Avoiding professional conduct pitfalls as a locum optometrist

For locum optometrists, who move between practices with different equipment, processes, and staff, there are specific vulnerabilities when it comes to navigating the risk of a professional conduct investigation.

In this feature, OT explores how locum optometrists can reduce their risk of a fitness to practise investigation with insight from the AOP and General Optical Council (GOC).

The Optical Consumer Complaints Service (OCCS) also shares tips on how locum optometrists can reduce the chances they will be the subject of a complaint in practice.

The AOP view

AOP head of clinical and regulatory, Henry Leonard, highlighted that, for locum optometrists, complaints often involve issues around referrals.

“We are aware of GOC complaints where this has become a significant feature of the investigation. Patients typically complain that their referral was overlooked, or was sent to the wrong provider, or was sent with an inappropriate degree of urgency, and the patient has come to harm as a result,” he said.

“This is a particular issue for locum optometrists, who may be working in different areas where they may not be as familiar with local referral protocols as resident optometrists,” Leonard added.

He shared that another common issue for locum practitioners is around deferred procedures – for example, where the locum has advised a patient to return for a follow-up test such as dilation or visual fields, but the results are overlooked.

Reflecting on the steps locums can take to reduce their risk, Leonard encouraged locum optometrists to familiarise themselves with local referral protocols for each area they are working in and ask the practice manager or resident optometrist for guidance if they are unsure.

He added that many local optical committees (and regional optical committees) publish information about local referral pathways on their website.

“If patients need to return for a deferred procedure on another day, we recommend using an internal referral template to ensure it’s clear that the responsibility for managing the patient has been transferred to another practitioner,” Leonard said. 

The AOP also has specific guidance for locum optometrists within its Managing Risk in Practice guidance. 

AOP clinical adviser, Kevin Wallace, highlighted that ideally a locum optometrist would do everything they can to manage a patient on the day.

However, he acknowledged that there would be times when this was not possible and also recommended making an internal referral in this situation.

“Essentially you are writing a referral, as you would to a hospital or GP, asking the other practitioner to take over the care of the patient because of your findings. Those findings should be clearly explained, as well as what you have asked the patient to do,” he said.

From what we see in our data, the issues that lead to concerns are often avoidable and tend to come back to the basics: good communication, accurate records, and being open and honest with employers and patients

Insight from the GOC

GOC head of investigations, Rebecca Bryan, told OT that data on fitness to practise investigations is not separated depending on whether a practitioner is a locum or employed.

However, the overall numbers remain low when viewed in related to the overall size of the register – with 45 cases appearing before the fitness to practise committee in 2024. Of these cases, six decisions resulted in erasure from the register.

“The themes behind those decisions – dishonesty, personal misconduct, and clinical issues involving dishonesty – are consistent with previous years,” Bryan reflected.

She highlighted that while a locum practitioner’s working environment may change, the expectations of the GOC remain the same.

“What helps is making sure you understand how each practice operates: things like referral routes, record systems, and who to speak to if something doesn’t feel right,” she said.

Bryan emphasised the importance of openness – noting that dishonesty is one of the small number of reasons behind decisions that have resulted in erasure.

“From what we see in our data, the issues that lead to concerns are often avoidable and tend to come back to the basics: good communication, accurate records, and being open and honest with employers and patients,” she highlighted.

Fitness to practise myths

Addressing common misconceptions about professional conduct investigations, Bryan shared with OT that only a “very small proportion” of the profession face a fitness to practise investigation.

“There’s sometimes a belief that the GOC investigates large numbers of registrants or that most concerns automatically escalate. The figures show a very different picture. With over 35,000 registrants in 2024–25, only 464 concerns were raised and just 137 became investigations,” she said.

She highlighted that there is also a misconception that the process takes a very long time.

“In reality, we make initial triage decisions in around five weeks, and most cases don’t progress further,” Bryan said.

She observed that the focus of the fitness to practise team is on “proportionality and risk.”

“When registrants understand that, they often feel more reassured about how the system works. That being said, full investigations do take longer, and it remains a priority for the GOC's investigations team to reduce the timeliness of our investigations,” she said.

Tips on avoiding patient complaints from the Optical Consumer Complaints Service

The OCCS is an independent and free mediation service for optical consumers and optical professionals funded by the General Optical Council.

Optical consumers can lodge complaints with the OCCS about goods or services that they received from an optometry practice.

In 2024–2025, the OCCS received 1679 enquiries. Prescription issues, complaint handling, dispensing and frame-related issues were among the most common complaints received by the OCCS.

Reflecting on her experience as a resolution manager for the OCCS, Dawn Slocombe highlighted that it is important for locum optometrists to understand practice protocols – including patient handover pathways, and the discussions and advice that practices expect optometrists to deliver to patients.

She added that understanding NHS pathways for each practice – such as where and when to refer – is also key.

OCCS resolution manager, Rachael Brennan, emphasised the importance of becoming familiar with the different technology that is available at each practice.

“This is especially important with OCT as interpreting different manufacturers’ readouts can be challenging,” she said.

Turning to record keeping, Brennan noted the importance of taking full and accurate notes – using language that can be easily understood by another optometrist.

“Avoid using acronyms that are very personal to the locum, which may be difficult for a fellow professional to understand. Also ensure that, where possible, the records are filled in in the same style as previous records,” she said.

“Comprehensive record keeping not only ensures best patient care, but also good continuity of care on subsequent visits, as well as ensuring that the locum has documented their advice and in doing so help protect themselves if any misunderstanding should arise in the future,” Brennan reflected.

She added that if a locum optometrist does have a complaint against them, it is important that they work with the practice to try and resolve the issue.

“Often a patient simply wants an acknowledgement that things went wrong and to see that the practice and practitioner have made changes to their routines to try and minimise the risk of the same incident happening to someone else,” Brennan observed.

OCCS resolution manager, Kayleigh Turnbull, highlighted that practices also have a responsibility to support locums in helping them to gain the knowledge required around patient and practice expectations.

“That support will engender trust between the practice and the locum, which in turn will create a better patient journey. This openness will also allow for proactive feedback from both patients and other practice staff, reducing the likelihood of a small complaint going unresolved and escalating into a much bigger issue,” she said.