Maintaining appropriate sexual boundaries

1. We have developed this guidance to help our registrants to understand the importance of maintaining appropriate sexual boundaries with patients and colleagues. Maintaining appropriate boundaries applies to your behaviours, actions and communications, both online and in person.  
2. It is crucial that appropriate sexual boundaries are maintained. Patients must know that you will ensure their care and safety and behave appropriately towards them, not engage in sexual conduct with them or violate their dignity. Students, colleagues and others with whom you have a professional relationship must know that you will not engage in unwanted sexual conduct with them or create an intimidating, degrading, humiliating or offensive environment.  
3. In this document, when we use the term ‘sexual misconduct’ we mean unwelcome or uninvited behaviour of a sexual nature, or which can reasonably be interpreted as sexual, that offends, embarrasses, harms, humiliates or intimidates an individual or group. It also includes any sexual activity that takes place without consent. Sexual misconduct encompasses elements of harassment, violence and abuse, and can be physical, verbal or visual.  
4. 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 apply to their practice 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)). 
5. Standard 15(14) outlines the importance of maintaining appropriate boundaries with others and never abusing your professional position. In this context, ‘others’ can include patients, students, colleagues and people with whom you have a professional relationship. Standards 15.3(14.3) and 15.4(14.4) focus on the importance of maintaining appropriate sexual boundaries with colleagues and patients (annex 1). 
6. Standard 17(16) outlines the importance of ensuring your conduct does not damage public confidence in you or your profession, whilst standard 11(10) makes clear that you must protect and safeguard patients, colleagues and others from harm. 
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. The most relevant standards in the Standards for Optical Businesses are standard 1.1, which outlines the importance of protecting patients in your care from abuse and standard 3.3 which ensures that staff who experience bullying, discrimination or harassment in the workplace are supported.  
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. In this section ‘you’ refers to the individual registrant.  

The importance of maintaining appropriate sexual boundaries with patients and colleagues 

13. The Professional Standards Authority (PSA) outline the importance of maintaining clear and appropriate sexual boundaries with patients.[1] Maintaining appropriate boundaries with patients is an important aspect of being a registered professional, upholding the trust between you and your patient. When those boundaries are breached it can have a detrimental and lasting impact on patients and carers, and fundamentally damage their trust and confidence in health professionals. 
14. It is also important to maintain appropriate boundaries with students, colleagues and others with whom you have a professional relationship. Appropriate professional relationships are important for ensuring effective collaborative working in the best interests of patients. When boundaries are breached in the workplace, it can contribute to a negative or hostile working environment, with a detrimental impact on both those who work there and the patients who receive care there. 
15. Maintaining appropriate sexual boundaries with patients and colleagues is also important to manage the power imbalances within healthcare. There is a power imbalance, and therefore the potential for abuse of power, between health professionals and their patients and there may also be one between more junior and senior colleagues, or between students and supervisors. You should recognise that power imbalance and ensure that you do not take advantage of it to unduly influence or exploit patients or colleagues.  
16. Inappropriate sexual behaviour isn’t limited to criminal acts such as sexual assault or rape, but can include a range of behaviours, for example, use of sexual humour, sharing sexual images or messages, or making inappropriate comments. All acts of inappropriate sexual behaviour have the potential to cause significant emotional or physical harm to a patient or a colleague.  
17. These principles also apply to digital communications in line with standard 17(16), which requires conduct in the online environment not to damage public confidence. 

18. Inappropriate sexual behaviour (including actions and communications) of any kind, including all forms of sexual harassment and abuse, is unacceptable.  
19. In their guidance on ‘Identifying and tackling sexual misconduct’, the General Medical Council provide a helpful list of inappropriate and unacceptable sexual behaviours[4]. The examples provided can include, but are not limited to:  

• sexual or sexist comments, jokes, innuendo and ‘banter’; 

• suggestive looks or leering; 

• groping or repeated unwelcome touching;  

• sexual gestures; 

• a person discussing their own sex life; 

• intrusive questions about a person’s private or sex life;  

• sending sexually explicit emails, text messages or posts on social media; 

• displaying sexually graphic pictures, posters or photos;  

• spreading sexual rumours about a person;  

• propositions and sexual advances; 

• making promises in return for sexual favours; and 

• excessive or unwanted compliments on a person’s appearance. 

