Risk in the optical professions Final report General Optical Council July 2019 Thornhill Brigg Mill, Thornhill Beck Lane, Brighouse, West Yorkshire, HD6 4AH T: 01484 404797 W: www.enventure.co.uk Enventure Research 1 General Optical Council – Risk in the optical professions – Final report Report prepared by: Matt Thurman [email protected] Andrew Cameron [email protected] Kayleigh Pickles [email protected] Enventure Research Head Office: Thornhill Brigg Mill, Thornhill Beck Lane, Brighouse, West Yorkshire HD6 4AH T: 01484 404797 London Office: Smithfield Business Centre, 5 St John's Lane, London, EC1M 4BH T: 0207 549 1616 W: www.enventure.co.uk E: [email protected] Reg no: 4693096 VAT no: 816927894 Enventure Research 2 General Optical Council – Risk in the optical professions – Final report Contents Executive Summary .............................................................................................................................5 1. Introduction ................................................................................................................................. 11 1.1 Background ................................................................................................................................... 11 1.2 The research questions ................................................................................................................. 11 1.3 The professions regulated by the GOC ......................................................................................... 12 1.4 The definition of risk ...................................................................................................................... 12 2. Methodology ................................................................................................................................ 13 2.1 Overview ....................................................................................................................................... 13 2.2 Risk in the optical professions survey ............................................................................................ 13 2.3 Qualitative research with registrants .............................................................................................. 14 2.4 Qualitative research with stakeholders .......................................................................................... 15 2.5 Analysis of secondary data sources .............................................................................................. 17 2.6 Literature, publications and other research .................................................................................... 18 3. Reading this report...................................................................................................................... 20 3.1 Interpreting survey data ................................................................................................................. 20 3.2 Interpreting qualitative feedback .................................................................................................... 21 3.3 Terminology and clarifications ....................................................................................................... 21 4. Perceptions of levels of risk in current optical practitioner roles ............................................ 22 4.1 The current level of risk in practice for optometrists ....................................................................... 22 4.2 The current level of risk in practice for dispensing opticians .......................................................... 28 4.3 Level of risk in comparison with other roles ................................................................................... 35 5. Likelihood and severity of all risks ............................................................................................ 38 5.1 Perceived likelihood of all risk factors ............................................................................................ 38 5.2 Perceived severity of all risk factors ............................................................................................... 40 5.3 Perceived likelihood and severity of all risk factors ........................................................................ 42 6. Competency risks ....................................................................................................................... 45 6.1 Likelihood and severity .................................................................................................................. 45 6.2 Misdiagnosis and failure to detect disease .................................................................................... 46 6.3 Failure to refer and inappropriate referral ...................................................................................... 48 6.4 Poor contact lens fitting and aftercare ........................................................................................... 49 6.5 Lack of clinical confidence or experience....................................................................................... 50 6.6 Lack of up to date knowledge and skills ........................................................................................ 51 6.7 Poor administration and record keeping ........................................................................................ 52 6.8 Sight test prescribing errors ........................................................................................................... 53 6.9 Poor dispensing of spectacles ....................................................................................................... 55 7. Conduct risks .............................................................................................................................. 57 7.1 Likelihood and severity .................................................................................................................. 57 7.2 Inappropriate behaviour towards patients or colleagues ................................................................ 58 7.3 Not maintaining confidentiality ....................................................................................................... 59 Enventure Research 3 General Optical Council – Risk in the optical professions – Final report 7.4 Physical or mental health concerns ............................................................................................... 60 7.5 Not being honest when things go wrong ........................................................................................ 60 7.6 Poor communication with patients ................................................................................................. 64 7.7 Poor communication with colleagues ............................................................................................. 67 8. Contextual risks .......................................................................................................................... 69 8.1 Likelihood and severity .................................................................................................................. 69 8.2 Poor or inadequate equipment ...................................................................................................... 70 8.3 Time constraints with patients ....................................................................................................... 71 8.4 Poor or inadequate staffing ........................................................................................................... 74 8.5 Commercial and performance target pressure ............................................................................... 75 8.6 Remote or isolated practice ........................................................................................................... 78 8.7 Working as a locum ....................................................................................................................... 79 9. Changes in the optical sector and the impact on risk .............................................................. 83 9.1 The changing level of risk associated with the optical professions ................................................. 83 9.2 Factors influencing change ............................................................................................................ 84 9.3 Changing scope of the role of optical professionals ....................................................................... 85 9.4 Development of technology and artificial intelligence ..................................................................... 90 9.5 Population changes ....................................................................................................................... 96 9.6 Changes to the NHS ..................................................................................................................... 97 9.7 Changes in consumer expectations and behaviour ....................................................................... 99 10. Future risk .................................................................................................................................. 103 10.1 Suggestions of risks in the near future ....................................................................................... 103 10.2 Future risks posed by the changing roles of optical professionals, an ageing population and pressure on the NHS .........................................................................................................................