The major changes to the Guidance relate to the contact lens sections and the chapter on the use and supply of drugs and medicines in optometric practice. This document was prepared by Dr Sue Blakeney, clinical adviser to the College of Optometrists.
The Act imposes a new method of supply of contact lenses – namely supply under the general direction of an optometrist/dispensing optician/doctor. There are minor changes to other sections of the Guidance to reflect other changes introduced by the Order, namely the requirement for compulsory CET, PI insurance and the inclusion of the requirement for the optometrist, if they are referring the patient, to notify the patient of the reason they are referring them.
Chapter 1
1.02 makes it clear that it is a legal requirement for optometrists to abide by compulsory CET rules.
1.12 expands the section relating to PI, and highlights to members the fact that there is more than one type of PI cover.
Chapter 2
2.18 is a new paragraph explaining that the GOC now has power to request information from an optometrist.
Chapter 4
4.13 has been amended, as the Direction to Fit has now been abolished.
Chapter 16
16.07 is expanded to reflect the wording of the Act which states that the patient, if they are being referred, should be given a statement giving the reason for referral.
Chapter 23
23.02 is expanded a little and 23.03 reinforces the fact that all findings and advice should be recorded.
Chapter 27
27.01 expanded to include plano lenses.
27.03a is expanded to include the fact that patients cannot be fitted with lenses unless they have a valid prescription or statement issued no longer ago than 2 years.
27.05 and 27.06 have been amended to make it clear that there is a difference between delegating some of the patient’s care to an unregistered colleague (where the optometrist retains fully responsibility) and referring the patient to a suitably qualified colleague. The Direction to Fit has now been abolished.
27.08 and 27.09 state the relevant provisions of the Opticians Act.
Chapter 28
This Chapter has been retitled to make it clear that it applies to new contact lens wearers. The Guidelines relating to existing wearers are covered in Chapter 29, Aftercare.
28.03a now mentions that patients need to have had a recent eye examination.
28.03d covers the need for aftercare with the need for regular contact lens check-ups. The two are differentiated because the Act imposes requirements on the supplier of contact lenses to make arrangements for ‘aftercare’.
28.06. This section has been considerably expanded. 28.06a includes advice on what should be on the contact lens specification. The time scale has also changed, and the new advice is that most contact lens fittings will be completed within a period of 3 months. If the optometrist considers that the fitting will take longer than this s/he should warn the patient of this and make a note in the patient’s record.
28.06b expands what should be considered when determining the expiry date of the specification. It also reinforces the need for aftercare.
28.06c advises members of the new requirement imposed by the Act if the patient wishes to purchase lenses using a copy of their specification. In this case the supplier is required to verify the specification with the fitter. It advises members to verify any specification in writing, to keep a note of requests for verification and to alert the supplier if excessive verification requests are being received.
28.06d reminds practitioners that they must comply with the Data Protection Act.
28.07 Restates the Opticians Act, reminding practitioners that the patient needs to have had a recent eye examination before they can be fitted with lenses.
28.09 updates the equipment list with keratometer and slit-lamp being considered essential for contact lens practice. A corneal topographer is also added to the ‘additional items’ list.
Chapter 29
This has been expanded to include refitting existing contact lens wearers as well as simply providing aftercare. This is partly because optometrists who perform aftercare check-ups on patients may be asked to revalidate the patient’s specification or refit the patient.
29.02k reinforces the need for aftercare.
29.04 is new, and reflects the fact that this section is no longer only about aftercare.
29.05 is new and reminds practitioners that they are responsible for the content of any specification that they issue. It also highlights a problem when the practitioner is unsure of the exact specification the patient is wearing.
29.06 is new and reinforces 29.05
29.07 is new and advises as to what should be considered when determining the expiry date of the specification.
29.08 is new and mirrors the provisions of 28.06c.
Chapter 30
This section now deals with the supply of contact lenses, and is no longer divided into sections dealing with conventional use and disposable lenses separately.
The section has been largely rewritten, and should be read in its entirety. Main points are:
The old advice to check with the prescriber that the patient has received adequate aftercare (old 30.04) has been removed, as the supplier now has a duty to ‘make arrangements’ for aftercare.
The new 30.04 advises that patients should not be supplied with more lenses than will take them up to the expiry of their specification.
A new section on supervision and general direction (30.07 et seq) gives advice as to the responsibilities that are incumbent on an optometrist who is supervising or generally directing a contact lens sale. 30.10 lists things that protocols for the supply of lenses should include.
30.11 and 30.12 give advice on the new duty to provide aftercare that is imposed by the Opticians Act.
30.13 reminds members that, should a complaint arise, the GOC will consider the whole circumstances of each case in deciding whether or not the optometrist has fulfilled their responsibilities to the patient.
Chapter 36
36.05 has been updated to include the reason for the referral.
Chapter 37
37.08 advises that VA is subject to the Data Protection Act, and so patient consent is required before this information is divulged to third parties.
37.09 advises that the patient’s PD is not a required part of the prescription. It advises that it is in patients’ best interests that their spectacles are dispensed by a qualified optometrist or dispensing optician.
Chapter 39
The old 39.06, relating to read made spectacles has been deleted.
A new 39.08 has been added, to reflect the new s.27(s)(b) of the Act.
Chapter 40
This section has been largely re-written and should be read in its entirety. The changes reflect the changes in the medicines legislation. The changes are to separate the chapter into sections on the use of drugs in optometric practice, supply of drugs in optometric practice, co-management schemes and the storage and disposal of drugs.
40.02 outlines the changes to the medicines legislation with the two categories of exemption.
40.03 advises optometrists to include their GOC number on written orders.
40.09 et seq covers the supply of drugs in optometric practice, recommending that supply is normally done by a pharmacist.
40.12 if the optometrist does decide to supply therapeutic drugs to their patients they have a duty to ensure that this drug is appropriate for the patient. Supply should normally only be made following an eye examination, or within a reasonable time afterwards.
The chapter now includes advice on co-management schemes (40.15) and the storage and disposal of drugs (40.16 and 40.17).
The information section also now includes a paragraph on patient group directions (40.22) and the pharmacists’ code of ethics relating to the supply of pharmacy medicines (40.23).