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Codes of Conduct consultation

As part of the consultation around the proposed new Codes of Conduct, the GOC held a discussion event on 16 April. A variety of stakeholders attended including registrants, members of the public, students and representatives of patient groups, optical bodies and other regulators.

The event provoked lively debate which will help the GOC formulate its revised Codes of Conduct. The key focus was a series of breakout groups to explore some of the outcomes of the GOC’s proposed new codes of conduct. This fell into four main categories:

Standards of behaviour
Equality and diversity
Promoting the Codes of Conduct

The GOC received positive feedback from the event with the vast majority of delegates finding it ‘useful’ or ‘very useful’ and all saying they would consider attending future GOC events.

Delegates particularly enjoyed the breakout groups and the opportunity to share views with other people. The GOC also took on board improvement points that delegates fed back and will address these for future events.

The next similar events are likely to be in the autumn around the GOC’s revalidation proposals. Please email if you would like details of these events when they are available.

What happened next? 

The consultation period closed on 24 April with a healthy response rate. Analysis from both the event and the written consultation was analysed by Council and we have now published a new Code of Conduct. This will take effect from 1 April 2010. 

Feedback from the event

Should an optometrist be obliged to report concerns about their own or a colleague’s fitness to practise?

Case study 1 concerned an optometrist who had been convicted of drink-driving. His colleague was concerned that he had also been drinking at work. Groups also discussed whether a disease affecting his physical health should be treated differently to alcoholism.

Groups were keen to distinguish between alcoholism as a disease and a single conviction for drink-driving. Groups felt that alcoholism is a disease that could potentially render someone unfit to practise. On the other hand, there was a feeling that a drink-driving conviction did not in itself render someone unfit to practise – it could be a one-off mistake that would not put a patient’s wellbeing at risk. On the other hand, being drunk at work is a much more serious offence.

Groups raised concerns about indiscriminate reporting, trivial cases inundating the GOC and at what point someone becomes unfit to practise.

With FTP issues inside and outside work, the underlying question that groups asked was whether this is damaging to the patient?

Concerns were raised about the speed at which the GOC comes to a decision. Delegates stressed that the FTP system needs to be robust enough to prevent abuse and such that the GOC should be able to filter such cases out.

A delegate mentioned that the General Dental Council already has a similar provision in their code of conduct. The issue of protecting whistle blowers was also raised.
One group mentioned that the first port of call should be to get help for the registrant. Registrants must report convictions to the GOC anyway, but an addiction is less clear-cut and would depend on the registrant acknowledging that he was addicted. A delegate noted that there was not a panel or any other mechanism to deal with these cases.

One group decided that it would depend on whether the registrant was an employee or self employed. If employed then there would probably be a company policy for this and his colleague should notify the employer. If not he should seek advice from a colleague, the LOC or AOP and only notify the PCT or GOC as a last resort. For dispensing opticians the PCT would not be an option as they don’t register with them. One delegate made the point that employers can be lay people without adequate knowledge of whether someone is fit to practise or not.

Particular concerns were raised about degenerative illnesses such as Parkinson’s Disease – at what point is somebody not fit to practise? Such an eventuality would need an investigation but there is a scale of illness – it would be hard to regularly monitor this to ensure they are still fit to practise.

The issue was raised as to whether registrants would be safe to report this to the GOC and they shouldn’t get into trouble for reporting physical health problems. It should only be brought to the GOC’s attention if no remedy is available in-house. There could possibly be a trial period to improve conduct. If the situation continues this should then be brought to the attention of the GOC. 

Case study 2 concerned an optometrist who employed other optometrists. She was concerned about the record-keeping and clinical decision making of one of her employees.

The general feeling was that training and performance management were more sensible courses of action than reporting to the GOC. The employer should be setting and explaining her own standards and have standard review processes at regular intervals as in any job. The employer should supervise the employee before reporting if there is no immediate short-term risk.

