FtP Focus: why do we erase registrants from the register?

'FtP Focus: Why do we erase registrants from the register?' was emailed to registrants on 17 November 2023. The copy as it appeared in the e-bulletin is below:

Hello, and a warm welcome to our Autumn 2023 Fitness to Practise (FtP) Focus bulletin.

I recently joined the General Optical Council (GOC) as Acting Director of Regulatory Operations and am pleased to introduce the latest bulletin. In this edition, we’ll be looking at erasures from the register – why it happens and how often it occurs. As we saw in edition five of FtP Focus, erasure is one of the possible sanctions that can be imposed by our Fitness to Practise Committee if they decide that a registrant’s fitness to practise is impaired.

However, erasures are very rare as the Committee must ensure the sanctions imposed are the least severe to protect the public. Registrants may be worried they will be removed from the register for things that may seem quite minor, but as we go on to show this is not the case.

We will hear from Ian Crookall, one of our longstanding Fitness to Practise Committee Chairs, on why the Committee has decided to erase registrants and look at some case studies of registrants that have been erased.

Ian also provides some general advice to registrants on what they should do if they face an FtP hearing.

We hope you find this issue of FtP Focus useful. As always, if you have any thoughts or feedback, please email us at focus@optical.org.

All the best,
Carole Auchterlonie
Acting Director of Regulatory Operations

Why do we erase registrants from the register?

To start, Ian Crookall, one of the Chairs of the Fitness to Practice Committee, provides insight into his role and erasures.

I am one of the 12 Chairs of the GOC's Fitness to Practise Committee. One of us is selected to chair a Committee to deal with a specific case. I have been in my role for the past nine years and have been a Chair at other health regulatory bodies too.

We ensure impartiality and fairness in several ways. We are all fully trained by the GOC in interpreting Regulatory Law and the GOC standards, and we all work to guidance which the GOC issues to its committees to ensure that there is consistency. We have held special events to learn about equality and diversity issues and how to address bias when making decisions. Every decision must be supported by sound reasons which relate to the law and GOC guidance. Decisions based on poor reasons and which demonstrate unfairness or prejudice are always open to appeal.

"Whilst the duty to protect the public is the prime consideration of the FtP Committee, all my colleagues wish to restore registrants to good practice wherever that is possible."

There are a few reasons why registrants may be erased from the register. This includes failing to engage with the GOC, for example when a registrant has not provided representations during the investigation stage; failing to explain the conduct which has led to a complaint; or when some behaviour is so in breach of the GOC standards that it puts members of the public at risk and damages public confidence in the profession, for example extreme levels of persistent dishonesty. Some types of clinical failings will also give rise to erasure where a registrant has been wilful or grossly negligent in providing services to patients. However, whilst the duty to protect the public is the prime consideration of the FtP Committee, all my colleagues wish to restore registrants to good practice wherever that is possible.

In the past, I’ve been part of making difficult decisions which have led to erasure. I remember a case of an optometrist who accessed seriously offensive sexual material on the internet and which led to a conviction and being placed on the Sex Offenders Register. Strong mitigating factors were put forward with assurances that the actions were not likely to be repeated. However, the nature of the conviction and the fact that the registrant was on the Sex Offenders Register meant that there was really no alternative to erasure.

Similarly, there have been occasions when registrants have abandoned their practices leaving their patients without access to their records, and in some cases financially disadvantaged, or where older registrants have simply carried on when they were no longer able to provide the level of service which patients should expect. None of these decisions are easy. My experience is that GOC registrants have invested heavily in time, effort and expense to achieve their professional status. However, there are occasions when safeguarding patients and upholding public confidence in the profession are of greater importance than the effect on an individual registrant.

Statistics – how many registrants are erased per year?

The figures below show the number of registrants erased between 2019 and 2022. As you can see, it is a tiny proportion of the circa 30,000 fully qualified and student registrants we have on the register.

Year	Total number of erasures	Number of optometrists	Number of dispensing opticians	Number of student optometrists	Number of student dispensing opticians
2019-20	18	4	6	1	7
2020-21	7	4	3	0	0
2021-22	4	0	1	1	2
2022-23	11	4	3	0	4

What happens if an individual registrant is erased?

If a registrant is erased, the individual’s name will be removed from the register and they cannot practise as an optometrist/ dispensing optician, or in the case of student registrants, cannot continue with their training. If the individual’s name is removed from a specialty register, they cannot perform any duties associated with that specialty.

However, the sanction cannot be imposed if an individual’s fitness to practise is found to be impaired because of adverse physical and/or mental health. The most serious sanction in these cases is suspension from practice for a defined period which is kept under review.

Sanctions come into effect 28 days after the substantive hearing unless an immediate order is imposed. The 28 days is the appeal period for the registrant, so if a registrant appeals, the sanction imposed may not come into force for some months.

Case study #1: Referral from a third party regarding several clinical concerns against the registrant

The registrant in this case was an optometrist with two practices. The GOC became aware of this matter when NHS England referred it to them. The registrant had a contract with NHS England to provide General Ophthalmic Services (GOS) and routine inspections were conducted to ensure compliance.

During a routine inspection at one of the registrant’s practices, several concerns about the registrant's practice were identified by and reported to NHS England, leading to a formal investigation. Further visits and patient record reviews occurred at both practices along with meetings with the registrant.

