Dian Taylor	One Vision Direct Ltd.
Chief Executive/Registrar	15 High Street
General Optical Council	Dingwall
41 Harley Street	Highland
London	United Kingdom
W1G 8DJ	IV15 9RU

4^th March 2010

An appeal to update the Sight Testing Regulation (No2) 1989 to include the inter-pupillary distance.

Dear Ms Taylor

I believe that the General Optical Council (GOC) is failing to regulate the optical profession in the best interest of UK glasses wearers and is instead preserving an outdated sight testing regulation in order to protect the financial interests of its membership and to restrict innovation and development in the optical marketplace.

The failure by GOC to mandate the inclusion of a patient’s inter-pupillary distance on the prescription issued after an eye examination is restricting the operation of a free and efficient market for prescription eyewear. It is also contributing to an increasing public perception that there is a real conflict of interest and ethical dilemma between the clinical aspects of eye examination and the commercial activity of eyewear sales carried out under the same roof by opticians in the UK. This perception is to the detriment of the profession as a whole.

This situation needs to be urgently addressed by reviewing and updating the sight testing regulations, including mandating the inter-pupillary distance as part of patients’ prescriptions. This will make it easier for consumers to purchase glasses online and will also help to make a clearer distinction between the eye testing and eyewear dispensing activities of opticians. This will have the effect of reducing consumer concerns about the conflict of interest between eye testing and dispensing and go some way to restoring public confidence in the integrity of the eyecare profession.

The GOC is the government-appointed regulatory body entrusted to look after consumer welfare for eye health in the UK. Part of the GOC’s role is regulation of the clinical procedure of sight testing: THE SIGHT TESTING (EXAMINATION AND PRESCRIPTION) (No2) REGULATIONS 1989. Section 5 of this regulation describes the particulars that the clinician must include in the written statement or prescription to be given to patients[1] following an eye examination.

It is the natural and realistic expectation of every patient that the prescription issued following their eye examination will contain all the information necessary for them to purchase corrective eyewear if required. It is also a reasonable expectation of the consumer that they will be free to shop for their glasses wherever they can obtain the best choice or the best service or the best value for money or any combination of these, and that this may or may not be in the shop where they had their eyes tested.

Crucially, Section 5 of the aforementioned regulation fails to mandate the inclusion of the patient’s inter-pupillary distance on the prescription. This is a simple piece of information which takes an optometrist only seconds to measure but which is nevertheless essential for a lab technician to prepare corrective eyewear.

Up until 2005 the omission of the inter-pupillary distance from the prescription was largely irrelevant and inconsequential. During the mid 1980s the GOC was instructed by government to relax the rules on who could advertise and sell glasses in order to stimulate competition and lower the price of glasses in the High Street. [Incidentally a paper prepared by the DTI in 2006 reported that these attempts to stimulate competition and lower consumer prices have largely failed[2]]. One outcome of the de-regulation process was that from this period onwards opticians were obliged to provide consumers with a written prescription following an eye exam. The purpose of this was clearly to ensure that consumers were free to buy their eyewear with confidence from wherever they chose. The fact that the prescription was issued without the pupillary distance measurement was inconsequential at that time, since consumers were only able to choose between one High Street shop and another, where their physical presence meant that the PD could be measured at the point of sale.

Since 2005, however, the omission of the pupillary distance from the prescription has grown both in significance and consequence in line with the increased numbers of glasses wearers who are choosing to purchase their prescription eyewear over the internet. For this growing customer segment the omission of the PD by clinicians not only poses an annoying and unnecessary obstacle to them making their online purchase, but also raises in their minds an ethical question of precisely where the boundary lies between the clinical process of eye testing (a discretely billed and paid for service) and the entirely separate and distinct commercial transaction of selling glasses. The fact that these clinical and commercial processes frequently take place under the same roof and by the same personnel is considered irregular by many and is giving rise to increasing concern among consumers about whether or not opticians are acting in the best clinical interest of their patients or the best commercial interest of their practice. This juxtaposition has done nothing to dispel consumers’ widely held view (as evidenced by the 800 or so signatories to my petition www.givememypd.epetitions.net) that the PD measurement is being withheld by clinicians in order to coerce patients into the commercial transaction of purchasing glasses in the same premises where they have had their eyes tested, or at the very least forcing them to purchase from another High Street outlet. As consumers become more educated and more discerning there is a growing realisation that there is potentially a real conflict of interest between the clinical and dispensing activities of opticians, which only complete transparency in the provision of all the information required to produce the required spectacles can overcome.  This needs to be urgently addressed by the GOC. Line 11 of the Code of Conduct for Individual Registrants (“to ensure that financial and commercial dealings do not compromise the interests of the patient”) is proving to be a wholly inadequate protection for consumers against this conflict of interest, which holds great potential for bringing the profession into disrepute.

