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Aipedia: Optometrists and opticians
An AI tool can suggest whether and how urgently to refer, but the decision to refer stays with the optometrist under GOC Standards 6.1 and 7.8. Getting urgency wrong is a direct route to harm, complaints and claims.
Part of: AI in Optometrists and opticians
In short
Some practice systems and referral platforms now suggest a referral pathway or urgency from examination findings, images and symptoms. These tools can improve consistency, but they can under-refer an urgent case or over-refer routine findings into busy hospital eye services. The GOC Standards of Practice require you to work within your scope (6.1), apply professional judgement to technology-generated data (7.8) and keep clear records (8.1). Whether you follow or override the suggestion, record why. Indemnity usually responds to a claim about a referral decision as a claim about your judgement, subject to the policy wording.
Referral decisions are among the most consequential an optometrist makes. AI triage features appear in several forms: decision-support prompts in practice management software, image analysis that attaches an urgency level to a finding, and referral platforms that pre-sort referrals before they reach hospital eye services or community schemes. Some suggest "routine", "soon" or "urgent"; others suggest whether to refer at all or to monitor and recall.
The appeal is clear: consistent decisions, fewer inappropriate referrals and support for less experienced staff. The difficulty is that urgency depends on symptoms, history, onset and the patient's circumstances, which a tool may weigh poorly or not see at all.
The main duties that apply are:
The College of Optometrists' interim AI position stresses patient safety and that AI supports rather than replaces clinicians. If a referral decision is made solely by software with no meaningful human involvement, section 80 of the Data (Use and Access) Act 2025 restricts solely automated significant decisions on health data.
Illustrative scenario: a patient reports a few days of new floaters. The examination is limited by small pupils and the triage tool, given the recorded findings, suggests routine monitoring. The optometrist accepts the suggestion without recording the onset or whether there was a curtain or shadow. The patient later presents with a retinal detachment and alleges that urgent same-day referral should have been made.
The opposite failure matters too. A tool that over-refers can fill hospital clinics with routine cases, delay patients who need to be seen and erode trust in community optometry. Over-referral rarely leads to negligence claims but can lead to complaints and commissioning concerns. Both risks come back to the same point: the tool works from what it is given, and the optometrist decides.
In a claim, the record of the referral decision is often the most important document. If you followed the tool, the note should show that you agreed with it for clinical reasons. If you overrode it, say why: for example, the patient's symptoms, history or examination findings. A record that simply says "triage: routine" invites the argument that the decision was delegated to software.
GOC Standard 12.2 requires adequate indemnity. A referral-decision claim is usually treated as a claim about your professional judgement, and cover commonly responds on that basis, subject to the policy terms. Where a chain or platform built the triage logic, its own policies and contracts may also be relevant.
These steps reduce the risk:
Related: AI OCT scan analysis, AI retinal photo screening, AI chatbots and bookings, the doctors' guide to AI triage in online consultations and the optical AI hub.
Apex arranges PI for optometrists and optical businesses. A broker can review how your cover treats referral decisions made with AI decision support; see our optometrist PI guide.
No. Standard 7.8 requires you to apply professional judgement to technology-generated data, and Standard 6.1 requires you to work within your scope. Use the suggestion as one input and record your own reasons for the referral decision.
Record what the tool suggested, what you decided and why, such as specific symptoms, history or findings. Also record the advice you gave the patient. This shows the decision was yours and was reasoned.
It is less likely to cause a negligence claim, but it is not risk-free. Unnecessary referrals can delay other patients, cause anxiety and lead to complaints. The aim is an appropriate referral, reached through your own judgement.
Usually, because a claim about a referral decision is normally treated as a claim about your professional judgement. It depends on the policy wording, so check whether it says anything about AI or decision-support software, and how it sits alongside any cover held by your employer or chain.
Tell us about your firm and the work you do. A broker will review how your current PI treats AI-assisted work, or arrange new cover. No fee for a quote. Or call 0117 325 0027.
Start a PI quote Request a callbackApex Insurance Brokers Limited is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales, company number 07014570. This page is general information about how AI is used in the profession and how insurance may respond. It is not legal, regulatory or insurance advice on your circumstances, and it does not guarantee that cover will be available or on what terms.
