The Optical Consumer Complaints Service Beyond 2020 - Our Vision - Reflecting on five years, and looking to the future
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Optical Consumer Complaints Service The Optical Consumer Complaints Service Beyond 2020 – Our Vision Reflecting on five years, and looking to the future Annual Report 2018-19 www.opticalcomplaints.co.uk
Contents Foreword 3 1. Executive Summary 4 2. 2018-19 Objective Review 9 3. OCCS Overview 10 3.1. Enquiry Volumes 10 3.2. Source 11 3.3. Conclusion Rates 12 3.4. Outcomes 12 3.5. Remit 12 3.6. The Impact of the OCCS 13 3.7. Timescale and Resolution Periods 15 3.8. Feedback 16 3.9 Complaints Regarding the OCCS 18 4. Learning From Complaints 19 4.1. What Do Consumers Complain About? 19 4.2. Who complains? (EDI & Geographical) 20 4.3. Who Do Consumers Complain About? 22 4.4. Outcomes 23 4.5. Analysis and Insight 24 4.6. Future Awareness 28 5. The Impact of the OCCS 29 6. Operational Review 32 7. Objectives for 2019-20 33 Conclusion 34 Analysis Area (Appendices) 35 -2-
INTRO/FOREWORD Foreword On 31 March 2019, the OCCS marked five years since the appointment of Nockolds ADR to deliver the service. In reviewing the 2018-19 year and reflecting on the work of the past five years, the team is incredibly proud of the positive impact, constructive working relationships within the sector and the sector-wide change facilitated through OCCS insight sharing and our impartial voice. The OCCS has supported 4,500 consumers and practices to resolve complaints either swiftly at a local level, or through mediation. I would like to take this opportunity to thank the OCCS and all those in the optical sector who have supported the OCCS. All of those contributions have helped to create a highly effective and accessible mediation service which combines the day to day mediation, helping individual consumers and practices, and also the more strategic consumer focused initiatives to support the wider optical community, and benefit patients and the general public. With the introduction of Acceptance Criteria by the General Optical Council last autumn, and many fast-paced changes in community-based optometry and ophthalmology, the OCCS welcomes the opportunity to provide further support during 2019-20. Foreword by Jennie Jones Head of OCCS -3-
EXECUTIVE SUMMARY 1: Executive Summary 1.1. Volumes Fig. 1 Enquiries Received by OCCS Per Annum 1,500 1,200 900 600 300 0 2014-15 2015-16 2016-17 2017-18 2018-19 55.7% 44.3% 1% 5.8% (1493) -4-
1.2. Nature of Complaints Fig. 2 Nature of Complaint (01/04/18 - 31/03/19) 6% Charges 35% Customer care 45% Goods and service 3% Other 11% Product 1.3. Trends • Busiest fourth quarter since Nockolds was appointed in 2014; • Increase in core optometric and dispensing related complaints; • Increase in complaints involving businesses not registered as ‘body corporates’ and where no individual registrant involvement in the complaint circumstances (87.5% increase to 60); • Referrals involving complaint handling increase, and further analysis reveals this increase is driven by: a. Practices seeking OCCS guidance and support in resolving consumer complaints at a local level b. Where a practice has ceased trading c. Transfer of practice to new owner – who deals with the patient complaint. • An increase in the number of consumers contacting OCCS with queries regarding the provision of a written prescription (116% increase); • An increase in complaints where a practice has dispensed an external prescription, and in particular, the consumer benefit in raising awareness of Optical Confederation guidelines on dispensing of prescription from another practice (44% increase); • An increase in complaints concerning patient belief that their eye condition has been misdiagnosed or delay in diagnosis. Many of these complaints involve issues of communication and expectation management, rather than clinical concern. These are triaged carefully by the OCCS to ensure they fall within the remit of the service. Where appropriate, mediation can assist in facilitating further explanation and reassurance. This increase does flag the importance of communication and explanation, particularly with the evolving and expanding role of optometry in community practice. -5-
• The nature of complaints received by the OCCS also suggests the challenging market for optical practices: a. Delay in supply (43% increase); b. Complaints arising as a practice ceases to trade; c. Sale of practices; d. Response to complaints and requests for refund. 1.4. Outcomes Fig. 3.1 Outcomes (All Enquiries Concluded) 9% Out of remit 63% Preliminary mediation 8% Consumer not pursue 13% Resolved on mediation 3% Mediation unsuccessful Fig. 3.2 Outcomes of Enquiries in Remit Concluded through Preliminary mediation and 97% OCCS process 41% referred back to the practice Advice brings complaint to Consumers do not 29% a conclusion – this includes practice enquiries 9% proceed further 87.3% successfully resolved through meditation in 2018-19 -6-
1.5. Objective Review - Sector —— Domiciliary sector During 2017-18, the OCCS concluded the initial consultation phase of a Vulnerable Consumer Accessibility Project. The OCCS accessibility plan has now been implemented and will be evaluated on an ongoing basis during the course of the year. The OCCS has also visited several domiciliary providers to understand their approach to customer care, safeguarding and complaint handling. This was useful to explore distinct approaches relevant to the provision of optical care in the home, and how the interests of consumers are protected. There has been no increase in complaints received by the OCCS regarding domiciliary providers. —— Contact Pathways During 2018-19, the OCCS had continued to: • Check reference points online; • Contact charities, referral organisations or advisory bodies to ensure good awareness of the OCCS; • Update and ensure that information available and provided to these organisations is accurate; • Share insight with National Optometric Advisors Association and with relevant bodies in the four nations. 1.6. Objectives – Feedback Response The OCCS has achieved an increase in feedback response rates from around 10% to 33% over the past 12 months. This has been achieved through an ongoing review of how we request feedback and the feedback requested. The feedback received on individual mediations continues to be positive in terms of the impartiality and effectiveness of the OCCS. “Thanks a million for all your efforts, I couldn’t be happier. This is completely unexpected.” “Again, I couldn’t have asked for a better support. Top marks to the OCCS team” “What an amazing service you are, I hope you all know that :)” “I was not optimistic of getting a positive outcome but the lady who liaised with me was patient and terrific and did her best to understand the point I was making and the outcome I wished.” 1.7. Objectives – Acceptance Criteria and Supporting Efficient Management of FTP The OCCS has continued to ensure the service has maximum opportunity to support the FTP strategy of the GOC to conclude complaints more quickly and effectively. Ultimately, the OCCS seeks to be part of the foundations which enable the GOC to be a proportionate and agile regulator. -7-