Following this, the matter was referred to the GOC. Based on the nature of the concerns, the GOC applied for an interim order and the registrant was suspended from practising for a period of 18 months. The matter was subsequently referred to the Fitness to Practise Committee. The Committee assessed whether an erasure order was necessary, considering that the registrant's misconduct significantly deviated from professional standards and had the potential to harm patients.

The Committee found that the registrant's deficiencies in practice had not been rectified, and the registrant demonstrated no interest in addressing them. Consequently, they concluded that if the registrant were to return to practice, they would pose a risk of serious harm to individuals.

The Committee further determined that the registrant lacked insight into repeated failures and their consequences. Given the lack of improvement in patient care, including clinical failures and record keeping, the Committee had no confidence that the registrant could develop insight and learn from their mistakes. Therefore, the Committee decided that the most suitable sanction was erasure to protect the public and maintain public confidence.

The Committee also acknowledged that this decision might adversely affect the registrant but concluded that the public interest in this case outweighed any potential impact on the registrant.

Case study #2: Referral from the registrant’s employer regarding the registrant, who processed several false refunds for personal use.

The registrant in this case was a dispensing optician who worked at an optical practice.

Concerns arose about unusual financial activity at the store, involving multiple refunds processed under the registrant's operator number but not associated with any customer account. An internal investigation followed, including the review of CCTV footage, staff schedules, and refund records. During an investigative interview, the registrant admitted to suspicious refund transactions. The registrant also sent an email to the GOC, making admissions.

It was alleged that over a period of five months, the registrant processed false refunds amounting to over £5000 in cash for personal use. The matter was subsequently referred to the Fitness to Practise Committee.

The Committee determined that the registrant's misconduct significantly deviated from professional standards, and there was a risk of repetition. They believed that taking action was essential to uphold proper conduct and public confidence in the profession. Consequently, the Committee found that the registrant's fitness to practise as a dispensing optician was impaired on public interest grounds.

Mitigating factors included the registrant's previous good character, expressions of remorse, and full admissions. Their employers had regarded the registrant positively and were willing to support them.

However, there were several aggravating factors including a pattern of repeated dishonest behaviour, sustained over several months, and an abuse of their position. The registrant also did not engage with regulatory proceedings, and there was no evidence of insight or remediation.

The Committee concluded that neither taking no further action nor imposing a financial penalty was appropriate given the sustained dishonesty and risk factors. They considered erasure as the only suitable sanction to uphold public confidence in the profession, maintain its reputation, and declare proper standards of conduct and behaviour.

Advice on facing a hearing

Ian Crookall also provides five pieces of general advice for registrants should they have to face an FtP hearing:

Get independent advice and support from one of the professional associations.
Look at the GOC’s guidance and prepare well for the hearing, rehearsing what you are going to say and anticipating any difficult questions which you may be asked about your actions.
Try to view the complaint from the point of view of the complainant and with reference to the GOC’s guidance.
It is hard not to get anxious, but keeping a clear head, not getting angry nor annoyed and focusing on what you did and the reasons for it is important.
Be honest and truthful, accepting criticism of your actions if it is well based, but be prepared to explain and support what you did if you are satisfied with your actions. Your reflection and insight into how the complaint came about and the way in which you might have acted differently is important to the Committee.

Useful links

Association of British Dispensing Opticians: ABDO are a representative membership organisation for dispensing opticians, currently representing over 6,350 qualified dispensing opticians in the UK.

ABDO College: ABDO College provides programmes leading to professional qualifications awarded by the Association of British Dispensing Opticians.

Association of Contact Lens Manufacturers: Established to publicise the work of UK manufacturers, ACLM represents over 95% of all prescription contact lens care products in the UK.

Association of Optometrists: The AOP are a representative membership organisation for optometrists, currently supporting over 82% of practising optometrists in the UK.

British Contact Lens Association: BCLA is a membership organisation that seeks to provide members with access to training and relevant information, as well as the opportunity to communicate with others involved with contact lenses, whatever their role.

The College of Optometrists: The College is the professional body for optometrists. It qualifies the profession and delivers the guidance, development and training to ensure optometrists provide the best possible care.

Federation of Ophthalmic and Dispensing Opticians: FODO is a representative membership organisation for eye care providers working in primary and community.

Optical Consumers Complaints Service: The OCCS is an independent and free mediation service for consumers (patients) of optical care and the professionals providing that care. The service is funded by the General Optical Council who regulate optometrists and dispensing opticians.

Latest news from the GOC

Last chance to apply: Opportunities for dispensing opticians available on our Investigation Committee
We are seeking to appoint two dispensing optician/contact lens optician registrant members to our Investigation Committee. Investigation Committee members play a key role in decision-making for cases at the investigation stage of the fitness to practise process. They consider allegations that a registrant may not be fit to practise where case examiners cannot agree, as well as referrals from case examiners for an assessment of a registrant’s health or performance.

Find out how to apply. The deadline for applications is this Sunday 19 November.

Last chance to apply: GOC seeks registrant Council member
We are also recruiting for a registrant member to join our Council. We are looking for someone who can think critically and strategically and will be able to express their point of view and provide objective advice. The successful candidate will join eleven other Council members as charitable trustees and work together to shape our future strategic direction.

Find out how to apply. The deadline for this position is also this Sunday 19 November.

Optometrist suspended for four months
This registrant was suspended for failing to conduct an appropriate eye examination, failing to refer the patient to hospital for further examination, and failing to maintain adequate records.

Find out more.

Optometrist suspended for two months
This registrant was suspended due to submitting fraudulent claims to his private health insurance provider using falsified receipts belonging to patients.