UK opticians call for mediation service

By Laird Harrison

The UK Federation of (Ophthalmic and Dispensing) Opticians (FODO) is calling for a mediation service to handle disputes over refractive surgery.

“In the rare case where trust breaks down, patients have little recourse other than to go to the regulators or to go to court,” said FODO Chief Executive David Hewlett.

The provision is included in draft standards for refractive surgery being devised by the UK Optical Confederation, a consortium of optical industry and professional associations that includes FODO.

The existing Optical Consumer Complaints Service already provides mediation between consumers and professionals in the United Kingdom regarding contact lenses and glasses, and its purview could be extended to refractive surgery, Hewlett suggested.

“It’s very cost effective,” he said.

The Optical Consumer Complaints service is run by the law firm, Nockolds Solicitors, and is funded by the UK General Optical Council, which regulate opticians, optometrists, and dispensing opticians.

It refrains from assisting in “claims involving allegations of negligence or where there are concerns about the practitioner’s fitness to practise,” offering referrals to solicitors in these types of complaint.

The draft standards of the Optical Confederation, “Multi-Disciplinary Professional Standards for Refractive Surgery Providers and Clinical Teams,” specifies that in instances where trust has broken down during refractive surgery, “providers should support the patient in accessing an appropriate independent dispute resolution service and, if requested by such a service, be willing to fund any reasonable, agreed costs of corrective surgery.”

The Optical Confederation is reviewing public comments on the proposed standards, having closed its consultation on 7^th April.

“Depending on the outcome of our consultation, what we hope is to lobby the regulators in the UK to ask them to make complying with a mediation service a condition of the license of providing services,” Hewlett remarked.

Registry to track outcomes

Another key provision outlined in the Optical Confederation draft standards is the creation of a registry to track outcomes of refractive surgery. Over time such a database could be used to improve refractive surgery techniques, Hewlett said.

“That will be great if we can get everyone signed up for that,” he said.

The Royal College of Ophthalmologists (RCO) is also promulgating new standards, “Professional Standards for Refractive Surgery, which it plans to implement on 1^st June.

The two sets of standards “should dovetail,” Hewlett suggested.

However, the Optical Confederation felt compelled to create its own set of standards because the RCO standards were designed with only ophthalmologists in mind, he said.

“The Royal College guidance is uni-professional for ophthalmologists and people working directly under their supervision, whereas ours are for optometrists and others who employ them,” he pointed out. “Optometrists have roles in follow-up and pre-surgical care. There are nurse practitioners, physician assistants, opticians-a whole range of professionals coming together to meet eye health demands.”

Professional standards are particularly important in refractive surgery because most of it is performed in the private sector, outside the aegis of the UK National Health Service, said Hewlett.

“The bulk of the refractive surgery in the UK is delivered in community settings,” he said. “What there hasn’t been in the past is any clear guidance for community providers and the whole multidisciplinary team.”

In addition to FODO, the Optical Confederation is made up the Association of British Dispensing Opticians (ABDO), the Association of Contact Lens Manufacturers (ACLM), the Association of Optometrists (AOP), and the Federation of Manufacturing Opticians (FMO).

As currently drafted, the RCO standards do not mention dispute resolution.

How they differ

The two sets of standards differ in their requirements for informed consent. Both call for patients and surgeons to discuss the procedure in advance of the surgery, but the Optical Confederation specifies that “in some instances this may be conducted by videoconference or telephone.”

By contrast, the RCO standards specify that the consultation “should be a face-to-face consultation (not conducted by telephone).”

“We think the interview prior to the surgery should be face to face,” Hewlett said. “We also recognise that there are other circumstances where a teleconference would be acceptable.”

Many patients today are quite comfortable discussing surgery through video conferencing technology, he said.

In many other respects, the two sets of guidelines are similar. Regarding the reporting of data, the RCO standards calls for refractive surgeons to report safety concerns and annual data about outcomes of their own practices and to “contribute to national programmes to monitor quality and outcomes, including those of any relevant device registries.”

Both the professional organisations’ proposed standards reference the General Medical Council (GMC), which has stated that standards for refractive surgery should be similar to those for cosmetic procedures laid out in its June 2016 document, “Guidance for doctors who offer cosmetic interventions.”

The draft standards both extrapolate from the principles in the GMC guidance to provide more detailed rules specific to refractive surgery.