During 2018-19, the OCCS Team: • Supported and contributed to the introduction and implementation phase of the GOC’s initiative to apply Acceptance Criteria in October 2018; • Reviewed and updated the Working Together Policy; • Achieved an operational way of working collaboration in conjunction with the FTP team. With the introduction of Acceptance Criteria and the potential for an increase of referrals to the OCCS by the GOC, the OCCS has undertaken an end of year review of complaints to evaluate the appropriateness of, and the robust referral criteria applied in referrals by the OCCS to the GOC. This review confirms enquires or complaints within mediation which include elements which could, if proven, indicate a registrant’s fitness may be impaired are referred to the FTP team. The number of referrals increased from 20 in 2017-18 to 37 this year. These include: • Complaint circumstances which meet the OCCS contractual obligation to refer potential FTP concerns to the FTP process; • omplaints where the OCCS explains to the complainant the scope of mediation and the remit of the OCCS, C compared to the regulatory role of the GOC, and the complainant requests their concerns to be reviewed by the GOC. In this situation a referral is made by the complainant and relevant information provided to the GOC. 1.8. Operation Review The OCCS undertakes ongoing evaluations of the process and approach to mediation and complaint resolution. There have been no significant changes to the process or the approach to mediation. GDPR implementation in May 2018 did prompt some revisions to the documentation used but the service has strived to maintain an accessible and agile process which meets the needs of as many service users as possible with the resource available. 1.9. Insight Sharing Activity Overview 25 1500 sessions clinicians CET numbers s g etin Soci s me al m tiple diae Mul St ak eh ss old pre er try m us ee tin Ind gs -8-
OBJECTIVES 2018-19 2: Objectives 2018-19 OCCS Strategy Achieved Good Progress Work in Progress Not Yet Actioned April 2018 - March 2019 Objective Progress: Share insight and analysis from OCCS activity to date. Develop greater understanding and awareness in the domiciliary sector of the industry to ensure practitioner and consumer awareness. Continue to support the GOC Strategy for Managing Fitness to Practise, by identifying and implementing ongoing plans to assist the FTP team to conclude FTP complaints more quickly and effectively and in the delivery of the milestones to track progress. Continue to examine and consider ways of working that will support the introduction of Acceptance Criteria. Continue projects and improving consumer contact pathways to increase direct enquiries with the OCCS rather than other organisations such as GOC FTP team and Citizens Advice Bureau. Improve feedback response rates to ensure OCCS effectiveness can be quantified and monitored. Evaluate the remit of the OCCS and the wider needs of the optical industry and patients for future development of the OCCS. -9-
OVERVIEW 3: Overview 3.1. Enquiries Volumes 3.1.1. During 2018-19, the OCCS saw a 5.89% increase in activity. While this increase does not match the 2015- 16/2016-17 volumes, it does represent a higher percentage rate increase than seen in recent years (1%). Fig. 4 Enquiries Received by OCCS Per Annum 2014 - 2019 1,500 1,200 900 600 300 0 2014-15 2015-16 2016-17 2017-18 2018-19 - 10 -
3.1.2. Activity increased in Q4, with the service seeing its busiest month yet in March 2019, with 167 enquiries, and 13.1% increase on January – March 2018. Fig. 5 Enquiries Received by OCCS Per Month 2018 - 2019 180 167 162 151 150 136 132 126 128 120 110 109 110 105 90 57 60 30 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 3.2. Source 3.2.1. Each service user contacting the OCCS is asked to identify the source of the referral i.e. where they heard about the OCCS. The rates of capture have increased in 2018-19 following an operation objective to focus on data capture. During 2018-19, only 2% of enquiries had an unknown source. 3.2.2. Around 1% of complaints are returning to the OCCS following preliminary mediation, and then the consumer having raised their complaint at a local level with the practice. The phone call system was very easy to use, get through to and it was great to have contact with one individual who clearly provided their name and took the issue forward personally, as one point of contact. - 11 -
Fig. 6 Source Data 2018 - 2019 67% Website 1% Professional event 15% Referrals 11% Other/not specified Citizens 2% 1% Unknown advice bureau Previous ref 2% News/press 2% to practice/advice 5% Referral practice 1% Referral other practice 5% Referral GOC 4% Referral 3.2.3. Website and online searches account for 67% of referrals, a decrease on 2017-18. This is likely to be linked to the increase in data capture and increase in practice referrals. 3.2.4. Referrals from the GOC to the OCCS represent 5% of all enquiries (68 complaints) with 44 concluded in preliminary mediation, and 19 at full mediation. In five referrals, the complaint fell outside the remit of the OCCS and so we actively signposted the consumer to the appropriate forum or service. 3.3. Conclusion Rates 3.3.1. As at 31 March 2019, the OCCS had concluded 1,549 enquiries and complaints. 3.4. Outcomes 87.3% 88% successfully successfully resolved resolved through through meditation meditation in 2018-19 in 2017-18 3.5. Remit of enquiries received are accepted 89% as in remit of the OCCS - 12 -
Outcomes – Out of Remit % All diff +/- % Practice not registered with GOC 60 4.02 28 87.5 Compensation claim 38 2.55 -3 -8.6 Fitness to Practise* 37 2.48 17 85 Other miscellaneous 49 3.28 Grand Total 184 3.5.1. The total number of complaints concluded on the basis of the complaint being referred to the GOC did increase from 20 to 37 during 2018-19*. This remains a small proportion of the enquiries and referrals received by the OCCS (2.4%). Analysis of those enquiries confirm 20 involved complaints where the OCCS considered the circumstances should be considered by the FTP team (1.3%). In 17 complaints, mediation was explored, and the consumer wanted the GOC to be aware of the complaint AND wanted the registrant’s fitness to practise to be evaluated. As such, the referrals into the GOC have remained consistent. 3.5.2. As reported in 2017-18, there is an ongoing increase in enquiries from patients whose complaints concern an optical business not regulated by the GOC or do not involve an individual GOC registrant. This 85% increase is still low in terms of numbers (14 in 2016-17 to 60 in 2018-19); however it is a significant and ongoing trend. 3.5.3. We note the GOC’s current review of the Code of Conduct, and new Standards for optical businesses taking effect from 1 October 2019. The GOC is encouraging optical businesses to register. The OCCS welcomes this initiative as research suggests an applied and relevant set of business standards enhances and increases trust in optical professionals. It is in the public interest to minimise any confusion or misunderstanding caused by the current regulation of business title, i.e. the use of ‘optician’ in their title or business name rather than activity. Many consumers assume that all optician practices are regulated by the GOC. Consumers have the reassurance and the protection offered by a regulated set of standards and expectations. There is also an issue of consumer perception as many consumers assume that all optical practices are regulated and must operate to a minimum set of standards. 3.6. The Impact of the OCCS Fig. 7 Outcome – In Remit 2018-19 Preliminary mediation and referred 70% back to the practice for local resolution 8% Consumer not to pursue 19% Resolved on mediation 3% Mediation unsuccessful - 13 -
