Commercial practices and patient safety: what our thematic review tells us

Today we published the report of our thematic review into commercial practices and patient safety.  

The findings of our thematic review present a mixed picture: patients are generally satisfied with the services they receive, but many registrants are concerned about their ability to deliver safe care in the face of workplace pressures. 

Why did we carry out this review? High street eye care sits at the intersection of healthcare and retail, combining significant benefits for patients including innovation, improved access to services and greater patient choice. Trust and satisfaction from patients remains high but we heard repeated concerns from registrants about the pressures of commercial practices. Our review therefore explored the impact of these on the public’s experience of, and registrants’ ability to deliver, safe and effective eye care for all, and aimed to identify opportunities to improve the sector. 

We used a mixed-method approach, ranging from a literature review, new questions in our registrant and public perceptions surveys, and in-house analysis of business registrant websites, General Ophthalmic Services (GOS) data and Trustpilot reviews. We also commissioned qualitative research with fully qualified registrants, business registrants, non-regulated eye care staff and patient representative organisations. 

Everyone should be able to access high-quality eye care with confidence. They should also be able to trust that the professionals caring for them are working in an environment that supports safe, effective practice. 

Supporting registrant wellbeing to deliver safe patient care 

We heard significant concerns about stress and burnout among registrants. This matters because registrant wellbeing and patient safety are closely connected. When professionals are under sustained pressure, their ability to provide safe care may also be put at risk. This is therefore not simply an employment matter; it is a regulatory concern. 

Students and professionals at the start of their careers appear to be particularly affected. Stronger support during education and training, and through the transition to independent practice, can help people entering the professions to provide safe care while protecting their own wellbeing. 

Removing barriers to eye care 

The review also identified barriers that may make it harder for some people to access care. These include limited online transparency about pricing and eligibility for NHS financial support. We also heard concerns about a minority of businesses not providing sight tests to young children. In addition, a fear of pressure selling could deter some people from attending routine sight tests. 

Improving the evidence base 

We found no direct evidence that commercial practices are causing harm to patients. However, gaps in patient outcomes data mean that the relationship is difficult to assess. Better evidence will help the sector identify potential risks earlier, understand where action is needed and respond effectively. 

Standards matter, but culture is critical 

Setting the right standards, and enforcing them effectively, remains central to good regulation. But standards alone cannot create safe care. Leadership and workplace culture are just as important. 

Optical businesses and those who lead them should create psychologically safe environments in which registrants can raise concerns without fear. Professionals must be supported to speak up when something is not right, including raising concerns with the GOC where appropriate. 

What happens next 

This review gives us a clearer picture of where patients and professionals may be vulnerable, while recognising the positive experiences reported by many patients. Its findings will inform our work to update our Standards for Optical Businesses, alongside ensuring our education and training standards equip newly qualified registrants to work safely and ethically in a business environment. We will also work with professional/representative bodies, optical businesses, educators and other partners to progress our programme of work and the recommendations within the report. 

Ensuring patient safety is a shared responsibility. By strengthening workplace culture, supporting professionals and removing barriers to care, the optical sector can help ensure that all patients continue to receive safe, effective and accessible eye care services.