Keeping an ‘eye’ on consent

The General Optical Council (GOC) has published new guidance on obtaining valid consent to assist optometrists and dispensing opticians in meeting its standards of practice.

The new GOC guidance applies to elective treatment, research and emergency situations. The key aspects of the guidance include:

Obtaining consent:

• Ensuring consent is obtained from an appropriately informed person. ‘Informed’ means having received an explanation as to what the procedure/treatment/care involves, including any risks and alternative options in terms of examination, treatment, sale and supply of optical appliances or research they are participating in. This includes the right of the patient to refuse treatment or have a chaperone or interpreter present
• Respecting that a patient with capacity has the right to refuse treatment, care or to withdraw their consent at any time, even if the optometrist/dispensing optician believes the treatment or care to be in the patient’s best interests. In these circumstances, the consequences of their decision should clearly be explained to them, but pressure must not be placed on the patient to accept the advice.
• Ensuring the patient is provided with clear and accurate information in a way that they can understand. This could be in writing, including a leaflet and by talking to the patient.
• Considering any disabilities, literacy or language barriers that may affect the patients understanding. Not making any assumptions regarding the patient’s level of knowledge and ensuring the patient is given the opportunity to ask questions, taking account of and responding to any concerns or expectations they have expressed.
• In some circumstances gaining consent can be delegated to other colleagues. However the optometrist/dispensing optician providing the treatment/care remains responsible for ensuring valid consent has been given.
• Obtaining consent is part of an ongoing discussion and decision making process, rather than something that happens in isolation.
• Making sure that the patient’s consent remains valid at each stage of the examination or treatment, and during any research in which they are participating. Consent cannot be presumed because it was given on a previous occasion. 

Recording consent/refusal to consent

• Clear, legible and contemporaneous patient records must be maintained. Professional judgement should be used to determine when and how to record consent based on proportionality, risk, the patient’s needs and circumstances and type of treatment or care.
• It must be recorded if a patient refuses or withdraws consent, to include the discussions that have taken place and the advice given. 
• If the optometrist/dispensing optician believes there is a risk of serious harm to the patient or others due to their decision to refuse treatment or care, the issue must be raised with an appropriate healthcare colleague or people involved in the patient’s care and the optometrist’s/dispensing optician’s employer. 

Emergencies

• In an emergency, if consent cannot be obtained, the optometrist/dispensing optician can provide treatment, take action or make a referral that is in the patient’s best interest and is needed to save their sight or prevent deterioration in the patient’s condition. 
• The exception to this is where a valid and applicable advance decision to refuse a particular treatment or healthcare is in place - this is very unlikely in the optical context.

The full GOC guidance on consent, including the legal framework on assessing capacity to consent for England and Wales, Scotland and Northern Ireland, can be found on the GOC website alongside the new guidance on the professional duty of candour.