29 January 2025

College responds to GOC consultation on Business Regulation

We have responded to the General Optical Council (GOC) consultation on regulation of optical businesses.

Summary

The College broadly welcomes the GOC’s proposals for changes to its framework for regulating optical businesses. We believe these will ensure consistency, and provide better patient protection and reassurance.

The proposals include bringing charities and university eye clinics into regulation, which we believe will be a positive step in enhancing protections for patients and staff; but we do have some concerns around duplication of regulation, and the impact of the administrative burden and cost, which we have highlighted in our response.

The proposal to require the appointment of a Head of Optical Practice (HOP) in each business is one that we welcome in principle, but the practicalities of appointing a HOP could be challenging in some practices, and there could be many deterrents to individuals adopting the role. We currently do not feel that a separate set of conduct standards for the HOP would be necessary.

The College also believes that the current Optical Consumer Complaints Service (OCCS) works well as a non-mandatory intermediary, and we see no reason to change the system.

Our response

A: Scope of regulation

Somewhat agree.

There could potentially be benefits to the GOC regulating GP practices and hospitals (NHS and independent), such as comprehensive GOC coverage and uniformity, patient reassurance and protection. 

However, these providers are already regulated by the CQC. As optometrists providing restricted functions in these settings will be regulated as individuals (and other healthcare professionals by their regulator) we think it could be disproportionate and unrealistic for the GOC to seek to regulate these settings as well. 

Furthermore, consideration needs to be given to the increased cost and burden of extra regulation on GP practices and hospitals, the evidence for such regulation being required, and the impact of this on wider patient care and services.

There could also be unintended consequences of regulating GP practices and hospitals, such as duplication of regulation, and the potential conflicts arising where contradictions and misalignments between different regulators occur. This could lead to complicated and unnecessary challenges.

Yes.

Whilst we believe it could potentially be disproportionate for the GOC to regulate GP practices and hospitals (see response to Q1), it would be beneficial - to ensure consistency and uniformity - that units providing commercial functions are regulated, particularly as some independent providers operate out of GP practices. This occurs for example where a room is hired in a GP practice by an optical business, in which restricted functions may be carried out. It would be important that these entities are regulated, as they are most likely not subject to the CQC regulation of the wider practice/hospital.

However, we would wish to see a clearer definition of what the GOC considers a ‘commercial unit’ before commenting further.

Somewhat agree.

We broadly agree with the principle that charities providing restricted functions should be regulated, in order to give users of their services confidence and protection. There is no compelling reason why standards for the users of these services should be, or be perceived to be, any lower than for any other provider.

We note as per Annex 2, that there are currently only four registered charities that provide specified restricted functions, three of which are already under GOC regulation, and we see no reason why all shouldn’t be. Should more charities begin to provide such functions in the future, we believe they should be considered on a case-by-case basis, but would anticipate that they should fall under the scope of GOC business regulation. 

Feedback from the College’s Policy Advisory Panel and Board, strongly recommends that the GOC should consider a fee exemption or a reduced fee model for charities, given that they are not primarily operating a for-profit model.  A fee could be a deterrent to new charities emerging to offer vital services to vulnerable groups and could reduce the ability of any charity reaching and benefitting the widest possible cohort of patients.

Somewhat agree.

This is a potentially complicated area of regulation. 

Whilst welcome in principle, university eye clinics exist as part of an educational setting and are not necessarily separate businesses to the University. They exist to support undergraduate teaching courses, while also providing restricted functions to patients, and are already subject to education-related GOC regulation to accredit courses. We would need reassurance that there will be clear distinction between both aspects of regulation e.g. education panel visits and business inspections, and that there wouldn’t be over-lap and duplication. 

We think that to ensure consistency and patient protection and reassurance, and to protect students and staff, regulation of university eye clinics would be positive, and we would be in favour of a light-touch approach.

Our Policy Advisory Panel have also suggested that consideration may need to be given to a reduced fee model for university eye clinics, as they are not-for-profit and university budgets should be focussed on ensuring optimal education provision.

Somewhat disagree.

We believe the GOC should establish from the start which entities fall under their regulatory remit, and which don’t. However, it may be useful for the GOC to have this option available to them to be used only in exceptional circumstances.

Somewhat agree.

If this proposal is taken forward and the Head of Optical Practice model (Section B) is not adopted, there would need to be an alternative proposition to ensure overarching clinical accountability for optical businesses.

B: Models of regulatory assurance

Not sure.

Whilst we are in favour of this proposal in principle (especially to ensure safe and robust systems and processes, transparency and professionalism), the practicalities of appointing a Head of Optical Practice (HOP) could be challenging, and there could be many deterrents to individuals adopting the role.

