Getting to grips with referrals

But for locum optometrists, who move between different practices, systems and regions, there are additional complexities when it comes to ensuring patients are seen in the right place at the right time.

Alongside referrals to secondary care, locum optometrists must have a thorough process for handing over care of a patient to another staff member within a practice that they may not return to.

Below, OT shares tips from locum practitioners as well as guidance from the AOP’s head of clinical and regulatory, Henry Leonard, on making effective referrals.

Clear and concise

Locum optometrist and chair of Nottinghamshire local optical committee, Roma Malik, shared that as a locum optometrist she has learned to adapt to local referral protocols, double-check details, and always ensure urgency is matched to clinical need.

“As a locum, you quickly learn the importance of making clear, concise, and clinically justified referrals – especially when working across multiple systems and regions,” she said.

Malik highlighted the importance of effective communication when it comes to referrals – clearly outlining patient history and red flags.

“Over time, you become confident in your judgement and more proactive in chasing up outcomes where necessary,” she said.

“It’s important to ensure patients are well-informed about red flag symptoms, when to seek further medical attention, and when to chase a referral if needed,” Malik emphasised.

“Any delays in the referral process can ultimately postpone the care that the patient needs”

Locum optometrist, Kam Sandhu, highlighted that being well-informed about local referral pathways as a locum optometrist can facilitate a smoother and faster referral experience for the patient.

“Working as a locum means you often face the unpredictability of not knowing when you'll be back at a specific practice, as clinic shifts can change at a moment's notice,” she said.

“It’s  crucial to ensure that your referrals are made accurately and with the right information,” Sandhu emphasised.

She highlighted that if a referral is rejected or not handled in the right way, another clinician will have to step in to resolve the issue.

“Moreover, any delays in the referral process can ultimately postpone the care that the patient needs,” Sandhu said.

When locum optometrist, Frank Eperjesi, starts working in a new area he will ask the practice manager or resident optometrist what the referral pathways are for different categories – including same-day emergencies.

“People with cataract or glaucoma sometimes have a different referral pathway than people with other eye conditions,” Eperjesi observed. 

He will complete all referrals himself – even if this means staying late after the last patient.

“It’s not fair on the patient to delay a referral and it's not fair to leave it to another member of staff. As the optometrist conducting the examination it's solely my responsibility to make sure that a referral is timely and appropriate,” Eperjesi highlighted.

Locum optometrist, Janki Vadgama, highlighted that knowing local pathways and contacts gives patients confidence in their locum optometrist in the event that a referral is required – especially in the case of emergency referrals.

“You may not be in the same practice again for a while, so you need to be thorough with the urgency of referral and making sure the right pathway is used to ensure your patient is given the right care in a timely manner,” she said. 

Locum optometrist, Rebecca Rushton, shared that she regularly checks referral guidelines to ensure that she has current information.

“I get up-to-date referral guidelines from my local LOC website which is a fantastic resource,” she said.

The two key questions that she aims to answer through her referral are: what is the problem and what should the person receiving the referral do about it.

“I keep my referrals concise because I don’t want to spend much time writing it and the person reading my referral doesn’t want to wade through paragraphs of irrelevant information,” she said.

Vadgama highlighted that clear communication with practice staff about any referrals that have been made reinforces a patient’s trust in the practice.

“Always approach the resident optometrist within the practice if they have one. If not, approach the practice manager and give an overview of any referrals made and where, with a list of patients’ names,” she said.

“Therefore, if the patient calls back to follow up, everyone is on the same page which reaffirms the patients trust in you,” Vadgama said.

Leonard shared that if a locum is unsure how to refer a patient, they can approach the resident optometrist or practice manager for advice.

He highlighted the importance of establishing the correct internal and external referral protocols before starting working at a new practice.

“Most practices will allow some time before the first clinic starts to familiarise yourself with the equipment, and many will have a ‘locum folder’ which contains helpful information, including referral pathways,” Leonard said.

Some practices will already have their own mechanism for managing internal referrals

Internal referrals

When passing on care of the patient to another staff member in a practice where Sandhu is familiar with the team, she will contact the clinician directly and share insights from the consultation.

Sandhu will ensure they have all the information they need to support the patient’s care, including what was discussed, findings and the proposed management plan.

“If I am not familiar with them, I make it a point to keep my record notes detailed and leave a message in their diary, prompting them to review the patient notes for additional context. I always encourage them to reach out to me if they need any further clarification,” she said.

Rushton will also leave clear notes if she is in a situation where she needs to hand over follow up care to another staff member.

“I try to leave as little work for my colleagues as possible but where necessary I either write an internal referral to a colleague or leave very clear instructions on a patient record about what needs to be done next,” she said.

Leonard shared that the AOP’s clinical and regulatory team assists around 300 members each year following a complaint or concern.

“Problems with referrals is a common issue we encounter,” he said.

Leonard highlighted that locum practitioners are more likely to make an internal referral for a follow up test in practice – for example, dilation.

“There needs to be a robust mechanism in place to ensure these patients aren’t overlooked,” he emphasised.

Leonard observed that there can also be confusion about which practitioner is ultimately responsible for managing the patient.

He added that in most cases this will be the optometrist who completes the examination.

“We recommend using an ‘internal referral’ form to make it clear that the first practitioner is transferring this responsibility to the second practitioner,” Leonard said.

He highlighted that there are AOP resources that locum optometrists can use when making an internal referral.

“Some practices will already have their own mechanism in place for managing internal referrals, so it’s important to find out what system you should be using when you start working at a new practice,” he said.