For employers: the practice team
It is important that all members of the practice team, whether registered professionals or support staff, permanent or temporary team members, are trained and supported in all their roles, and understand any risks involved in delivering safe and high quality patient care.
Delegation is a common feature of modern clinical practice and essential for the best use of clinical skills. In community optical practice, routine test procedures, such as non-contact tonometry, are often delegated to suitably trained support staff before or after the consultation. The practice should make sure that patients can identify who is who within the practice, for example by providing staff with badges showing their job titles.
Whatever delegation takes place, the optometrist is and remains responsible for ensuring that the person to whom a task is delegated is suitably trained and competent to carry out the task. The optometrist also remains responsible for the procedure, for reviewing the results, for ensuring the test is repeated when necessary and for taking the results into account in their clinical decision-making.
It is therefore important that:
- Practice systems ensure that support staff are appropriately trained and competent to undertake the procedures optometrists delegate to them
- Support staff training can be confirmed to the optometrist on request
- Optometrists are at all times clear about which procedures are being performed on their patients and by whom. They should dictate what clinically appropriate tests are done
- Staff carrying out delegated procedures are directly responsible to the optometrist dealing with the patient
- Staff carrying out delegated procedures always pass test results to the optometrist to be assessed, signed off and included in the patient record
Support staff are not qualified or trained to advise patients about the results of the tests and should not do so. Practices should ensure that fail-safe Standard operating procedures (SOPs) are in place so that:
- Optometrists know what procedures will be carried out routinely to support the sight test
- It is impossible for any unexpected procedure to be carried out without the optometrist’s knowledge
- The optometrist always reviews the results of all procedures for their patients
By definition, locum optometrists often find themselves in unfamiliar surroundings at short notice. It is important that locums new to a practice are given time to familiarise themselves with the operation of any equipment and software they may be required to use, and that staff are on hand to assist with this familiarisation. Practices should make sure that locums are clear on what pre-testing will be done and how the test process will be managed. SOPs should be made available to locums as well as information on local referral routes and protocols.
Repeat tests and follow-up are particular challenges for both the practice and practitioner where locum optometrists are involved. Locums may not be able to book repeat procedures for when they will be in the practice and so may be reliant on others to conclude the patient’s sight test.
It is here that both practice and any personal professional systems need to be absolutely watertight. All follow-ups should be assigned to an optometrist who understands that they are taking on clinical responsibility for the sight test or, alternatively, an internal practice referral should be made, as explained below under "Internal practice referrals". Arrangement for this should be agreed with all parties when the locum is engaged and confirmed again, where possible, before the locum leaves the practice.