While in large optical practices there are often multiple optometrists and dispensing opticians, in some practices there may be only one optometrist, or a practice may solely rely on locums to provide restricted functions. As such, there may not be a suitable individual to meet the requirements to assume the role of HOP. In these circumstances (particularly where the workforce may change daily), it is unclear on what basis a HOP would be identified and appointed. 

Our Policy Advisory Panel and Board felt strongly that an additional set of standards (and responsibilities set out in legislation – Paragraph 127) and accountability placed upon the HOP, would be a significant deterrent to registrants wishing to take on the role. It was felt that optometrists and dispensing opticians are already, and robustly, held to account as individual registrants, and additional regulation would be unwelcome. The additional administrative requirements of being the HOP, along with potential additional training required (particularly for locums), could be a deterrent and could reduce their capacity for clinical work. Furthermore, an individual adopting the role of HOP would, understandably, expect additional remuneration from their employer, which if not available could also deter registrants from taking on the role.

We are also concerned that, in order to fulfil the requirement to have a HOP, an individual could be ‘forced’ into the role, and may not have the suitable skills, desire or experience to fulfil it effectively.

We would like to see clarity on what powers the GOC would have should no suitable registrant be available for the role of HOP, or if no employee wishes to take up the role in a particular optical business. More detail would also be needed on the systems, policies and culture referred to in this section of the consultation.

If an HOP model is not adopted, an alternative approach to business regulation could be to strengthen the GOC’s enforcement and inspection powers and to ensure that all registrants are responsible, accountable and confident to raise concerns. 

Somewhat agree.

While the responsibilities are reasonable i.e. to ensure that the business: 

  • complies with the GOC’s standards for business registrants and other regulatory requirements and avoids breaches of those requirements; 
  • declares relevant information to the GOC, including material breaches of GOC requirements that may need investigation by the GOC; and 
  • maintains up to date GOC business registration requirements 

consideration could be given to the training required to enable registrants to confidently and effectively take on an HOP role if they have not previously had any experience of optical business management. This should include non-clinical leadership and communication with colleagues at all levels.

Our Policy Advisory Panel noted that the HOP should also receive training on how to deal with conflict or disagreements, for example where they disagree with the decisions of a lay senior manager/owner, as well as situations where a HOP and a registrant colleague disagree on a matter.

Somewhat disagree.

Education and training in optometry is a complex and technical space, for which we cannot give a full answer here, especially without more specific information on the proposal.

Under the Education and Training Requirements (ETR), qualification providers have responsibility for the quality of all learning experiences. There could be a potential role for HOP’s to have some responsibility for ensuring commitments to education providers are met and are properly managed, but not necessarily responsibilities around the “adequacy” of arrangements for training placements. In large practices, other colleagues may be better suited to be being responsible for managing the training.

If this proposal is adopted, the individual HOP may need training and support to fulfil this role. This additional level of responsibility (especially if the potential HOP lacks the experience in this increasingly complicated and technical space) could be a hinderance to registrants coming forward for the role.

Somewhat agree.

Should a Head of Optical Practice model be adopted, we believe that they should be a fully qualified GOC individual registrant. However, there may be exceptional circumstances where this is not possible e.g. to cover extended periods of HOP leave in a small practice owned by a non-registrant, and provision may need to be made to account for such circumstances.

Somewhat agree.

It would be reasonable that the Head of Optical Practice should be an individual employed by the business. However, there may be circumstances where this may not be possible, such as where no suitable candidate for the HOP is available, where the clinical services are provided by locums, or in circumstances where the HOP is on long-term leave. Provision should be made for this.

Somewhat disagree.

In most cases, it would be reasonable that for individual practices or small groups of practices, the Head of Optical Practice should be responsible for that one business. However, for some larger multiples, for operational reasons, it would be reasonable that provision is made for the individual to be responsible for several related businesses/franchises. Guidance may be needed on the potential maximum number of practices the HOP should be responsible for, and what structures should be in place for the delegation of responsibilities on a day-to-day basis.

In addition, where no HOP can be identified for an individual business, there may be no other option than to use a HOP who has a joint role across more than one business.

Somewhat disagree.

While the roles and responsibilities of an HOP should be made clear to the post-holder, we do not feel additional regulation is required. However, if the role of a HOP is ever filled by a non-registrant (dependent on acceptance of the related proposal above), the GOC may need to consider additional standards for such individuals.

Somewhat agree.

If a Head of Optical Practice requirement is introduced, it could be helpful that the GOC specify in rules/guidance, the essential characteristics that it considers necessary for the HOP. However, an unintended consequence is that if no employee or locum meets these characteristics, there would be no Head of Optical Practice. We would need to see the proposed essential characteristics first before commenting further.

Somewhat agree.