20. You must not display sexual behaviour or make sexual advances towards a patient.  
21. Grooming – when a person builds a relationship to manipulate, coerce or encourage actions that would otherwise not be consented to – is also a form sexual misconduct. 
22. Cultural differences can influence perceptions of appropriate behaviour. You should be sensitive to this, and treat patients, tutors, students and colleagues in a way that maintains their dignity. 
23. If you experience unwanted sexual behaviour from a patient, tutor, student or a colleague, you should tell them that the behaviour(s) are inappropriate, where it is safe to do so. If you feel unsafe and the perpetrator does not stop the behaviour, you should remove yourself from the situation and seek help. 

24. If you become aware that a colleague, tutor, student or patient has or may have committed sexual assault, rape or other criminal behaviour, this must be reported in line with your workplace policy and/or any safeguarding responsibilities to an individual who is able to act (e.g. senior leader/colleague). Please refer to our section on speaking up below.  

Relationships with patients 

Relationships with current patients 

25. As an eye care professional, you will see some patients only once whilst you may see other patients regularly. We recognise that the nature of your interactions with patients you see regularly may become more familiar over time. However, you must always maintain appropriate boundaries with patients, irrespective of how frequently you see them and how well you get to know them. 
26. You may find yourself in a situation where you are attracted to a patient you are treating. You must take steps to ensure you maintain appropriate boundaries, for example, you could hand care of the patient over to another professional.  
27. You must not engage in conduct of a sexual nature with patients or violate their dignity. This means that you should not engage in a sexual relationship with a current patient, nor should you treat someone you are in a sexual relationship with. Doing this would blur the boundaries between health professional and patient. 
28. You must make reasoned and informed decisions in the best interests of your patient. Treating a patient with whom you are in a sexual relationship could lead to a lack of objectivity about the treatment they should receive, result in you missing a potential issue or interfering with treatment provided by other health professionals. The patient might feel less comfortable discussing sensitive matters about their health or circumstances with someone they are also in a sexual relationship with.  
29. If you are in a sexual relationship with an individual who becomes a patient of a business that you work for, you must ensure that you do not treat them directly and always maintain appropriate boundaries. You should declare your relationship and ensure that a colleague or another member of the team treats the patient. 
30. You must not use your professional relationship with your patient to pursue a relationship with a patient’s relative or carer.  
31. If you are in a situation where a patient is attempting to engage in or pursue a relationship with you, you must ensure you establish/re-establish an appropriate professional boundary. 

Relationships with former patients 

32. Pursuing a sexual relationship with a former patient is potentially inappropriate depending on individual circumstances which may include:  

• the circumstances and nature of the previous relationship; 

• whether you are likely to care for other individuals that the patient is close to (e.g. family members); 

• if there is a possibility that the individual may require treatment from you again at some stage in the future; 

• the length of time between interaction with the individual as a patient and the present; 

• if the patient was vulnerable at the time that they were under your care, and if they are still vulnerable; 

• if the previous professional relationship is a factor in the patient’s current decisions; and 

• whether there could be a perceived power imbalance and therefore an abuse of your professional position. 

33. There is not a specific time period for when it is appropriate to start a sexual relationship with a patient after ending a professional relationship. However, the closer the time period between the professional relationship ending and the sexual relationship beginning the more likely it is that it could be perceived as a failure to maintain appropriate boundaries. 

Vulnerable patients 

34. Children and young people under the age of 18 years must be considered vulnerable. You must not pursue or engage in sexual relationships with any patient or former patient who is under the age of 18, however long ago the professional relationship ended. 
35. In your professional practice you will work with a variety of individuals who may be in vulnerable circumstances. Some vulnerabilities include physical and mental illness, frailty, disability or current circumstances (e.g. work or financial issues, family issues etc). It is important to note that a patient’s vulnerabilities can either be permanent or temporary. 
36. You must not pursue sexual relationships with vulnerable patients. A sexual relationship with a vulnerable patient will be considered a breach of professional boundaries.  

Professional relationships (relationships with colleagues, tutors and students) 

37. Relationships that are of a consensual and reciprocated nature are considered to be private between those individuals. It is important that appropriate professional boundaries are still maintained. Care should be taken to ensure that the relationship (either during or once it ends) does not impact clinical practice or the working environment.  
38. You must not engage in unwanted conduct of a sexual nature with students, tutors, colleagues or others with whom you have a professional relationship. You must not create an intimidating, degrading, humiliating or offensive environment, whether intended or not. This can include verbal or written comments, sharing or displaying sexual images, as well as unwelcome physical contact and could amount to sexual harassment under the Equality Act 2010. 
39. We expect registrants to be mindful of situations where relationships may be at risk of being seen as non-consensual, for example, where there are power imbalances (e.g. between tutors and students, or senior/junior colleagues). Relationships must not impact on clinical practice, the working or learning environments, and must not hinder nor advance career progression.  

