circumstance, unless indemnity premiums are still current or a one-off payment for future cover is made, the practitioner may not be covered for future claims.

Supervision

The new standard 9: ensure that supervision is undertaken appropriately and complies with the law, applies to supervision of pre-registration trainees and unregistered colleagues undertaking delegated activities and further states that the responsibility to ensure that supervision does not compromise patient care and safety is shared between the supervisor and those being supervised. The whole standard is a helpful reminder of a registrant’s obligations with respect to supervision. Standard 9.1: be sufficiently qualified and experienced to undertake the functions you are supervising and 9.2: only delegate to those who have appropriate qualifications, knowledge or skills to perform the delegated activity, are useful reminders of the roles of both supervisor and supervisee. Standard 9.3: be on the premises, in a position to oversee the work undertaken and ready to intervene if necessary in order to protect patients, reminds us of the conditions for supervision that should be in place.

Communication

The majority of the standards have a tangible content to them where compliance is objective in nature. However, compliance to some of the standards may be more subjective. Standard 2.1: give patients information in a way they can understand, and 2.4: ensure that the people you are responsible for are able to communicate effectively with patients and their carers, colleagues and others, are examples of this. Standard 4.1: treat others with dignity, and show empathy and respect, is a further example.

In considering how to comply with these standards there may be no right or wrong, as each patient interaction would be considered on its merits. These standards may be best explored using peer discussion and talking over situations with colleagues.

Summary

GOCstandardsWEB650The new standards will be a constant reminder of the conduct and ethics required of registrants and this article should serve as an introduction to the main areas. It is outside the scope of this article to go through each of the 19 standards and more than 100 bullet points. It is therefore each registrant’s professional duty to read, understand and consider how they will comply in the future and to seek help and support if they are not clear on any parts.

David Cartwright is an optometrist, practising in Nottinghamshire. He is chair of Derby/Nottinghamshire eye health local professional network and The Eye Care Trust.

Further reading

  • Standards in Practice documents are downloadable from www.optical.org/en/Standards

  • Quality in Optometry toolkit at qualityinoptometry.co.uk