Practice Director, Specsavers Blackburn

I would start by running an assessment and audit of the risk to previous patients who may not have been dilated, with potential recall and re-examination. I would also consider how to support the education and training of this colleague.

Challenging a colleague on competency can present some potentially uncomfortable conversations. We have regular optometry meetings, and this would be a good opportunity to have “When to dilate?” as a discussion point. Among our team, we try to get agreement as to how to deal with similar clinical presentations: “So we are agreed, if such and such presents, we are all going to do this.”

But the nettle needs to be grasped and someone needs to have a supportive discussion with this colleague about why they do not dilate, as the consequences to patient safety are so serious. From this, should they agree to change their clinical decision-making and they undergo further accredited and appropriate training, I would suggest a period of supervision then a further three-month review.

However, if they refuse to accept the clinical necessity of dilation, then I’d argue whether they should be practising at all.