The GOC mission statement says: “Our work is built on a foundation of six core values. These values are based on the Better Regulation Commission’s criteria for good regulation.” Ignoring the fact that the Better Regulation Commission was superseded by the Risk and Regulation Advisory Council (RRAC) more than two years ago on 16^th January 2008, and that the Code of Practice On Guidance On Regulation now has 8 Golden Rules and not 6 Core Values, both the old and the new codes place a duty on every regulatory authority like the GOC to review and improve their regulations in order to keep them “accurate and current”.  The GOC is clearly failing in this requirement, as the current regulations do not reflect the realities of the modern optical marketplace.

As government prioritises the activities of regulatory bodies like the GOC to focus on public protection, proportionality to risk and the removal of unnecessary administrative procedures, and as this complaint relates largely to consumers wanting to purchase glasses over the internet, it is worth reviewing the safety of internet purchases in light of the recent statement made by Jon Levett at the ABDO conference in October 2009. In response to a call from ABDO members for increased regulation in the face of growing internet sales, Mr Levett, Director of Standards and Deputy Chief Registrar of the GOC, said:

“The Department of Health has been presented with no evidence from the industry to show that de-regulation of spectacle sales has resulted in any harm to the public which might lead to a review of the regulatory framework”

He went further and warned ABDO members that any attempt to re-open the issue could actually result in further de-regulation.

The sight testing regulation is out of date, does not reflect the realities and needs of the current marketplace, is not fit for purpose, and is long overdue for a thorough review. I am therefore calling now for a re-opening of this issue with proper consideration given not only to public safety but also to how the regulation can be updated in the best interests of consumers and a competitive eyewear market.

The statement made by Mr Levett stands in stark contrast to a conflicting statement made in the most recently published annual report of the Optical Consumer Complaint Service. The OCCS, while claiming to be an independent organisation, is contracted solely by the GOC, receives all of its funding from the GOC, reports only to the GOC, is chaired by David Burt OBE,  past chairman of the GOC, and is to all intents and purposes part of the GOC.

This is what the OCCS had to say in its 2008 annual report about pupillary distance complaints made by consumers:

“Whilst we acknowledge the right of a consumer to choose where to purchase their glasses, we do not support internet purchases as being in the consumer’s best interest” (my emphasis).  The report goes on to say, “An optician has no obligation to measure the IPD if not supplying glasses, and if asked to do so we accept that a reasonable fee should be charged. We fear that with the increase in internet purchases problems will increase and we will continue to explain to complainants that we cannot act on their complaint.”

The report presents no evidence nor a satisfactory explanation of why the committee doesn’t support internet sales, or of why internet sales are not in the consumer’s best interest.  Given the fact that an executive officer recently made an explicit statement that there has been no evidence of harm to the public from internet sales, the only conclusion which can be drawn from this statement is that the OCCS, and, by direct, exclusive, contractual association, the GOC, are institutionally and systemically biased against internet sales of prescription eyewear. I hope that in your role as chief executive and registrar of the GOC you will investigate this situation thoroughly and objectively, and report your findings in a public statement.

My specific objective in writing this letter is to persuade the GOC to amend the sight testing regulations to include patients’ inter-pupillary distance. This objective may be achieved directly by the GOC acting of its own volition and through due process, or indirectly as a consequence of a simultaneous representation that I am making to the Office of Fair Trading.

I have also met with my own MP, Rt Hon Charles Kennedy, who wholeheartedly supports this initiative and who, incidentally, sat on the committee which was responsible for the de-regulation of the optical sector back in the mid 1980s. Mr Kennedy has agreed to take the matter up with the Secretary of State for Health, Westminster, the Cabinet Secretary for Health and Wellbeing, Holyrood and the Secretary of State for Business, Innovation and Skills.

