Care of patients in vulnerable circumstances

1. We have developed this guidance to help our registrants to consider and respond to the needs of patients in vulnerable circumstances. That could include patients with underlying health conditions, children, or those experiencing a difficult life event which could affect their ability to access eye care or make informed decisions about their care.   
2. The care, well-being and safety of patients must always be your first concern. This is at the heart of being a healthcare professional. Even if you do not have direct contact with patients, your decisions or behaviour can still affect their care and safety. 
3. You will likely come across vulnerable patients throughout your career. Being able to recognise and respond to vulnerability will help to make sure that you provide safe and effective eye care and improve access to care.  
4. This guidance provides an overview of the importance of understanding vulnerabilities, advice on how to support individuals in vulnerable circumstances, and guidance for businesses on how to support staff to identify vulnerabilities and adjust their practice accordingly.  
5. This guidance should be read alongside the Standards of Practice for Optometrists and Dispensing Opticians (‘Standards of Practice’) which all optometrists and dispensing opticians must meet and the Standards for Optical Students which all student optometrists and dispensing opticians must apply to their practice. Where we refer to both sets of standards for individual registrants, these will be referred to as “standards” for ease of reading. Where we refer to specific standards, we will put the number of the Standards for Optical Students in brackets after the number for the Standards of Practice, where applicable (e.g. 11(10)). Annex 1 of this guidance highlights relevant standards.   
6. Standard 1(1) outlines the importance of treating patients as individuals and where possible modifying your care and treatment based on their needs. Standard 7(6) focusses on the need to conduct an adequate assessment, which may include capturing any current symptoms, personal beliefs, cultural factors and vulnerabilities, whilst standard 8(7) covers record keeping. Standard 11(10) covers legal obligations in relation to safeguarding of children, young people and vulnerable adults. Standard 13(12) includes the need to consider and respond to the needs of people in vulnerable circumstances and make reasonable adjustments to your practice.  
7. If you are an optical business registered with the GOC, you should read this guidance alongside the Standards for Optical Businesses, which all registered businesses must apply to the conduct of their business. Where we refer to these standards, we will always provide the number and refer to these standards explicitly. 
8. Standard 1.1 of the Standards for Optical Businesses covers patients’ expectations that they can be safe in the care of the business, including in relation to safeguarding. Standard 1.2 highlights the need to provide a suitable environment and standard 1.3 sets out the importance of clear communication with patients. Standard 3.1 identifies the importance of staff being able to exercise their professional judgement to meet the needs of patients, including those in vulnerable circumstances.  
9. The word ‘must’ indicates a mandatory requirement, for example, registrants must comply with the law and must meet the GOC’s standards. 
10. You should use your professional judgement to apply this guidance to your own practice and the variety of settings in which you might work. 
11. There are two parts to this guidance: part 1 which focuses on guidance for individual registrants (optometrists, dispensing opticians and optical students) and part 2 which focuses on guidance for businesses. Whether you are reading the guidance from an individual or business perspective, it is important to read both parts.  

12. The concept of vulnerability is an important one within healthcare, recognising that there is a power and knowledge imbalance between health professionals and their patients. This vulnerability is amplified due to the anxiety that many people will naturally feel in any healthcare interaction. We cover the need to maintain appropriate boundaries because of that power imbalance in standard 15(14) and in separate guidance on that topic. Vulnerability also features in legislation, often in relation to children or vulnerable adults, where there are legal duties to protect them from harm or abuse. This is covered under standard 11(10) and also in standard 1.1.1 of the Standards for Optical Businesses but legal duties on safeguarding are not covered in detail within this guidance.  
13. In the introduction to the standards and in standard 13.7(12.7) we refer to ‘patients in vulnerable circumstances’. These are patients who, due to their personal circumstances are in need of particular care, support or protection or at risk of abuse and neglect.  
14. Patients may be vulnerable for a range of reasons, including physical or mental health conditions, capability in managing their health, or handling a difficult set of life events. Vulnerabilities can often be invisible and therefore difficult to identify. Some examples of vulnerable circumstances include: 

• physical health conditions 
• disabilities  
• mental health conditions; 
• learning difficulties such as dyslexia; 
• past trauma, including within the healthcare system; 
• difficult life events, such as a recent bereavement; 
• financial difficulties; 
• language barriers that may prevent individuals seeking the care they need and understanding what is being communicated;
• domestic abuse; and
• neurodivergence. 

