Returning to locuming after two decades away

Before I started locuming...

I was working mainly at Aston University, as one of the lecturing staff. I had also previously worked as a locum for around eight years, in the 1990s.

Before I became a locum, I wish I had known...

I thought it was a natural assumption that every practice I’d go to would be able to find the previous records of the patient that they were asking me to see, but I found out that it varies from practice to practice.

In my first spell as a locum, in some of the practices, the patient had been six or seven times in the past, but no one could find the previous records. Of course, that makes an eye examination more challenging and frustrating, because you know that the records are somewhere in the practice, but have probably been misfiled under somebody else’s name. I’d stop working in those practices, because I felt it was unfair on me and unfair on the patients.

It’s probably less of a problem now, because back in those days, it was pretty much all paper records. Now, many practices have electronic records.

Someone who has helped me out in the world of locuming is...

In one of the first practices I went to as a locum, there were two optometrists who at the time were residents, but shortly afterwards also became locum optometrists.

I socialised with them, because we’d made good friendships in the early days. We kept in touch, and they helped me get locum work. We would share difficult cases and they would offer their advice.

It was pure luck that I started locuming in that practice, they were there, we got on straightaway, and then they decided to locum too. Their shared experiences helped me in my clinical challenges, but also helped me get work as well.

I made the decision to become a locum because...

The first time round, I wanted to get more experience of working with different methods, systems, practices, and patients. If you work in a in a practice in a shopping centre, you tend to get mainly younger people. If you work in an independent practice, slightly off the beaten track or off the High Street, that has been there for 30 years, you tend to get older people.

I spread my locum work, the first time, amongst different practices, so I could get the experience of working with different practices, but also different patients. I felt that having that breadth of experience would be useful to me in my future career.

Four years ago, I decided to go back into locum work because I wanted a little bit more freedom from the corporate nature of working for a big organisation. It’s easier to take time off for family things, or for holidays. Of course, the flip side to that is that, as a locum, you don’t get paid when you’re not working. So again, you have to balance that by saving and planning.

The flexibility of not having to work five days a week gives me the opportunity to do other things – home-based work, that I wouldn’t be able to do if I was working five days a week as a locum or for a big organisation full-time.

Some of the things I do aren’t aligned to optometry. I started taking DJ lessons about a year ago, and I’ve just done one of my first mixes. I don't think I’d have the time or the energy for lessons if I was working five days a week. I don’t need to squeeze it in anymore, because I’ve got the time. It’s something I've always wanted to do. That's just one example.

I started taking DJ lessons about a year ago, and I’ve just done one of my first mixes. I don't think I’d have the time or the energy for lessons if I was working five days a week

 

On my first day of locuming...

I remember thinking, ‘okay, I’ve done my pre-reg in a hospital, I know all these fancy clinical things, but can I do a full eye exam in regular, everyday practice, and get the prescription right and spot everything that needs to be spotted, and keep to time?’ That was one of my main worries. Hospital practice is different from community practice, obviously. After pre-reg, I had felt I needed to branch out and get that experience of working community practice.

Luckily, the people I was working with understood that my background was hospital work, and it was different, so they allowed me to get used to the pace of working in community practice. Thinking back, my main worries were, ‘will I get the right prescription for the patient?’ and, ‘will I stick to the allocated testing time?’

My biggest challenge as a locum is...

Most of my patients are older people. Sometimes, examining an older person’s eyes presents challenges: small pupils and cataracts, for example. It’s a clinical challenge, which I’m fully up for. I dilate pupils as and when I need to.

It’s sometimes a challenging eye exam, but the other side to that is that older people bring with them lovely stories, about when they were children back in the 1940s or even 1930s. Some of the people I see are in their late 90s. I have the luxury of having the time to listen to those stories. I've got plenty of time for each person. I'm very happy to listen to them. Often, I'll say to the practice members, ‘Oh, Mrs Smith has just told me a story about when she was a child, back in 1941, and she remembers the Blitz in London because she was living it.’

Some of the people I see are in their late 90s. I have the luxury of having the time to listen to those stories

 

Practices can make life easier for locums by...

Having a reasonable schedule, with a reasonable examining period. Not expecting every single patient to need glasses – not expecting an 80% or 90% conversion rate. Obviously, making sure the room is nice and tidy, and that the equipment is there and working.

Allowing a decent lunch break. I’m not saying an hour, but some practitioners seem to expect, if an emergency patient comes in, that the locum will give up their lunch break to see them. I’ve worked in practices where there is a 15-minute lunch break, which is not good for the wellbeing of the practitioner. Being reasonable in their expectations, I think, and of course, having the previous notes ready.

My advice for new locums is...

Make sure you get to the practice in good time. My experience is that patients will be there on time. It’s not fair on the staff members, it’s not fair on the practice owner – it’s not fair on anybody to get there late.

When I used to work in Leicester, I planned for bad traffic, left super early, and knew where I was parking and how to get from the car park to the practice. If I’d never been there, I looked it up in advance.

I get there about 15 minutes before the day is about to start, so I can get set up. Plan, make sure you’re there on time, be nice to the staff. And occasionally smile, perhaps, when it’s appropriate.

One change I have seen whilst locuming is...

I’ve worked all over the West Midlands and beyond, and when I first started, the referral system was the same: you filled out a certain form, and either you gave it to the patient or you popped it in the post.

Now, the referral system varies from place to place. In my experience, the practice owner or the resident optometrist will know what to do. But don’t assume that the referral system is the same in all the places that you might work. Ask about how the patient needs to be referred. Sometimes it’s straight to the hospital. Sometimes it’s to another optometrist. The local people will know, so ask about the referral system used in that in that locality.

My favourite thing about being a locum is...

The flexibility it gives me to do either other things in optometry, or other things outside of optometry, and the flexibility of being with family or travelling when it suits me. Family is important.

The most important thing in my locum kit bag is...

My retinoscope. Sometimes people are new, and they don't have records, or they’ve lost their previous glasses.

This happens quite a lot when I’m working for Vision Care for Homeless People. The people there, through no fault of their own, have sometimes either lost or broken their glasses, or have had them stolen, so you have to start from scratch. The best way to start from scratch is with a retinoscope.

Also, sometimes people don’t have the ability to converse in English or in any language. You can work through that, and get a really good prescription, or at least a starting point, through using your retinoscope.

My last word on locuming is...

Take the time to socialise with the practice staff. I’m not saying go to the pub afterwards, but take the time to talk with the staff in your lunch break. People like that. It’s nice to be a member of the team, rather than the person who just sits in that room and only comes out when there’s a patient to collect.