When the Opticians Act was rewritten in 1989 to include the relaxation of competition rules that allowed practices to advertise their prices, the consumer was the real winner. No longer were Deirdre Barlow and Elton John used to drive sales, but it did lead to phrases like ‘should’ve gone to…’ Successful advertising is now defined by who has the largest budget, but competition isn’t exactly fair when a single company has a 40% market share.

Technology has also changed a lot since 1989. Deep-learning artificial intelligence (AI) can detect a patient’s gender from a fundus image with extremely high accuracy; slit lamps can record an examination so patients can be shown how terrible their lid hygiene is and spectacle lenses can change power with a flick of a switch. We don’t know what technology will exist 35 years from now and this is where the General Optical Council (GOC) has a problem: it can’t regulate a landscape that is changing so rapidly. The GOC needs to make sure the Opticians Act is fit for whatever the future might bring, and they need the flexibility to address these issues. The GOC’s stakeholders have already said it needs to take action now.

The GOC has called for evidence on the Opticians Act in arguably its most important consultation this decade, but it needs to listen to the respondents. In the consultation document the GOC states, ‘we have already started to develop our policy thinking.’ This left me wondering if perhaps the consultation is simply a tick box exercise for the GOC to justify decisions it has already made? It did nothing for my confidence as I sat and read through all 29 pages of the accompanying document and decided whether I had the will to answer all 54 questions.

Restricted change

An example of an area they are looking at is the right to refract for dispensing opticians. The Association of British Dispensing Opticians (ABDO) has long campaigned for change, but the GOC has put up barriers. In a 2012 article by Peter Black, then ABDO vice president, mentioned that for dispensing opticians to be given the right to refract it would require a change to section 24 of the Opticians Act. However, recent models of care like Brillen UK, who use Indian optometrists unregistered in the UK to perform refractions, have raised questions on the restrictions the GOC has imposed on dispensing opticians. Especially since when Optician asked the GOC about Brillen’s model last year, the GOC said: ‘Refraction for purposes other than the sight test is not restricted by the Act.’ This makes me wonder if the GOC is enforcing this on its registrants because it is the only group it can maintain control over.

Some would argue that the GOC has already lost control over the sale and supply of contact lenses as they have struggled with non-UK sellers in the past and now concede that ‘it is not realistic to expect the GOC to achieve legislative reform that enables [the GOC] to routinely act against non-UK sellers.’ Its solution baffles me, though: de-regulate all contact lens sales and transfer the onus of compliance to the consumer. While it might make their job easier, it is not a solution that supports its remit to protect the public.

The future holds endless possibilities as we enter the age of the AI revolution. The GOC says it ‘wants to explore how a regulator can ensure that this technology is safe, that patients are protected, and who is responsible should things go wrong in these circumstances.’ This raises questions on what good regulation of AI looks like and how we could even begin to develop a framework for it. We all know what happens to a registrant when pathology is missed, but what should we expect if a computer were to miss pathology? I’m doubtful I will see ‘Standards for Robots’ in the next 35 years, but at the same time it wouldn’t be fair to registrants if computers and data sets were not held to the same standards of practice.

There is so much to consider and although I am disheartened by the massive size of the consultation, I wouldn’t expect anything less for something so important for the future of the profession. However, I don’t feel entirely confident in the GOC’s ability to address a changing landscape, after all, it did acknowledge some of its statements during the pandemic caused ‘confusion and concerns,’ but I do agree with the stakeholders in that we need to take action now.