In order to ensure transparency with the public, and enhance communication between optometry practices and the GOC, this would be a reasonable measure. This would also make it clear to the public and other healthcare professionals who is responsible for ensuring the practice/s meets GOC standards.

Somewhat disagree.

There may be occasions whereby a registrant is the HOP of one practice, but also works in several other practices/businesses (e.g. as a locum) where they are not the HOP. This would cause confusion with the public. As per our response to Q15, a distinct list of businesses with the individual HOP’s name included would be a better option.

C: Enforcement approach and sanctions

Linking the financial penalty to turnover.

We believe the fairest option would be to link the financial penalty to turnover (or possibly profit), and to have a cap (i.e. a hybrid b and c option). An uncapped financial penalty would be an extreme and unnecessary measure.

One option could be to grade the penalty according to the severity of the offence, and to couple this with a dual approach of using other limitations and sanctions such as suspensions.

If a new maximum amount was selected, this should be tapered according to the size of business. We would also like to see what the new maximum amount would be before commenting further.

In all cases, the impact of financial penalties on smaller practices must be considered, particularly where a small practice is one of the few (or only) options for patient access to eye care (e.g. rural areas) and a large fine would prevent them from making the required improvements and therefore remaining operational.  While there should be a financial penalty as a deterrent, and safeguards in place to protect the public, the sanctions should not risk the provision of safe patient care in areas of greatest need. 

Somewhat agree.

Having the ability to inspect optical practices could enhance the reputation of the GOC’s role as regulator, provide additional confidence to patients and the public, and enable the GOC to fully investigate concerns where they arise – if the inspections are carried out effectively, by suitably qualified ‘inspectors’ and bring about positive change. This would also bring optometry in line with other healthcare professions such as pharmacy. This may be beneficial, as the majority of optical practices are not regulated by the CQC and therefore are not subject to CQC inspections. 

In the absence of evidence of need, we would not support the need for regular or routine inspections, but only when a complaint or issue is identified and needs further investigation.

As GOS contract holders are already subject to inspection by national health services, there is a risk that routine inspections could be duplication of work, as well as increased administrative burden and costs for optical practices. 

In our survey of members (2022), 69% said the GOC could more effectively regulate businesses if it had powers of inspection (18% were unsure and 12% disagreed). However, a further analysis of their free text responses showed that members would only support inspections in certain circumstances, particularly to investigate illegal practice or sales, to investigate fitness to practise allegations, or in situations where non-registrants were involved. 

Furthermore, inspection powers should be used and exercised fairly and appropriately. This will enable universal business regulation rules to be better enforced, and improve both public and optometrist trust in the GOC’s role as regulator.

D: Consumer redress

Somewhat disagree.

The current Optical Consumer Complaints Service (OCCS) works well as a non-mandatory intermediary, and we see no reason to change the system and make this mandatory. The current GOC triage of complaints works well and should continue. 

Strongly disagree.

The current scheme works well, and we see no reason to change the system. Legally binding decisions - in the absence of any evidence to the contrary - would be an unnecessary step.

Strongly agree.

The current delivery model and process for identifying a single provider appears fair and effective. We see no reason to change the system.

Other (please specify).

We agree with paragraph 198 in the consultation document i.e. continue with the current funding arrangements.

E: General questions

Yes.

In appointing a HOP, there is a risk that employers could favour those who are full-time employees, over part-time employees, which could affect those with childcare and other caring responsibilities. This is more likely to disadvantage female registrants – who are less likely to work full-time [GOC Registrant Survey 2024].

Yes.

If the GOC were to specify in rules/guidance, the essential characteristics that it considers necessary for the HOP, this could help enable some younger optometrists to qualify for the role, who otherwise may have been not considered experienced enough solely due to their age.

The introduction of business regulation also provides an opportunity for the GOC to further tackle the illegal supply of eye care services and optical appliances from both within the UK and abroad. 

In recent years, there has been an increase in online prescribing and dispensing of optical appliances. This raises issues concerning potential lack of appropriate supervision for the safe supply of contact lenses without specification verification, and spectacles supplied without ensuring the prescription is valid. This has always been a concern for the sector, and even more so as people’s habits related to accessing healthcare online change. We appreciate that the GOC does not have jurisdiction to take action on overseas sales, but we would like the GOC, as a minimum, to raise the issue with the appropriate national regulator/authority and have the powers to end the illegal practice occurring in the UK.

Related further reading

As the demand for ophthalmology services among new and existing patients mounts, Sophie Goodchild explores a pathway to support people on NHS lists at every stage of their eye care journey.

Olivier Denève, College Head of Policy & Public Affairs, heralds a new era in UK politics and calls for action to end the eye care crisis.

Claire Moulds examines the impact of a power of attorney on the patient relationship.