Fairer and more inclusive eye services

GOC’s draft corporate strategy 2025-30 includes an objective of creating fairer and more inclusive eye care services. We’ve chosen this because while our evidence suggests the last five years have been successful for patients in overall terms, the benefits have not been equally shared among different sections of the population.

This year’s GOC Public Perceptions Survey provides fresh insight into why this is so important. Mirroring results in previous years, around nine in ten patients were satisfied with their overall experience when visiting an opticians/optometrist practice – this is something for the sector to take great pride in. However, patients from an ethnic minority background were less satisfied than white participants (84% vs. 91%) and those with a disability were also less likely to be satisfied with their overall experience (82% vs. 89% of those without a disability).

Registrants are likely to interact with patients in vulnerable circumstances regularly as part of their practice. Vulnerability is not limited to protected characteristics in equalities legislation, but also includes things like personal circumstances and someone’s confidence in managing their own health. Therefore, we asked new questions in this year’s survey to understand how ‘vulnerability markers’ impact on patient access to and experience of eye care. We tested for a range of markers, including financial (e.g. low income), going through a difficult life event (e.g. bereavement), having a disability, and low confidence in managing your own eye health.

The figures suggest that vulnerability has a significant impact on both access and experience, especially where there are multiple markers (see chart). For example, 82% of participants with no markers of vulnerability had a sight test in the last two years compared to 63% of those with four or more markers. Similarly, 94% of participants with no markers of vulnerability were satisfied with their overall experience compared to 77% of those with four or more markers.

These issues are not unique to eye care and reflect wider societal problems beyond our remit. Tackling them effectively will be a long-term journey and involve many actors. But how can GOC, as a statutory regulatory body, begin to make a positive difference?

Firstly, by carrying out surveys like this, highlighting the findings, and publishing the raw data sitting behind them for anyone to use. We’ll continue to refine our methodology and our commitment to conduct the survey annually means we’ll be able to track trends. While quantitative research provides useful information, qualitative research helps to get under the skin of the issues. We’ll soon be commissioning ‘lived experience’ research designed to bring these numbers to life and provide insights for policymakers to turn into effective interventions.

Secondly, it’s important for registrants to be alert to patients in vulnerable circumstances and adjust their practice, as necessary, to take account of any additional needs. Last September, the first cohorts of students began qualifications that meet our new education and training requirements. The new outcomes for registration include “taking into consideration the additional needs of vulnerable people and specific requests/requirements”. We’re currently completing our update of the GOC’s standards of practice following public consultation. If adopted, the revised standards will require registrants to identify, support and treat patients in vulnerable circumstances appropriately. Since our CPD scheme maps onto the standards of practice, patient vulnerability will become a growing feature of lifelong learning. Finally, in a small number of cases, we may need to investigate concerns as a fitness to practise matter.

Thirdly, by working in partnership with others. While our harder-edged regulatory tools are important, ultimately success will lie in supporting both individual and business registrants to improve their practice. For this reason, the draft corporate strategy also includes themes around supporting responsible innovation that can dismantle barriers to access and improve services, working more closely with patient groups and using our convening role to bring the sector together to tackle issues requiring a collaborative approach.

While pleasing that public satisfaction and trust levels remain high overall, it’s worrying that experience of eye care can vary considerably based on someone’s background and life circumstances. We know registrants want to give all patients the best possible care and the sector needs to work collaboratively to reduce the inequalities revealed by our survey.