40. Any sexual misconduct is serious and should be reported. 
41. If a patient breaches boundaries with yourself or a member of staff, you should highlight this to the patient if safe to do so. Where required, you should remove yourself from the situation and report the incident to a senior member of staff.  
42. If you are made aware that a colleague or other person has behaved inappropriately towards a patient, you must speak up and report this as soon as possible and offer support to the patient where possible. 
43. When reporting an incident to a senior colleague or organisation, you should ensure you respect patient confidentiality. Any issues relating to patient safety must be prioritised. If patient identity needs to be disclosed as part of an investigation, ensure that the patient is made aware of this. Where possible, patient consent must be obtained. 
44. In circumstances where consent for identity disclosure cannot be obtained, you must inform the patient that you are reporting the incident. Please view our guidance documents on consent, disclosing confidential information and speaking up for further information. 
45. If you have been in a situation where you have experienced inappropriate sexual behaviour(s), including from a patient or colleague, you should report this to your line manager if able to do so, or another appropriate individual in your workplace who will be able to investigate. 
46. You have a responsibility to speak up and take action if you become aware of inappropriate sexual behaviour(s) within your workplace including between colleagues. This could include challenging the behaviour with the perpetrator, reporting it to a line manager, or offering support to the individual who experienced the behaviour. 
47. Registrants who are in leadership positions must take steps to ensure that the workplace environment is a safe place for reporting concerns. It is important that leaders demonstrate and model the behaviours of challenging inappropriate behaviour, speaking up and reporting where appropriate. 
48. Report any incidents in line with your workplace policies, and access support if required. 
49. You may also want to refer to our separate guidance on speaking up.  

50. 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). 

Ensuring appropriate processes are in place 

51. As a healthcare provider, you must ensure that you are upholding professional standards, ensuring that patients are safe in your care. You have a responsibility to ensure that both patients and those who work for you are supported and protected. 
52. You must understand your legal and professional responsibilities to safeguard patients from abuse and ensure that you and your staff are prepared and supported to do so. 
53. You must ensure that staff are adequately supervised and supported (standard 3.3). This includes providing support to staff who have experienced harassment, such as sexual harassment, in the workplace.  
54. Since October 2024, employers have a legal duty to take reasonable steps to prevent sexual harassment and create a safe working environment. They also have a duty to anticipate when sexual harassment may occur and take reasonable steps to prevent it.[5] 
55. You must ensure that you develop appropriate workplace policies (standard 2.2) that outline procedures and actions in regard to sexual boundary violations/incidents, including reporting procedures. Incidents should be addressed quickly and appropriately. Policies should support staff in managing situations that they have experienced with colleagues, as well as understanding how to support patients.  
56. You must ensure that you provide an open and transparent environment where speaking up is encouraged. You should also ensure that you and your staff are familiar with our speaking up guidance and process. 

57. Patient care and safety should be at the heart of your organisation, and it is therefore crucial that any incidents that affect the care of a patient are dealt with quickly. 
58. You should provide an open and transparent environment around reporting any complaints from your patients and support them if they wish to report any inappropriate behaviour or incidents to a higher authority. 
59. You should ensure there are policies and procedures in place that outline management and escalation of incidents, and that patients are able to find a safe place to talk through or report incidents. 
60. You should ensure that patient confidentiality is respected and maintained where appropriate, only disclosing information where there is consent to do so, or where not disclosing the information will significantly harm the patient/others. See our guidance on consent for further information. 

61. Where staff have experienced a boundary violation or an incident has taken place, whether from another member of staff or health professional, or from a patient, they should be supported by you as the organisation. Support will include ensuring that the incident is appropriately reported, and that any escalation is acted on quickly. 
62. Where appropriate, policies and procedures should outline how staff or health professionals that work within the context of your business will be supported on a long-term basis, and you should be open and transparent about any changes that are put in place following an incident. This can include, for example, offering time off, or referral to an appropriate support service if required. 
63. Workplace policies should ensure that staff, students and other professionals who work within the context of your business are provided support to return to work and maintain a working relationship at the business. 

Note that we have only provided the relevant standards below and have not replicated the entire standard unless necessary.