GOC consultation on Disclosing confidential information about patients guidance

Using the guidance

16. Is the guidance presented in a way that is clear, accessible and easy to use?

Yes

17. Is anything missing, incorrect or unclear in the guidance?

Yes

Please explain your answer, with reference to the guidance where possible.:

Please see our answer to question 18 below.

18. Does the new supplementary guidance make clear what the GOC expects of its registrants?

Not sure

Please explain your answer, with reference to the guidance where possible.:

The most common situation in which optometrists are likely to need to consider breaching patient confidentiality is when a patient consults an optometrist and indicates that they are driving when they may be unfit to do so. Optometrists often worry about disclosing information about their patient to the DVLA, even when the patient has indicated to the optometrist that they are still driving when they are unfit to do so, and the patient themselves should have notified the DVLA already.

We welcome paragraph 25 of the GOC guidance, which says ‘In cases where a patient who drives and is unfit to do so either will not or cannot notify the DVLA/DVA, you should notify the DVLA/DVA yourself if you are concerned about road safety, in relation to both the patient and the wider public.’ We agree with this guidance, which is clear. Optometrists can then refer to College Guidance which encourages optometrists to consider the consequences of not raising this (paragraph A222) when asking themselves whether they should act.

We agree with paragraphs 29-31, which are similar to College Guidance, paragraph A223.

We note that paragraph 33 of the GOC guidance states that optometrists should notify the patient’s GP ‘if possible’, whereas College Guidance (A223e) says this should be done ‘if appropriate, with the patient’s consent’. As part of our forthcoming guidance review we will be considering whether to retain this sub paragraph, as part of a discussion as to whether notifying the patient’s GP is necessary.

We agree with the AOP that paragraph 35 of the GOC guidance is not clear and should be phrased in more definite terms, as is paragraph 25. We also agree with the AOP, that it is not a matter of professional judgement for the optometrist as to whether or not the patient will not or cannot notify the DVLA/DVA themselves. The professional judgement should relate to whether or not the patient meets the vision standards for driving, as the nature of the subjective tests involved will always cause some variation, and so decisions around the borderline are not clear cut. We agree with the AOP’s suggestion that it would be better if the GOC guidance said ‘if it appears that the patient would not meet’ the visual standards for driving. Paragraph 25 could then read ‘If a patient drives and you consider they do not meet the visual standards for driving and they will not or cannot notify the DVLA/DVA, you should notify the DVLA/DVA yourself if you are concerned about road safety, in relation to both the patient and the wider public’.

We agree with the structured approach as laid out by the AOP.

19. Will the guidance help registrants to understand when and how to apply their professional judgement to override patient confidentiality and consent, i.e. when there is a duty to protect the public from risk of harm?

Yes

Please explain your answer, with reference to the guidance where possible.:

We feel it is helpful for the GOC to clarify that patient confidentiality, although an important part of optometric practice, is not absolute, and to discuss situations in which this can be breached. We largely agree with the guidance, but we have seen the AOP’s working paper on this and agree with them that section 2, which is by far the most likely situation that optometrists are likely to experience, could be made clearer.

Please see our answer to question 18 above.

20. Is the supplementary guidance sufficiently flexible to accommodate any differences in practice within the optical sector (for example, differences in the nations of the UK or in how optical care is provided)?

Yes

21. Are there any specific issues or barriers which might prevent registrants from using the guidance?

Yes

Please explain your answer, with reference to the guidance where possible.:

Please see our answer to question 18 above.

22. Would any further supporting activities be beneficial to registrants in implementing the guidance?

Yes

Please explain your answer, with reference to the guidance where possible.:

We feel that some sort of decision tree, as laid out by the AOP, would be helpful. Alternatively, an online decision aid as on the GMC website could be useful. We also feel it would be helpful if the GOC could reference to College Guidance, which covers this issue.

Disclosing information to the DVLA/DVA

23. Will the guidance give registrants more confidence to report directly to the DVLA/DVA, where appropriate?

Yes

Sharing information with other healthcare professionals

24. Will the guidance give registrants more confidence to share information about patients with other healthcare professionals, such as GPs?

Yes

Impact

25. Overall, do you expect that the guidance will be beneficial to, or have a positive impact on protection of patients and the public?

Yes

Please explain your answer, with reference to the guidance where possible.:

It gives greater clarity for optometrists and patients in this difficult area.

26. Overall, do you expect the guidance will be beneficial to, or have a positive impact on individual GOC registrants (optometrists and dispensing opticians)?

Yes

27. Are there any aspects of the guidance that could have an adverse or negative impact on any group of patients, the public, GOC registrants or others?

Yes

Please explain your answer, with reference to the guidance where possible.:

There is a danger that patients with correctable poor vision may be deterred from seeking optometric services if they are worried that their vision is not up to standard and they feel that the optometrist may inform the DVLA of this. This may happen even if the patient’s vision may be correctable to the standard with a change of spectacles, for example. The consequence of such patients not seeking optometric advice is that they will continue driving with poor vision when this could be improved if they visited the optometrist.

28. Are there any aspects of the guidance that could discriminate against stakeholders with specific characteristics? Please consider age, sex, race, religion or belief, disability, sexual orientation, gender reassignment, pregnancy or maternity, caring responsibilities or any other characteristics.

No

Publication

31. Can we publish your response?

Yes

Submitted: June 2019