15. Vulnerable circumstances can also include the situation in which the patient meets with the eye care professional. For example, patients receiving care in a domiciliary setting may be considered vulnerable because the eye care professional has come into the patient’s home to deliver their care. The patient may feel more pressure to purchase an optical appliance because they find it more difficult to say no in their own home.   
16. Levels of vulnerability may vary between contexts and change over time. Everyone can be vulnerable at some point in their lives, even if only for short periods. 
17. Therefore, a series of factors combine to shape vulnerability including an individual’s personal characteristics (e.g. health conditions, capability) and life circumstances (e.g. finances, where they live), inherent features of eye care (e.g. knowledge imbalance, stressful situations) as well as the actions of eye care professionals and businesses (e.g. empathy, communication, adaptations).  

18. There are inequalities in eye health outcomes, for example, around 60% of people living with sight loss are women, and people from certain ethnic groups are at greater risk of some leading causes of sight loss, such as glaucoma and diabetic retinopathy. Addressing inequalities is a challenge in all healthcare environments, and some causes of these inequalities reflect structural features in society that are beyond the influence of registrants. However, there is evidence of healthcare inequalities in eye care in relation to both access and patient experience, which registrants can help to improve through their professional practice. 
19. Our research shows that the most vulnerable patients experience significantly worse outcomes. Individuals in vulnerable circumstances are less likely to be satisfied with their care or may not access care at all.[1] Patients in vulnerable circumstances who have poor experiences, or who feel that registrants haven’t supported them appropriately, may be less likely to seek eye care in future. You play a vital role in supporting those individuals to access eye care and manage their eye health.  
20. Our 2025 public perceptions survey highlights the following[2]:  

• Patients from a global majority background are less likely to be satisfied with the overall experience of visiting an opticians/optometrist (82% vs 88%). They are also more likely never to have had a sight test (6% vs 3%). 

• Patients with a disability are also less likely to be satisfied with the overall experience (83% vs 88%). 

• Only 68% of patients who are not confident in managing their own eye health are satisfied with the overall experience (vs 87% on average). 

• Those who do not speak English as a first language are less likely to be satisfied compared to the average (77% vs 89%). 

21. Vulnerabilities may present in different ways and may also affect different patients in different ways. Patients who are vulnerable may be significantly less able to advocate for themselves and represent their own interests. They may require adjustments due to having more specific support needs. They may be less able to make informed decisions about their care or feel less comfortable declining treatment or choosing options they believe are best for them. They may also find it more difficult to take on board information being shared with them.  
22. However, you should not make assumptions about a patient’s vulnerabilities or how best to respond to them. It is therefore important that you use your professional judgement to support your patients and identify any additional needs they may have. 

23. In this section ‘you’ refers to the individual registrant.  

Identifying and assessing patients in vulnerable circumstances 

24. The first step in any episode of care is to carry out an assessment of the patient. You should conduct an adequate assessment for the purposes of the optical consultation or treatment. This includes where necessary any relevant medical, family and social history of the patient. This may include current symptoms, personal beliefs, cultural factors and vulnerabilities (standard 7(6)).  
25. In some cases, a patient’s vulnerability may not be obvious. Patients may provide you with information about their vulnerabilities, but there may be occasions where patients do not disclose sensitive information about their circumstances. Families and carers play an important role in supporting patients to receive effective eye care. These episodes of care and the conversations that need to take place may be more complex and involve considerations around consent (see paragraph 37). 
26. At the beginning of an assessment, you should ask patients if there is anything you need to know about their circumstances or anything else which you should know to help you to meet their needs.  
27. We do not expect you to probe for information that is not necessary to conducting an adequate assessment, but you should be alert to signs which might indicate a vulnerability. Listening to patients, giving them your full attention, responding with sensitivity and compassion, and treating patients as individuals are all ways in which you can identify potential vulnerabilities (standard 1).  
28. If you are seeing a patient, you have seen before, or has been seen in the practice before, there may already be a record of information which suggests the patient may be in vulnerable circumstances. As part of checking whether there have been any changes in the patient’s history or circumstances, you should check whether there have been any changes in their vulnerabilities.  
29. We acknowledge that registrants work in a variety of different settings and that many businesses may have their own processes for assessing patients. But as a professional you are still responsible for the adequacy of the assessment you carry out, ensuring that you capture enough information to make an appropriate assessment.  
30. You should make sure you record the details and findings of the assessment you carry out, including information on any vulnerabilities (standard 8.2.4(7.2.4)) as part of the record of the patient’s treatment.   
31. If you have concerns that a patient’s safety or wellbeing is at risk, including if they are at risk of abuse, you must follow reporting procedures in line with your workplace policies and any legal requirements.  