3.6.1. 97% of complaints within the remit of the OCCS (i.e. consumer complaints) conclude the process with a resolution. Outcomes - In Remit % - all % in remit % in mediation Preliminary - phase A 982 63 70 Consumer not to pursue 120 8 8.5 Resolved on mediation 268 17 18 88 Concluded without resolution 39 3 3 12 Preliminary Advice and Mediation 3.6.2. At this stage of the OCCS process, the Team provides: —— Initial complaint related advice (29% of in remit enquiries); —— Expectation management based on the OCCS Team’s understanding of consumer statutory and contractual rights when applied to a bespoke, healthcare related transaction; —— Consumers with assistance to articulate their complaint clearly and consider likely outcomes to resolve their concerns; —— An independent ear to listen and acknowledge their complaints. 3.6.3. There has been an increase in the proportion of enquiries received where the complaint is at a preliminary stage, and the practice local complaint procedure has not yet been started or is ongoing. 3.6.4. This has increased to around 70% of enquiries received. Analysis suggests that this increase may be attributed to: —— An increase in practitioner enquiries seeking guidance on handling complaints; —— Complaints involving multiple practices where one practice will contact the OCCS; —— An increase in complaints involving practices that have ceased trading. 3.6.5. The OCCS monitors returning referrals, i.e. where the parties exhaust the practice’s complaints process and the complaint remains unresolved. Last year, less than 2% return to the OCCS, suggesting the preliminary mediation combined with the parties’ commitment to resolving the complaint are largely effective. Mediation 3.6.6. Over 97% of the complaints in remit were successfully concluded during the OCCS process, and of those fully mediated by the OCCS resolution managers, 87.3% concluded with a resolution. 3.6.7. Mediation enables all potential resolutions to be explored and considered by the parties. It allows more creative and practical options to be agreed, and this means resolutions can be wider and more effective than financial resolutions. —— Replacement product; —— Re-issuing of NHS voucher; —— Re-examination or further appointment for explanation/clarification; —— Interaction between prescriber and dispenser; —— Apology; - 14 -
—— Refund (partial/full); —— Further explanations provided to enable the consumer to understand or accept the explanation provided; —— Consumer accepting information given by the practice or an offer from the practice; —— Review by a local independent practice or other branch. 3.6.8. During 2018-19, less than 40 complaints concluded the OCCS process without a formal conclusion. There is no variance based on the nature of the complaint or the type of business structure. With this equating to only 3% of the enquiries received by the OCCS, the service continues to be proud of the resolution rates achieved, and the benefit bought to the sector and consumers. Where complaints remain live following an OCCS mediation, the parties are open to take all and any action available to them. The OCCS resolution managers will help parties to weigh up the pros and cons of alternative and escalated action. 3.6.9. Further options fall into two main categories: —— Fitness to Practise – contacting the GOC. The OCCS will provide consumers with clear guidance on the role and statutory function of the GOC; —— Legal action either in terms of clinical negligence or asserting their consumer rights through small claims county court process. Consumers may also provide feedback online either via a practice’s own social media or other review sites. 3.7. Timescale and Resolution Periods 3.7.1. The average number of days to conclude enquiries/ complaint in the OCCS is 19.9 days. Fig. 8 Timescale of All Enquiries Concluded in 2018-19 86% 8% 6% 45 days and 46 - 90 days Over 90 days under Fig. 9 Timescales of All Mediated Complaints Concluded in 2018-19 56% 26% 18% 45 days and 46 - 90 days Over 90 days under - 15 -
3.7.2. he timescale for mediation is calculated based on the number of days between the consumer returning T the signed consent form to the OCCS through to resolution agreed and complaint archived. When comparing timescales to published data from other ADR schemes, it should be noted that while industry standard is 90 days, this runs from the date a complete bundle of relevant documentation is held by the mediator/resolution manager. The OCCS calculates timescales from an earlier point to encourage the service and practice to engage and provide relevant information as quickly as possible. 3.7.3. The OCCS has evaluated mediations exceeding 90 days. Analysis has shown that these complaint mediations have taken this time period because: —— Refractive surgery related complaints; —— They have involved active GOC investigations; —— The consumer had complex optical needs and the mediation stayed pending further secondary care; —— Varifocal intolerance where the practice and consumer are in dispute regarding the extent of, the reason for or ways in which the intolerance should be approached; —— Attitude or absence of the practice or the consumer. At the conclusion of all mediated over 45 days, the OCCS Team will review whether any reflections can inform future mediations to aid swifter resolutions. 3.8. Feedback 3.8.1. Current feedback response rates equate to 33.8% of mediations (7% of all enquiries). Service users who conclude their interaction with the OCCS at a preliminary mediation phase are far less likely to complete the feedback request. The OCCS will continue to obtain feedback at a strategic level from stakeholders, representative bodies and professional/customer services team in the multiples. I have never Thanks a million received a complaint What an amazing for all your efforts. via the OCCS and service you are I couldn’t be happier. You were am impressed at the absolutely brilliant, I hope you all This is completely mediation service know that :) unexpected. couldn’t have asked that you offer. for any more support, help or advice. - 16 -
