Who is it that guards the guards? Whenever I engage with anyone in the NHS there is a random chance that I will meet an international health care professional. This may be a Philippino nurse, an Indian doctor or an Australian dentist. Rarely, however, have I come across a non-British trained optometrist. For some reason it has always been incredibly difficult to acquire British registration from overseas.

For decades this was because in our view of the world British optometry was the pinnacle of optometric scope of practice, however, this ceased over 30 years ago as the already diagnostic drug equipped US optometrists moved into therapeutics and latterly as first Australia, then New Zealand and finally Canada acquired such rights. We are now firmly fifth in the global pecking order.

Despite our wide-ranging Independent Prescribing legislation there are still only about 4% of registered optometrists who are IP. There appears no possibility of new registrants graduating with this speciality because our professional body is set firmly against the concept, no university is prepared to break ranks and seemingly every month yet another same-as optometry course is announced. Meanwhile, the GOC’s educational strategic review appears to be still gathering information.

Anther potential reason for restricting trade (for that is what it is) is a fear that the near monopolistic multiple sector would use this route to increase optometry numbers and further lower declining salary levels. Many of us are old enough to remember the 1960s horror stories of Australian dentists, residing in Earls Court, conducting trench fillings before flying home with a backpack full of cash! For goodness sake surely we have moved on?

Sadly no. Last month the GOC tabled papers at council that placed incredibly onerous obligations on potential non-EEA registrants that has effectively closed the door. The bottom line is that any non-EEA optometrist has to suffer the ignominy of first having their course and qualification assessed as being up to Stage 1 level (the defunct PQE 1 examination that every UK degree optometrist is exempted). Bad enough, but once through this hurdle the ‘lucky’ applicant will then have to sit the entire professional qualifying period and undertake assessment of all competencies right through to the final OSCEs.

This entire process seems to have passed under the opto-political radar and it is impossible to believe that the GOC has undertaken any meaningful consultation with the profession, the universities or international colleagues. The question has to be who exactly is providing high-level educational and professional scope of practice advice to the regulator.

There are two areas of huge concern. First the GOC and ipso facto the British are setting themselves up to be on some sort of pedestal that our situation is so unique that in spite of any number of years experience or competence no test can be set to establish a public safety profile that is worth the risk. It is tragic that this is before the Honey Rose case has completed the FTP process (Honey Rose was trained in India and completed a previous non-EEA system).

The second area of concern is the de facto clampdown on any intellectual exchange at higher educational levels. All UK universities oblige their clinical lecturing staff to be registered with the GOC and this now imposes an impossible burden that a clinical teacher possibly a doctor of optometry with a PhD is obliged to complete a pre-reg period (and register with the GOC as a student while they do). There are non-clinical lecturers within optometry but we do not have any concept of an academic clinical licence. Can we really have students taught by qualified and experienced clinical optometrists who cannot register as clinicians? With this system we are destined to a self-perpetuating closed gene pool of academic optometrists apart from what we export.

The biggest stumbling block to achieving IP, apart from the professions side-step into Mecs and the, at best, ambiguity of the College, is the lack of clinical placements as a result of local ophthalmological intransigence. Surely we need clinically capable academic optometrists to advance this and there are fewer IP registered optometrists among academic staff than there are in the community. The GOC is denying this recruitment avenue out of misplaced loyalties and an inflated perception of its role in public safety. The only real difference between practice in the four countries above us will be understanding the now almost irrelevant GOS sight test, managing the inter-professional hierarchy of the NHS and a few drug names. Surely it is not beyond the wit of man to facilitate and delegate this task to a higher education institution (the College is not the only route to registration) with the bulk of the cost to be borne by the putative registrant.

Frankly the publically available GOC council papers dismissing any such tender or approach is a hugely disingenuous insult to the intelligence of 14,500 optometrists and those universities training optometrists. Please, GOC, consult and think again. This is unworthy of a professional regulator. If you want to understand risk, talk to the indemnity providers, they will tell you by virtue of premium and schedule if incoming USA, Canadian, Australian or Kiwi optometrists constitute a risk to public health. I doubt that they do.