“The duty of care ends with you”

I wish I had known… What a strong community locum optometry can be. 

I realised this when… I joined a locum WhatsApp group. I think there are about 250 of us on there. It's a godsend, because it means we can chat about normal things. Because we're not part of the practice, there are things that sometimes we just don't know about, or we need help with – more locum related aspects of the job. It really is helpful.

An offshoot of that is another WhatsApp group where there's an ophthalmologist who shares clinical cases with optometrists. If you're in practice and you're not sure what to do about a referral, or you've seen an OCT image, you can post it on there. He's brilliant, and he'll come back with answers.

The person who helped me realise this was… When you're a locum, it's extremely difficult to get someone to sign off so that you can get your CET grants. Locums are always disadvantaged on that. I put a message on the locum Facebook group, and a lady got back to me and said, 'Have you tried WhatsApp?' I didn't even know there was a WhatsApp group, but lot of locums had been on it for a few years.

As locums, we definitely feel a bit more connected to each other. I don't know if COVID-19 propelled us into this.

It has helped me because… As locums, we definitely feel a bit more connected to each other. I don't know if COVID-19 propelled us into this. It almost felt like, if you were a resident during that time, there were things being done for you – financial help and schemes, for example. As locums we felt like we were on our own, wondering how on earth we were going to get through. I feel like we've banded together a lot more, and for me the WhatsApp group has really helped. There is a bit more of a community spirit around locums now. I like that. We have more communication, and there are more platforms where we can share ideas.

My biggest locum challenge is… Most locums probably have a notebook where they keep a list of all the patients they refer, and try and follow them up if they're ever back in the practice. But it's so difficult, because if you're not back in the same practice, you've really got to rely on the fact that a referral is going to get posted. You've written the letter; you've left it for them to post. You've got to have that element of trust that someone's going to take it on.

Also, if you're unsure about something and just need a second opinion from another colleague, that is really difficult because often the resident isn't there and you're by yourself. You have to rely on your knowledge. I get the feeling sometimes that maybe as locums we tend to over refer, because we're worried that we're not able to follow up.

Even though you're a locum, you are an optometrist – the duty of care ends with you. You've got to make sure everything benefits the patient. It's about reminding, even with full-time staff, that sometimes what they're proposing might not work for a patient. It may seem logical, but it's not always the best way to do it.

As a locum, I’ve adapted by… getting there early in the mornings to understand how the practice works. Often now, I’m finding that staff are asking if I would like to do things a certain way.

Things keep changing, especially with COVID-19 restrictions. There has been a lot of need to adapt. That's been a little bit hard. I think when you've been practising for a long time you do pick up your own way of doing things and you become a little bit set in your ways. One thing COVID-19 has made us do is become a little bit more flexible and adaptable. We've had to adapt the way we do our sight tests.

Practices can make life easier for locums by… improving communication. It feels like you do your referral, and then you never hear back. That's not just in practice, but even when you send the patient to their GP, who might send them to hospital. You never really know whether you did the right thing, or what happened, or what the outcome for that patient was.

Triage questions were introduced for a reason. There are ways that reception staff can be trained to ask the right questions, and to appropriately communicate. I think it's about saying the right things to patients. The staff that do the pre-screening, and sometimes take the fundus photos and do the pressures, often get asked, 'So, what does this show?' It's only natural for patients to want to know what the results are. Staff should be appropriately trained to give a response and to be able to put the patient's mind at ease. Sometimes things can feel disconnected. As a locum, there's that disconnect about how I can get involved, or how I can influence this aspect or the training that happens for the staff.

One change I’ve seen whilst working as a locum is… It's always been a front of house, reception, or optical assistant confirming appointments and triaging, but I think more and more that triage systems across practices are now quite similar. When I first started, different practices were doing very different things. I think it was very dependent on the particular resources that they had.