3.8.2. Feedback Responses 2017-18 2018-19 % % % of consumers who would return 39 to the practice following mediation 48 % of consumers who 76 would use the service again 78 % of consumers who 80 would use ADR again** 67 100 Found OCCS easy to contact 97 Found the OCCS 83 to be understanding 84 Found the OCCS 82 to be helpful 85 Found the OCCS 82 to be fair 72 Found the OCCS process 82 to be productive 75 Found the OCCS process 83 to be efficient 77 Would recommend 83 the OCCS others 83 ** the question has been rephrased as to improve accuracy of response as the meaning of ADR (Alternative Dispute Resolution) was not clear. - 17 -
3.8.3. When benchmarked with other published ADR services, these response rates and results are exemplary, particularly given the marked increase in response rates. 3.8.4. This year, the OCCS continued to evaluate and revise the approach to feedback capture. This has included: —— Research into text based surveys – which is continuing and evaluating this medium as an option for some service users; —— Revised questions to reflect more basic feedback responses for enquiries concluded at a preliminary stage; —— Personal interaction with service users on a sample basis (telephone based) – this was conducted during Q4 2018-19. 3.8.5. Narrative feedback is set out in the Analysis Area. This reflects the positive impact of the OCCS on service users, and reflects the service’s ability to maintain impartiality whilst providing experienced based reflections and suggestions. Feedback comments are overwhelmingly positive. They express gratitude and an acknowledgement of the approachability, professionalism and effectiveness of the team. With an increase in response rates, it is expected that responses will range and the feedback will become more useful in terms of evolving and developing the service. Three respondees have provided detailed narrative responses to the request for feedback. These are summarised in Appendix 4. Where critical feedback is received the mediation or interaction with OCCS is reviewed. They relate to: a. Voluntary nature of mediation i.e. consumer seeking to have an individual registrant disciplined or a practice ordered to pay compensation. b. Frustration if their desired outcome is not achieved as their complaint fell outside the remit of the OCCS or the mediation concluded without a resolution. 3.8.6. All feedback is reviewed by the Team. Following ongoing reviews during the year, the OCCS has: —— Updated the ‘How We Can Help’ guide to provide clearer explanations of the remit of the OCCS, the role of mediation and clarifying that the OCCS is not an advocacy service. This guide supports the explanation given by the OCCS when an enquiry is initially received. As a benchmark, these response rates and results are exemplary; —— Made direct contact with one individual service user who felt a clinical examination should be available, and that the OCCS was biased in that the explanation provided by the practice concerning a prescription variation, was accepted without challenge; —— Fed this insight into planned CET to support practices in preventing complaints arising and also managing complaints at a local level so that consumer frustration is minimised. 3.9. OCCS Complaints There have not been any formal complaints or concerns raised under the OCCS complaint procedure during 2018-19. The phone call system was very easy to use, get through to and it was great to have contact with one individual who clearly provided their name and took the issue forward personally, as one point of contact. - 18 -
COMPLAINTS 4: Learning From Complaints 4.1. What Do Consumers Complain About? Fig. 10 Nature of Complaint (%) 6% Charges 35% Customer care 43% Goods and service 3% Other 11% Product 2% Unknown - 19 -
2018- % +/- % 2017-18 2016-17 19 Known % (known) % Goods and service 648 45 +3.6 Goods and service 46.6 53.5 Product 160 11 -1.7 Product 12.7 Customer care 515 35 +7 Customer care 28 33 Charges 85 6 -3.4 Charges 9.4 9 Other 48 3 +0.2 Other 2.8 4 Unknown 37 n/a n/a Unknown Total 1493 Total 100 4.2. Who Complains? a) Geographically 4.2.1. Geographical Overview Scotland % of enquiries: 5 Population as % UK Total: 8.2 Variance Against Population Data: -3.2 Northern Ireland % of enquiries: 1 Population as % UK Total: 4.8 Variance Against Population Data: -3.8 England % of enquiries: 91 Population as % UK Total: 84.2 Variance Against Population Data: +6.8 Wales % of enquiries: 3 Population as % UK Total: 2.8 Variance Against Population Data: +0.2 - 20 -
4.2.2. Geographic data suggests the OCCS Team receives complaints from all four nations in comparable proportions to the overall population. There are slight differences: • Scotland 5% OCCS enquiries variance 8.2% population, which may be linked to variation in the NHS structure and entitlement in Scotland. • N orthern Ireland 3.8% variance against population. The OCCS will continue to raise the profile of the OCCS in Ireland. b) EDI Overview and Comment 4.2.3. The OCCS continues to request: —— Age; —— Gender; —— Marital status; —— Sexual orientation; —— Religion; —— Ethnicity; —— Disability; and —— Gender re-assignment. consistent with the GOC’s own EDI data capture. 4.2.4. Response rates during 2018-19 were on average 39.3% of all enquiries. Response rates are higher in enquiries received via the online referral form, which is not a surprise. This is likely to impact on some of the EDI data analysis as groups of consumers may be more inclined to utilize the online facility. 4.2.5. The OCCS EDI response data remains largely in alignment with general population data. 4.2.6. The OCCS will be re-evaluating the EDI data and categorisation in 2019-20. 4.2.7. An overview of the data can be found in the Analysis Area. Was not optimistic of getting a positive outcome but the lady who liaised with me was patient and terrific and did her best to understand the point I was making and the outcome I wished. - 21 -
4.3. Who Do Consumers Complain About? Fig. 11 Business Type 70% Multiples 26% Independents 4% Other 4.3.1. The proportion of complaints involving independent and multiple practices reflects the estimated market share of those respective groups within the optical sector. 4.3.2. As in previous years, there is no distinction in terms of the nature of complaints raised by consumers in different Fig. 12 Nature of Complaint as a % Per Business Type Unknown Other Charges Customer care Product Goods and service Multiples Independ- NHS Other Practice ent details unknown - 22 -
business structures illustrating a likelihood that complaints of a similar nature arise in both independent practices and multiples. 4.4. Outcomes 4.4.1. Outcomes and resolution rates are consistent across the different categories of complaints. Fig. 13 Outcome as a % Per Business Type Currently in mediation Mediation unsuccessful Resolved on mediation Resolved at early stage Partial resolution Consumer not pursue Advice only Referred to practice Out of remit Multiples Independent NHS Other Practice details unknown Fig. 14 Outcome as a % by Nature of Complaint Mediation unsuccessful Resolved on mediation Resolved at early stage Partial resolution Consumer not pursue Advice only Referred to practice Out of remit Goods and Customer Product Charges Unknown Other service care - 23 -
