Keeping up with technology and prioritising peer support as a locum optometrist

Before I became a locum, I was working...

In community practice. I did my pre-registration year with Dollond & Aitchison in Darlington, then I became a resident at Vision Express in Workshop, and then later at Specsavers in Derby.

Two or three years into my career, I started locuming, because I had more confidence and I had seen a variety of patient episodes. I started to go in on a regular Sunday, and I’d usually do that across various Specsavers practices, because I’d become familiar with the Specsavers system. Over the years, I took on other roles – I became a part-time resident, and continued locuming for Specsavers, as well as for some independents and some of the other multiples.

Now, alongside locuming in independent practice, I also work for Newmedica. That was specifically to use my independent prescribing (IP) qualification. I qualified in IP more than 10 years ago, and I found that I didn’t really have opportunity to use it in High Street practice. So, I’m trying to do some clinics at Newmedica, to refresh and upskill.

When I started as a locum, I wish I had known…

That it’s a learning curve initially, and then you get the hang of it. For example, locuming in a busy city centre practice is very different to locuming in a quieter store in the suburbs.

In the city centre practice, because you get a higher footfall of patients from different socio-economic backgrounds, you’re likely to see more pathology. That means more referrals. There is also more pressure to squeeze in patients, because you get more walk-ins. In the quieter practices, you’ve got more time to spend with patients, but you might get older patients in that setting.

Some practices, because of where they’re based, will have a certain patient base. My experience of working in a city centre practice was that I saw a bigger range of patients at different ages, which is very good as a newly qualified optometrist, because you want to see as many different types of patient episodes as you can. I saw a lot more pathology, a lot more referrals, and it was really good to build up that experience and patient base.

Working in a city centre practice was that I saw a bigger range of patients at different ages, which is very good as a newly qualified optometrist

Then, I moved to an Asda Opticians in West Bridgeford. As a supermarket, with high footfall, the patient base was a little bit different. Because it wasn’t city centre, there weren’t as many students, but I’d see families, children, and more elderly patients. That was a different demographic, and although it was busy because of the high footfall, it was more laid back than a city centre practice.

As a resident at Boots Opticians, I moved to a quieter practice, on the outskirts of town. That was mostly elderly patients, with a longer testing time, so it was more relaxed, but the patients were more demanding because they needed a bit more support.

The main thing is to start off in a quieter store if you’re newly qualified. But I think that as much experience as you can get, in as many different settings as possible, is important. You learn to take what you need with you. Rather than adjusting to different types of equipment, adjusting to the types of patients and how busy the store is what I found surprising.

The people who helped me as a locum were…

My early colleagues in practice. Because I started locuming at busy city centre practices initially, there were always four or five clinics running simultaneously, and there were always more experienced optometrists who were really happy to help. I’m still good friends with them now. Everybody has their own way of testing and managing patients, and I learned a lot from all of them. Now, I do solo clinics, but when I was newly-qualified, it was really helpful to work with other optometrists.

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

I’d only been working two or three years, but I wanted the experience of working for different companies. Also, I was keen to build my patient experience. I remained as a part-time resident at first, but I enjoyed the flexibility of doing an extra couple of days if I was able to, and the flexibility of having time off if I wanted to.

On my first day of locuming...

Because I did Sundays, there were fewer members of staff on site. Usually, if you start a new job somewhere, as a resident or as a locum, you have bit of an induction. But on Sundays, there are no managers in, and no senior staff. I was thrown in the deep end. Luckily, because the team was really nice, it was a straightforward day.

Every multiple has its own standard operating procedures, so they run quite similarly. What’s different is just the management and the staff.

Now, I do solo clinics, but when I was newly qualified, it was really helpful to work with other optometrists

My biggest locum challenge is…

Staying up to date with different types of machinery. Now, we regularly see optical coherence tomography (OCT) scans from different machines, so it’s knowing how to view the different images that have been taken if you work at a new practice. It doesn't take long, but it’s helpful at first to have somebody there, so you can ask whether you have viewed the right images, or whether you need to do something differently.

As a locum, I have adapted my days…

Because when you’re a resident, there’s more continuity. If a patient wants to come back, it’s easier, whereas as a locum, you prefer to see your patient for that full appointment that day, to ensure that everything has been done. If not, you can refer to another optometrist who you know will be in later in that week. But as a locum, there is a bit more pressure to try and get everything done that day.

Practices can make life easier for locums by…

Having a clear structure in place, or a help point – almost a buddy, who is familiar with the different machines or the testing system to help you if you need support, or if you’re struggling with the system. That could be a more experienced member of staff, or an optometrist on standby, on the other end of the phone. It’s usually only a few things, and once you're set up and you've seen the first patient, you do become familiar with everything.

One change I’ve seen whilst working as a locum is…

That the optometric landscape is evolving rapidly. For example, there were no fundus cameras when I started locuming, but everybody has a fundus camera now. There were no OCT machines; now everybody has one. Rather than changes to locuming itself, it’s more of a change in technology, and in the direction of travel, with sight tests evolving and more enhanced services.

I’ve mostly locumed in Nottinghamshire, and a little bit up north, so it’s easy for me to be familiar with the different referral systems and processes in place. But if you’re locuming in different cities, it’s important to be up to date on the local referral criteria, because it can vary from place to place.

My favourite thing about being a locum is…

The flexibility. It’s nice to meet different people, in new places. You meet different patients anyway, but it’s nice to work with different teams and see how different places are run, because you always learn something new.

Also, if I want to go travelling or on holiday at short notice, or see friends, it’s easy to do, whereas, if you’re a resident, you have to put in a request for leave, which might take time to get signed off.

My advice for new locums is...

That if you’re newly qualified, it’s good to work with other optometrists, rather than in isolation, because you can learn a lot from your peers. In tech, for example, it’s good to know what changes there are, and how things are being managed.

Real life, and actually seeing patients, is very different to theoretical textbook learning. Although you have your pre-reg, the first two or three years qualified are really important, to build that knowledge base and experience.