32. Once you have identified that a patient may be in vulnerable circumstances, you should consider and respond to their needs (standard 13.7(12.7)). In doing so, you may find it helpful to speak to the patient sensitively to understand if there are any adjustments they have found beneficial in the past. This may be particularly helpful in situations where the patient has been managing these vulnerable circumstances for a long time.  
33. The concept of reasonable adjustments relating to disabilities has specific meaning in equalities legislation, which you should be aware of. This guidance covers adjustments to meet the needs of patients more broadly. 
34. You should make adjustments to your practice to accommodate these vulnerable circumstances and improve access to care. The adjustments will vary depending on the individual and there is no ‘one size fits all approach’. Adjustments could include but are not limited to:  

• giving the patient more time to complete their consultation or any aftercare, or pausing the consultation or aftercare to give the patient time to consider their options; 
• providing written information on next steps or treatment plans; 
• adjusting the treatment or shop floor environment to be more conducive to the patient (for example, reducing distractions or noise); 
• using an interpreter or a chaperone for the patient;  
• adapting your communication style, by explaining technical terms or using visual aids; and/or
• considering physical proximity; and/or 
• regularly reviewing consent. 

35. Patients, including those in vulnerable circumstances, may experience some anxiety about the consultation or treatment. Whilst some patients may be familiar with the sight test, or process of purchasing glasses or contact lenses, for others this may be the first time visiting an optical business. Clear introductions and expectation setting, combined with being verbally reassuring throughout your interaction with them, can help to reduce levels of anxiety and make sure that patients understand what is happening throughout their visit.   
36. You should not make assumptions about the patient’s level of knowledge or understanding and you should give them the opportunity to ask questions and take account of and respond to any concerns or expectations they may have expressed. 
37. Vulnerable circumstances may also affect a patient’s capacity to consent (standard 3(3)). The existence of these circumstances should not lead to an automatic assumption that the patient does not have the capacity to consent. Instead, you should use your professional judgement to make a decision based on all the circumstances and the information reasonably available to you. You should also refer to our separate guidance on consent.  
38. If you are unsure about a how to adjust your practice, you should get advice from your employer, other colleagues, health and social care professionals or people involved in their care. If you are still unsure, you may need to consult your professional or representative body, or obtain legal advice.  
39. If you need to develop your skills in assessing vulnerable circumstances and adjusting your practice you should undertake further training as appropriate. 

40. In this section ‘you’ refers to the body corporate or the director or responsible officer of an optical business (whether or not you are a registered optometrist or a registered dispensing optician). 

Workplace policies and procedures 

41. Businesses will already have in place policies and procedures relevant to patients in vulnerable circumstances. For example, they will have procedures to meet their legal and professional obligations to safeguard patients from abuse or to provide an accessible patient care environment in line with equalities legislation and the law on mental capacity. You should make prospective patients aware of potential access barriers in advance of appointments, such as stairs.  
42. You should consider whether your business needs any additional policies or procedures to support patients in vulnerable circumstances. This could include making changes to any assessment processes to support staff to identify these patients, such as providing examples of questions that staff could ask to draw out this information or making changes to written assessment forms.  
43. You should make sure that any record keeping system allows your staff to capture information about a patient’s vulnerable circumstances and hold it safely and securely (Standards for Optical Businesses, 2.4.1).  

44. It is important for staff to be able to exercise their professional judgement in fulfilling their duties to patients, and to meet the expectations of their professional regulator. Empowered staff can take into consideration what is best for patients, including those in vulnerable circumstances, and act in their best interests.  

45. You should support staff to have the confidence to make decisions in their role, including decisions on how to adjust their practice to respond to the needs of patients in vulnerable circumstances (Standards for Optical Businesses, 3.1.2-6). Making decisions on how to support these patients may sometimes be difficult for staff, particularly for those who may not have supported patients in similar circumstances before. So, encourage staff to seek appropriate advice if needed.  
46. To help staff to communicate effectively with patients in vulnerable circumstances, you should provide information that is accessible to patients in a way they understand, taking into consideration individual needs and requirements (Standards for Optical Businesses, 3.1). Conversations about vulnerability may touch on sensitive or personal matters for a patient. So, supporting staff to develop their communication skills and to treat patients with care and compassion is vital.  
47. Patients in vulnerable circumstances may need more time to process information they have been given or make decisions (which could include changing their mind). So, you should ensure, so far as possible, that operational or commercial pressures do not inhibit staff from allowing patients the time they need (Standards for Optical Businesses, 3.2). You should also allow staff sufficient time, as far as possible, to accommodate patients’ needs within the provision of care. 
48. You should also provide clear information to patients about the costs of products and professional services (Standards for Optical Businesses, 2.1.8). Transparency in pricing is important so that all patients can make informed decisions. Vulnerability could make it more likely for patients to feel confused or pressured to buy services. For example, patients who feel less confident managing their own health may feel less confident in seeking information on pricing. Equally, those who have experienced a serious life event may feel less able to make an informed decision at the point of purchase.  
49. You should support patients to understand their eligibility for financial support, such as NHS funded sight tests and which products are available to patients who are using NHS optical vouchers. Training staff on how to handle conversations about pricing will further support patients in vulnerable circumstances.