4.4.2. Further analysis suggests that: —— Complaints falling within the ‘other’ category, involve miscellaneous matters and are more likely to be concluded with advice. This is to be expected as these queries will often relate to patient rights i.e. prescriptions and PD measurements or NHS entitlements/process; —— Complaints concerning charges and fees are also more likely to be resolved in the preliminary stage of the OCCS process. Many of these complaints also involve NHS voucher entitlement or procedural issues, pricing or ‘in practice’ queries. 4.5. Analysis and Insight The ‘Analysis Area’ contains data and more details on the nature of the complaints referred to the OCCS. When considering the analysis of 2018-19 activity, the improved data capture rates will have an impact. The complaints categorised as unknown has been reduced by 68.9% to just 37, and this will be reflected in the variance in the other categories. Customer Care 4.5.1. Main category of complaints referred to the OCCS relating to customer care have remained static: 2018-19 2017-18 1 Complaint handling Complaint handling 2 Delay in supply Delay in supply 3 Attitude Attitude 4.5.2. In 2017-18, the OCCS reported a decrease in the proportion of complaints concerning customer care. 2018-19 has seen an increase in those enquiries categorised as ‘customer care’ issues. 4.5.3. Having evaluated and reviewed the complaint circumstances, the OCCS reports that the increase would appear to be linked to several factors, including increases: —— In practice complaints/contacts with the OCCS (23%). Most of these involve preliminary mediation advice which in turns supports the practice to attempt local resolution within the practice; —— In the number of complaints referred to the OCCS where the consumer has used an online complaint portal such as Resolver, to register and log their complaint. Many practices have made a policy decision to not engage with these portals and ask consumers to send the complaint to them directly. These can then result in a referral to the OCCS based on the practice’s decision not to utilize the portal; —— In complaints arising at the point of or shortly after the sale/transfer of a practice to a new owner; —— Impact of achieving 97.5% data capture, as it is likely that some of the increase is accounted for by data quality. 4.5.4. We have also seen a 40% increase in complaints involving: —— Delays in supply; and —— Practice staff/team attitude. In the context of 23 million sight tests and eye examinations, only minute proportions give rise a complaint, and then remain unresolved. Anecdotally, the OCCS Team reports that these complaints may also be impacted by the retail and commercial pressures on practices and their owners. - 24 -
4.5.5. There has also been an increase in complaints where the consumer alleges they have been inappropriately sold an optical product. The numbers are low, but we have seen a 253% increase. These included complaints where a consumer feels they should not have been dispensed spectacles because of cataracts. As expected, a higher proportion of these complaints are raised by representatives on behalf of patients. Optical Care 4.5.6. Main concerns referred to the OCCS relating to optical care are: 2018-19 2017-18 1 Concerns regarding accuracy of the Concerns regarding accuracy of the prescription prescription 2 Dispensing accuracy Outcome of refractive surgery 3 The dispense of a prescription from Dispensing accuracy another practice Concerns Regarding Accuracy of the Prescription 4.5.7. omplaints involving concerns about the prescription provided continue to be the most common, and is double C the second most common complaint reason, complaint handling. 4.5.8. In most complaints, the perceived or actual errors in prescribing relates the success of the subsequent dispense. Some complaints are resolved with further explanation and reassurance i.e. where any transposition confusion is resolved or where a small variance is explained by the practice, assisted by the OCCS. Helping consumers to appreciate the subjective nature of the sight test as well as the art of prescribing where a significant change in prescription is found will often resolve a complaint of this nature. There are also scenarios where the prescription is incorrect, and with 23 million sight tests conducted and a significant number of prescriptions issued a year, a small percentage will always involve an element of subjective or human error. Insight on these complaints would emphasis the importance of communication and ensuring trust and confidence is maintained so difficulties, misunderstandings or errors can be overcome and remedied efficiently. Dispensing Accuracy 4.5.9. Complaints concerning the expectations and dispensing measurement accuracy continue to be the third most common complaint circumstance referred to the OCCS. As with the prescription, this is the central element of the consumer-practice relationship. The numbers have remained largely consistent with 2017-18, and therefore given the increase in complaints relating to optometric and dispensing, this represents a decrease in the proportion of overall complaints. 4.5.10. Complaints in this category include: —— Non-tolerance of multifocal lenses; —— Fitting concerns; —— Alleged errors in placing the order – prescription or specification. - 25 -
Dispensing of a Prescription Issued by Another Practice 4.5.11. There has been a 44% increase in complaints concerning the dispense of a prescription issued by another practice, increasing from 49 to 71 enquiries this year. 4.5.12. The OCCS does refer consumers and practices to the Optical Confederation guidance issued in December 2014, and 80% are resolved at an early stage. OCCS anecdotal experience suggests some practices (in all types of business groups) are unaware of the guidance. Once practices are made aware of the guidance, the dispensing practice will normally seek to remedy the consumer’s concerns and then liaise with the prescriber directly if they consider that to be appropriate. 4.5.13. The guidance is persuasive where practices or individual professionals involved are members of representative bodies within the Optical Confederation or are GOC registered. If a practice is not registered as a body corporate and it is not owned/managed by an individual registrant, then the complaint falls outside the remit of the OCCS and the guidance is also less persuasive on the business. Further Insight - Misdiagnosis 4.5.14. Although much of the OCCS case load revolves around consumer related concerns, the OCCS does inevitably see and try to support resolution of clinical based concerns wherever appropriate and possible. 4.5.15. Within this category, complaints can involve a patient’s perception or concern that a practice has misdiagnosed or there has been a delay in diagnosis. In these complaints, the OCCS will review and the triage process is more in depth. The complaint is reviewed from a clinical perspective to guide the remit assessment. 