If such issues were recurring they needed to be rectified. The period of time where the employer should take action was variable, however, and it required pragmatism.
Where clinical competence was involved it is of greater urgency than record-keeping. Groups distinguished between issues which would not harm the patient and clinical decision-making which would.

The employee was obviously competent enough to be on the register and to have passed a selection process for the position. References and CET should have been checked at that time. It was agreed that in house training should be offered and maybe supervision for a time. The GOC should only be involved after all other avenues had been pursued.

What kinds of behaviour, whilst practising or not, should put a person’s registration at risk?

Accessing lawful pornography at work

Although in a work situation this may be viewed as gross misconduct, some groups saw this very much as an issue for the employer and not the GOC. The key word was lawful and it should not be an offence worth losing your registration. It should be a matter of internal discipline, especially if it could be viewed by other staff members. If children or vulnerable adults could have seen it, then that is a far more serious offence.

Another group felt this is initially an employment issue and the employer should issue a warning, though as this took place in the examination room, it could also be referred to the GOC. If he were an employee, there would probably be a policy to cover this and it would be an employment issue and maybe a disciplinary matter. 

Claiming for replacement spectacles that have not been provided to the patient

Groups took a very strong point of view that fraud is fraud, no matter what the amount, and that this is wrong. This should be reported to the PCT Counter Fraud Services. This is theft, whatever the amount and if the registrant is found guilty, it must be reported to the GOC.

A female registrant given a suspended sentence attacking her husband

Groups felt this had to be reported although there could have been extenuating circumstances. It’s a criminal assault but there is a need for proportionality and the process has to be honest and transparent.

People have a right to make mistakes and it is once again a matter of whether patients were at risk. It was pointed out though that the GOC would be at fault if it did nothing in such an instance and then something worse did happen. However, it was felt that the process should not be to automatically strike off the registrant.

It would probably be common knowledge so it could damage the optometrist’s reputation. As it was a suspended sentence, the courts would not consider her a danger to anyone else.

A PCT has suspended a registrant due to concerns about their clinical competence

It was felt that the PCT should tell the GOC – if a registrant is suspended, the GOC is one of many bodies that a PCT must tell. There was a feeling that this takes away the responsibility for optometrists to be reporting each other – if there are good performance management systems in place within the PCT, there is less need to report this to the GOC. 

Do the proposed Codes cause equality and diversity issues?

Concerns were raised about issues such as language barriers and wheelchair accessibility. Although these should be covered by the NHS Patients’ Charter, there were concerns about how well publicised this is.

It was agreed by one group that the optical profession is a generally diverse field already. They felt the proposed wording adequately covered needs – opticians already work under existing legislation such as the Disability Discrimination Act (DDA) and Race Relations Act (RRA) and repeating such legislation in the Codes of Conduct would only cause confusion.

A group pointed out that the NHS or employers can dismiss someone when they reach retirement age but retirement age would not be a bar to GOC registration. There was agreement that it is good that the GOC sticks to judging registration on competencies and not on age.

Some important issues were raised that fell outside the remit of the Codes of Conduct. For example, the GOC will be looking at how we can help to boost registrants’ awareness of disability issues to help patients.

Promoting the Codes of Conduct

It was pointed out that the codes are hard to find and should be a lot higher up on the GOC website. There was a suggestion of a small poster similar to statutory health and safety information, giving a brief summary, saying something along the lines of “we operate under the codes, for more information please see…” It was suggested that this should be small, to fit perhaps on the reception desk. There was also the suggestion of a logo for registrants saying they are registered with the GOC that they can use in their shop and for correspondence. Certificates should be on display.

There is also the need to know who the different staff are in opticians’ practices as customers are not always sure who they’re dealing with and the accountability is not clear. It should be made clear to patients that optics is a profession with proper standards.

There was a suggestion that when you order a sight test online it could link to the GOC codes. This plan may, however, prove impractical.

Not all groups felt it necessary to let patients and the public know what the Codes of Conduct contained, just that it existed and where to find it.

The GOC is continuing to look into this issue and conducted a poll in the recent issue of eBulletin.