As part of its due process I hope the GOC will take proper consideration of both the new RRAC guidelines and more particularly the competition assessment guidelines issued by the Office of Fair Trading.

The Office of Fair Trading (OFT) provides government-controlled authorities such as the GOC with a set of guidelines or tests which should be applied to the policies or regulations which they set, to ensure such policies and regulations do not unduly limit or restrict competition in the market place. The competition assessment poses 4 questions, as follows.  Does the policy or regulation:

1. Directly limit the number or range of suppliers? [Possibly not in this case],

2. Indirectly limit the number or range of suppliers? [YES: because the regulation gives consumers incomplete information, they don’t have equal access to internet and High Street retailers].

3. Limit the ability of suppliers to compete? [YES: internet retailers become dependent on a small sub-section of the market able and willing to measure their own PD].

4. Reduce suppliers’ incentive to compete vigorously? [YES: it gives High Street retailers an unfair advantage over internet retailers, thereby reducing High Street retailers’ incentive to compete].

When these tests are applied to the current eye testing regulation it becomes abundantly obvious that it is both protectionist and anti-competitive in its present form.

There is a significant body of evidence to show that the government initiative of stimulating competition in the prescription eyewear market through de-regulation has been completely ineffective. Instead, the effect of de-regulation has been to allow 54% of the UK optical market to be dominated by only two companies, Specsavers (38%) and Boots/D&A (16%), to the detriment of independent practice. This in itself should be of grave concern to both the GOC and the competition authorities. Furthermore, Optician magazine 26/02/10 reported that this is an ongoing trend.

More worryingly for the consumer, the same issue of Optician Magazine reported two significant facts: firstly, that glasses sold with reflection-free coatings during 2009 fell by 6% over the previous year to only 42% of all glasses sold, which is one of the lowest levels of reflection-free coatings dispensed in all Europe. And secondly, at the same time the average turnover per eye examination rose by £15.00 (average sale value of £128-£154). In summary, this shows that for UK consumers the price of their glasses has increased by 10% for a poorer specification of product during the worst recession for 60 years, and graphically demonstrates how inefficient the prescription eyewear market is in the UK.  This is at least partly due to the protectionist regulations set by the GOC which prevent internet retailers competing on an equal footing with High Street shops.

It can be hypothesised that a significant part of the shift in market share from independent opticians to the multiples is due to the dubious marketing tactics of advertising and offering so-called free eye tests as a loss leader and buy-one-get-one free offers. Of course every consumer knows there is no such thing as a free lunch; nevertheless, a free eye test is a seductive offer, especially if the outcome of the eye test is that a prescription is unchanged or no corrective eyewear is required. However, both these marketing practices seriously destroy value over time. For consumers the buy-one-get-one free offer raises the question, ‘Why can’t I just have one pair at half the price?’ Likewise, the offer of free eye tests has had the effect of greatly diminishing the undisputable value of an eye test in the public mind. By diminishing the value of an eye test in this way there is a strong argument that the profession is in fact creating a serious risk to the public health the argument goes: if an eye test doesn’t cost anything then it can’t be worth anything, which we know is not the case. Offering free eye tests also serves to seriously blur the distinction between the clinical and commercial activities taking place in an opticians practice/shop.

The council might consider that by amending the eye testing regulations to provide a prescription with all the necessary information required to make a pair of glasses (there being no need for the customer to have their pupillary distance measured at the point of sale) that this might even result in a reduction or the demise altogether of the free eye test marketing tactic and remove any perceived or real conflict of interest between the testing and dispensing processes resulting from a more efficient market place.

Internet retailing of prescription eyewear has arisen as a consequence of changing consumer trends in the way they want to purchase their eyewear and the GOC should be fully engaged with this trend and not work or regulate against it. Choice, service, convenience, buyer protection and price are all equal factors giving rise to internet demand.  It should be borne in mind that it is only possible for internet retailers to flourish when High Street opticians fail their customers through inadequate choice, deficient customer service or poor value for money. Conscientious, innovative, customer-focused opticians have nothing to fear from a more open and competitive marketplace.

I look forward to receiving your response in due course.

Yours faithfully

Ewan McFarlane

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[1] It is recognised that there a small number of exceptions to this rule.

[2] DTI Economics Paper No9 The Benefits from Competition: some illustrative UK cases.