4.5.16. It is noteworthy that this year, the OCCS has handled necessarily, although small, an increasing number of concerns relating to progression from dry to wet age-related macular degeneration. Whilst not indicative of any clinical failing on the part of the sector it does flag a consequence of an increasingly ageing population with ever increasing quality of life expectations and increased complex optical needs being managed in the community. As a profession we will need to be effective in managing this situation not only clinically but also in terms of communication and explanation. 4.5.17. These complaints are considered carefully as it is critical that the OCCS assesses whether these complaints fall within the remit of the OCCS, and whether an alternative complaint pathway is required. Having reviewed this category of complaint: —— Nine were referred to the GOC; —— Three sought compensation and was signposted for independent legal advice; —— 10 were mediated, and the consumer concern was allayed through further explanation and reassurance by the practice or other relevant parties (hospital optometrist, consultant etc); —— The remainder were assisted in preliminary mediation. This often involves helping the consumer to articulate their concerns or fear so they are then able to ask the right questions of the practice to improve understanding and gain reassurance. 4.5.18. The Head of OCCS and a Clinical Advisor have reviewed all complaints in this category and are confident that all appropriate referrals have been made, and where a GOC referral was not appropriate. In many instances, the complaints arise through communication and a wavering in the trust aspect of the patient/optometrist relationship. 4.5.19. If the OCCS assesses the complaint and deems it to be within remit or require further information to make - 26 -
that assessment, the optical records will be obtained. If at any stage during the mediation, it is felt that a referral should be made to the FTP team at the GOC, the Head of OCCS and Clinical Advisors will review, and a referral can be made at any stage of the OCCS process. 4.5.20. The implementation of Acceptance Criteria by the GOC is relevant in these (as in all) complaints handled by the OCCS. As set out in the section of this report sharing our interaction activity with the GOC, ongoing collaboration and the Working Together Policy will ensure both organisations maintain public protection as a priority while ensuring complaints are handled in the most appropriate, effective and proportionate forum. Further Insight - Supply of Prescription 4.5.21. Complaints where the consumer has not been given their prescription at the conclusion of the eye examination have also increased noticeably. 4.5.22. As set out in section 26(2) of The Opticians Act 1989, and supported by the Sight Testing (Examination and Prescription) (No.2) Regulations 1989, there is a statutory duty on the optometrist to provide a written prescription and statement. 4.5.23. In complaints where a patient has not received or a request for a prescription has been declined, the OCCS will remind the practice of the above duty, and if the practice did not supply the prescription, the OCCS would consider a referral to the GOC. The OCCS will also consider a referral to the GOC if a number of consumers contact the service to complain that a particular practice or individual registrant are reluctant or refuse to comply with the Act. 4.5.24. A failure to supply the prescription, particularly when requested by a patient, will impact on the trust and confidence in that practice/optical professional, and by association, the sector. Consumers can start to question the practice’s integrity and whether the best interests of the patient are at the forefront of their mind and business practices. Products 4.5.25. Complaints concerning distinct issues of product quality have remained consistent compared to 2017-18, save for a small increase in the number of complaints regarding frame quality and durability. Nature of Complaint Concerning Product Supplied (In Order) Frames Lens Coating Lenses Contact Lenses Charges and Fees 4.5.26. The OCCS had seen an increase in complaints concerning fees and charges in 2017-18. During the last 12 months, complaints of this nature have dropped back to previous levels, at around 6% of all enquiries. 4.5.27. When reviewing complaints of this nature, trends include: —— Cancellation policies when a consumer changes their mind shortly after placing the order; —— Reglaze charges; - 27 -
—— NHS entitlement – such as early re-check; —— Price increases. 4.6. Areas for Greater OCCS Awareness and Profile/Trends: Domiciliary 4.6.1. Complaints involving domiciliary eye care referred to the OCCS remained static during 2018-19. 4.6.2. Complaints involving domiciliary eye care are more likely to involve customer care concerns rather than product quality issues. These include: —— Supply time frames; —— Ability to contact and speak with either the optometrist who attended or the support team when a query or concern arises; —— Price and costs. 4.6.3. As part of the OCCS’ objective to raise profile with the domiciliary sector, the Team has engaged with domiciliary providers to gain a clearer understanding of the approach, consumer protection and complaint handling processes within this are area of optics I queried a negative response from the opticians (over the phone) with you about faulty lenses and you gave me very clear advice what to expect. When I went into the shop I saw a different manager who told me the procedure was exactly what you had outlined. So that was good and in the end it was resolved easily (preliminary mediation) - 28 -
IMPACT OF OCCS 5: The Impact of the OCCS 5.1. General Optical Council Relevant Objectives: Continue to support the GOC Strategy for Managing Fitness to Practise, by identifying and implementing ongoing plans to assist the FTP team to conclude FTP complaints more quickly and effectively and in the delivery of the milestones to track progress. Continue to examine and consider ways of working that will support the introduction of Acceptance Criteria. Share insight and analysis from OCCS activity to date. 5.1.1. A key objective for the OCCS is to support the GOC FTP team, alongside consumers and optical professionals by providing effective and proportionate mediation for concerns that do not amount to FTP. A specific objective was defined for 2017-18 consistent with the GOC strategy aim: 5.1.2. Over the past 12 months, the OCCS has made good progress on this strategic aim: —— Presentation to Council in July 2018 to share the key insights from the 2017-18 Annual Report; —— Regular team-to-team interaction to discuss those concerns which fall within the ‘grey’ area between FTP and consumer complaints and to familiarise the new GOC triage personnel to ensure awareness, good understanding of the role and remit of the OCCS and to secure a constructive and effective relationship and dialogue; —— Collaborative planning to define ways of working to maximise the impact of the OCCS; —— Working Together Policy review undertaken by OCCS and GOC to reflect the evolved relationship between OCCS and GOC since Nockolds’ appointment in April 2014; —— Quarterly reviews between senior team members at the GOC and FTP; —— Monthly operation telephone conferences to discuss activity, trend insight and matters of mutual interest; —— This year we have been heavily invested in co-designing and delivering the FTP team training around - 29 -
