Updated guidance for health care professionals that provide refractive surgery

The General Medical Council (GMC) considers that refractive surgery is a medical procedure which falls within the scope of their Guidance for Doctors who offer Cosmetic Interventions. The Royal College of Ophthalmologists has produced specific Professional Standards for Refractive Surgery which apply to this procedure. The Standards are reviewed periodically, and the last review took place in December 2024.

The purpose of the latest review if to update the Standards in line with the latest version of the GMC’s Good Medical Practice effective as of 30 January 2024. Below is an overview of the key areas within the Standards that have been affected by the December 2024 review:

a) The knowledge, skills and performance section now includes a requirement for practitioners to have "the necessary knowledge of the English language to provide a good standard of practice and care in the UK". This is in line with a pre-existing duty for practitioners to accept the limits of their own competence, work within such limits, and redirect a patient to a different practitioner if they feel unable to meet the patient's needs in a safe manner. For surgery post 1 August 2018 the Standards state surgeons should:

1. be on the GMC Specialist Register in Ophthalmology
2. hold the Cert LRS entry qualification
3. undertake appropriate professional development activities across the 5-year revalidation cycle
4. undertake at least one patient feedback exercise that includes patients' experience from their refractive surgery practice.

b) Regarding safety and quality, the Standards now highlight the importance of research on the part of practitioners to increase their understanding of health conditions, including available options for their prevention, treatment, and care. Practitioners are encouraged to engage in research to improve conditions for current and future patients, and for the benefit of the health of the population at large. Practitioners are also encouraged to inform patients if they become aware of any research opportunities suitable for participation by a particular patient. The Standards state surgeons should: 

1. maintain an accurate portfolio of data regarding their clinical activity using outcome means
2. undertake regular audit to identify areas of improvement
3. take part in professional networks, national and international meetings
4. ensure there are policies in place to maintain compliance with MHRA guidelines on the use of implants, medicines and medical devices; the use of custom made or non-CE/UKCA marked devices, and the off-label use of medical device.

c)  In respect of communication, partnership and teamwork, the Standards have been expanded to stress the importance of providing safe and effective clinical care in person, or remotely by means of telephone, video link, or online consultations. If practitioners feel unable to provide safe care using a particular method of communication, then they are advised to either offer the patient an alternative or redirect them to a different service provider. The Standards set out recommendations regarding standardised patient information, information specific to the provider and the consent process.

d) In relation to continuity of care, the Standards now include a requirement to "respond promptly, fully and honestly to complaints". Practitioners are cautioned not to allow the level of care provided to a patient to be negatively affected as a result of any complaint made by the patient.. The Standards provide further comment regarding 'before the day of surgery', 'on the day of surgery' and 'at discharge' from the provider.

The Standards also now redirect practitioners to the GMC’s guidance on ending their professional relationship with a patient. This guidance refers to good practice, the circumstances under which it may be necessary for a practitioner to end a relationship with a patient, matters to consider before ending such relationship, issues to consider once the decision has been made to end the relationship, and advice regarding ending relationships with persons close to a patient. It also includes guidelines regarding best practice for a practitioner who is closing or relocating their practice or service.

The Standards describe good practice. Not every departure from them will be considered serious. What will be considered in cases where the Standards have not been followed by a practitioner is the seriousness and extent of their departure, the causes for such departure, its context and risk, the practitioner's response when concerns are raised, and whether the incident has occurred in isolation or as part of a pattern. The next scheduled review of these Standards is December 2027.

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