introduction of Acceptance Criteria. We continue to work closely with the new Director of Case Progression to ensure effective implementation of this key opportunity; —— Ongoing interaction between GOC Optometric advisors and the OCCS Clinical Advisors to explore extent to which complaint circumstances fall within the GOC regulatory framework or more suited to an OCCS mediation; —— Detailed response to GOC consultations on: —— Acceptance Criteria, which was informed by the review of the possible Ways of Working defined by the collaborative work of the two teams; —— Education strategic review; —— Reviewing the published consultation overview relating to Acceptance Criteria. —— Hosting Council member meetings as OCCS offices to showcase what OCCS does and how this is done, and then to discuss the future needs of the OCCS service. 5.2. Optical Stakeholders This group of stakeholders includes, but is not limited to FODO, AOP, ABDO, FMO, BCLA, College of Optometrists and National Optometric Advisors Association —— Worked closely with representative bodies to share insights and feedback from our case load; —— Facilitating interaction between Trading Standards and the Optical Confederation on industry wide interpretation of consumer regulations; —— Attend OC Domiciliary Eyecare Committee. 5.3. Corporates 5.3.1. As in previous years, the OCCS has met annually with the corporate providers of optical healthcare to share insight, benchmark and to discuss sector and individual trends. As leadership and professional standards teams change, the OCCS has embarked on clear strategic awareness and insight sharing to maintain good operational and strategic channels of communication. 5.3.2. The OCCS has also been invited to present insight sharing sessions at corporate professional conferences. These are on a first come, first served basis, with the direct costs met by the corporate. 5.4. Individual Practitioners 5.4.1. CET events – OCCS insight sharing is particularly effective though peer discussion workshops. This year saw the OCCS deliver 25 sessions reaching over 1,500 clinicians. Many are self-funded (at cost) by Local Optical Committees, companies or professional bodies. 5.4.2. The OCCS has continued to deliver sessions relating to candour and consent however our new content to support registrants in their understanding of which complaints escalate to Fitness to Practice and reinforcing how to effectively manage complaints has received excellent feedback and will be the cornerstone of our activity in 19/20. 5.4.3. The OCCS has continued to maintain the OCCS profile within the Optical Press, Optician and Optometry Today by writing and contributing to articles covering candour and consent. See Analysis Area for more details. 5.4.4. Social media interaction has increased this year with a particular focus on Registrants and how the OCCS is able to offer support. A six month overview of social media activity is provided in the Analysis Area. 5.4.5. This year has seen the OCCS promote the activity of OCCS and GOC in complaint management with other regulators such as the GDC. 5.4.6 See Analysis Area for more details. - 30 -
5.5. Media Activity 5.5.1. In addition to optical industry press, the OCCS has been contacted by consumer and general media for input on specific stories and topics involving optical, consumer or health issues. 5.5.2. In December 2018, Jennie Jones, Head of OCCS contributed to a live radio interview on BBC Radio 4, consumer programme – ‘You and Yours’ concerning domiciliary optical care and perceptions around sales and pricing. 5.5.3. Social media activity has been increased during 2018-19. 5.6. Conference Activity 5.6.1. Optrafair - The OCCS worked in conjunction with the FMO to deliver CET sessions covering varifocal non- tolerance at Optrafair 2018. The Team also worked with ABDO to deliver a session to international leaders in optical sectors from around the world. 5.6.2. AIO Conference 2018 - Delivered a peer group discussion at AIO Manchester 2018. 5.6.3. International - Delivered session to Hoya Academy Budapest September 2018 and ABDO Chinese delegation at NRC. 5.6.4. 100% Optical - Delivered our candour and consent session at 100% Optical in January 2019. - 31 -
OPERATIONAL REVIEW 6: Operational review 6.1. The OCCS Team continually reviews, evaluates and reflects on the approach to complaint resolution and the expertise required. 6.2. During 2018-19, the following have been undertaken: 6.2.1. Team wide training with ‘mind’ to support the Team in the implementation of the Vulnerable Consumer toolkit launched in 2017-18. 6.2.2. Consumer rights and legal basis to consumer, contractual and negligence claims to refresh team knowledge on alternative complaint resolution pathways. 6.2.3. NHS England refresher - training provided by NOAA Optometric Advisor. 6.2.4. Ongoing refresher training on: • Consumer capacity – consent; • Consumer credit related rights – credit card transactions. 6.2.5. Revised consent form (now termed an Agreement to Mediate) following the introduction of GDPR in May 2018. 6.2.6. Revised Privacy Policy and Notice in April 2017. 6.2.7. Introduction of a new telephone system which allows greater flexibility and call management. 6.2.8. Preparation of a Consumer Guide on what to do in the event of the practice ceasing trading. This was in response to an increase in enquiries and referrals involving these circumstances. 6.2.9. Revising wording in the How We Can Help guide based on service user feedback. - 32 -
2019-20 Objectives 7: 2019-20 Objectives 7.1. The following objectives are proposed for 2019-20: • Share insight and analysis from OCCS activity to date, to include activity with education establishments to reach out to optical students. • Continue to support the GOC Strategy for managing Fitness to Practise, by identifying and implementing ongoing plans to assist the FTP team to conclude FTP complaints more quickly and effectively and in the delivery of the milestones to track progress. • Continue to examine and consider ways of working that will support the embedding and development of Acceptance Criteria by the GOC. • Continue to monitor feedback responses and rates to ensure OCCS effectiveness and accessibility. - 33 -
CONCLUSION Conclusion 2018-19 was a year of milestones: five years of the OCCS under the tenure of Nockolds, a 97% resolution rate for five years in succession and an increase in feedback responses. The OCCS work supporting the GOC strategy to more efficiently manage complaints is aligned with the key objective of the OCCS: providing an alternative process to explore resolution at the most proportionate and effective level, thereby encouraging early resolution, support improving standards and ensuring agile and targeted public protection within regulation. During 2019-20 the OCCS is keen to explore how the service could and should continue to evolve the service to support the sector as it moves forward with an evolving optometric role and increasingly complex optical needs of patients and their families. We look forward to sharing the outcome of these conversations over the next 12 months. - 34 -
Analysis Area Content 1 Outcome data table 2 Timescale report – complaints remaining active after 90 days 3 Detailed categorisation data – nature of complaint 4 Feedback narrative comments 5 Equality and Diversity 6 Working Together Policy – revised in 2018 7 Media Activity Figure Contents Page 1 Enquiries Received by OCCS Per Annum 4 2 Nature of Complaint (01/04/18 - 31/03/19) 5 3.1 Outcomes (All Enquiries Concluded) 6 3.2 Outcomes of Enquiries in Remit 6 4 Enquiries Received by OCCS Per Annum 2014 - 2019 10 5 Enquiries Received by OCCS Per Month 2018 - 2019 11 6 Source Data 2018 - 2019 12 7 Outcome – In Remit 2018-19 13 8 Timescale of All Enquiries Concluded in 2018-19 15 9 Timescales of All Mediated Complaints Concluded in 2018-19 15 10 Nature of Complaint (%) 19 11 Business Type 22 12 Nature of Complaint as a % Per Business Type 22 13 Outcome as a % Per Business Type 23 14 Outcome as a % by Nature of Complaint 23 - 35 -
Appendix 1 Outcome Count of Complaint Ref Out of Remit 140 Referred to Practice 579 Advice Only 403 Consumer not pursue 120 Partial Resolution 18 Resolved at Early Stage 60 Resolved on Mediation 190 Mediation Unsuccessful 39 Data based on closed during 2018-19, and figures will Grand Total 1549 differ to data based on complaints opened during this Analytical Data on Outcome by Nature of Complaint Outcome (%) of Complaint Relating to Goods and Service 8% Out of remit 39% Referred to practice 22% Advice only 6% Consumer not pursue 2% Partial resolution 3% Resolved at early stage 16% Resolved on mediation 4% Mediation unsuccessful - 36 -
Outcome (%) of Complaint Relating to Customer Care 10% Out of remit 35% Referred to practice 30% Advice only 8% Consumer not pursue 1% Partial resolution 5% Resolved at early stage 10% Resolved on mediation 1% Mediation unsuccessful Outcome (%) of Complaint Relating to Product Supplied 7% Out of remit 46% Referred to practice 17% Advice only 8% Consumer not pursue 1% Partial resolution 6% Resolved at early stage 11% Resolved on mediation 4% Mediation unsuccessful - 37 -
Outcome (%) of Complaint Relating to Charges 3% Out of remit 43% Referred to practice 37% Advice only 8% Consumer not pursue 0% Partial resolution 1% Resolved at early stage 6% Resolved on mediation 2% Mediation unsuccessful Outcome (%) of Complaint Unknown 14% Out of remit 29% Referred to practice 14% Advice only 24% Consumer not pursue 5% Partial resolution 5% Resolved at early stage 10% Resolved on mediation 0% Mediation unsuccessful - 38 -
Outcome (%) of Complaint Other 20% Out of remit 14% Referred to practice 56% Advice only 4% Consumer not pursue 0% Partial resolution 2% Resolved at early stage 4% Resolved on mediation 0% Mediation unsuccessful - 39 -
Appendix 2 OCCS total All Mediated % Less than 45 days 87 12 46-90 days 59 41 More than 90 days 63 37 All Mediated Average (days) 18.34 57.02 % Less than 45 days 86 56 46-90 days 8 26 More than 90 days 6 18 100 100 - 40 -
Appendix 3 Sub Category - Complaint Data Complaints Concerning the Optical Care/Service 9 Cataract 12 Eye test 23 Reglaze - issue with consumers own frame 38 Missed diagnosis 43 Dispense of varifocal 46 Concerns with the examination 47 Outcome of laser eye surgery 56 Unknown 71 Prescription prescribed in one practice and dispensed in another 87 Dispensing 216 Error with prescription - 41 -
Complaints Concerning Customer Care 5 Non qualified staff issues 5 Dispensing optician customer care 6 Excluded from store 8 Pupillary distance - entitlement 8 Laser surgery - complaint handling 11 After care 22 Unknown 26 NHS voucher enquiry 27 Optom customer care 27 Customer change of mind 35 Failure to deal with concerns/ 39 No prescription provided 46 Alleged inappropriate selling 71 Attitude 76 Delay in supply 103 Complaint handling - 42 -
Complaints Concerning Products 1 Unknown 4 Varifocals - quality 13 Contact lenses 19 Product - lenses 24 Product - lenses coating Product - 99 frames Complaints Concerning Charges 15 Unknown 70 Charges and offer - 43 -
Appendix 4 Positive feedback themes Progress resolution Empathy Effective I received a full refund for the lenses, so Was not optimistic of getting a positive I am very grateful for your fair investigation I'm indeed satisfied with the outcome. outcome but the lady who liaised with of my situation and right and fair decision. Given the slow and lax attitude of the me was patient and terrific and did practice manager I don't think I would her best to understand the point I was have arrived at this result without the making and the outcome I wished. OCCS's involvement. Extremely helpful and very Pro-active in The support received from the OCCS Thankyou if it was you that put pressure my treatment. staff was incredible. All ladies who dealt on the practice. Their site does have many with my case were very efficient and happy customers but a lot that intimate prompt and provided a clear and helpful some retraining and customer satisfaction guidance throughout the entire process. checks. Very much so- I was not optimistic of You were absolutely brilliant , couldn’t Without your help, I would have received being treated fairly as the Practice were have asked for any more support , help no remuneration. I am very grateful to adamant in behaving badly. or advice. receive a cheque that covers the cost of the lenses. Thank you very much. Definitely glad I used your services. Particular thanks to our resolution I queried a negative response from the manager and the clinical advisor opticians (over the phone) with you about involved in our mediation. faulty lenses and you gave me very clear advice what to expect. When I went into the shop I saw a different manager who told me the procedure was exactly what you had outlined. So that was good and in the end it was resolved easily (preliminary mediation). I have never received a complaint via the Staff were very friendly and Yes was all very quick and efficient. OCCS and am impressed at the mediation understanding but fair to both parties. Thank you. service that you offer. Thanks a million for all your efforts. I Our resolution manager was extremely Really helpful couldn’t be happier. This is completely helpful and listened to my points and wish to express my thanks unexpected. engaged with the issue even though this Very helpful resolution managers, both was not an area of experience to herself, Kayleigh and Dawn. she found out and clarified the situation fully. Again, I couldn’t have asked for a better Actually all the staff and emails are support. Top marks to the OCCS team. excellent. Prompt with response. What an amazing service you are. I hope Very helpful and always responded to The phone call system was very easy to you all know that :) my emails. use, get through to and it was great to have contact with one individual who clearly provided their name and took the issue forward personally, as one point of contact. - 44 -
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