Locum lessons from 20 years in practice

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

As a resident at Camberley Specsavers. I did my pre-reg placement there, and then I was a resident for about a year. However, I got itchy hands quite quickly. They took on more pre-regs, and as soon as they qualified, I left to locum.

The main reason I started locuming was because I felt that repetition was too much. I was scared to work anywhere else, with new machines, new people, new equipment, and new types of patient. The clientele is different in different areas. That fear of working outside of my environment was chewing away at me, so for that reason, I had to leave. I had to experience something different.

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

That I needed to plan ahead of time exactly where to go, to let the practice manager know I’d be in early, and to get someone’s number, so I could get in early and familiarise myself with the setup.

I started showing up earlier, and waiting outside until the first person showed up. I needed to know what entrance I should go in, so I could get into the testing room, and get familiar with the equipment, the setup, the expectations on me, and what the practice’s offers were.

I needed to make sure I was confident inside the room. Patients can pick up when you’re not confident. If you’re not confident using the equipment, the patient might think you’re not competent.

Patients can pick up when you’re not confident. If you’re not confident in the equipment, the patient might think you’re not competent

The person who helped me as a locum was…

I had a network of locums in those days. We didn’t have WhatsApp – this was 20 years ago. I had two or three good friends who were optometrists, and they were locuming. I had them on call. They were amazing. They said, ‘anytime, just call or text us, we will always be there.’ I knew that if they didn’t pick up immediately, I could almost guarantee they would pick up within half an hour, before they saw their next patient. If they were home, they would answer straightaway and help me out. It’s about having that confidence network – someone to bounce off, so you’re not alone.

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

I had a fear of using the same equipment, and seeing the same people. When you move to a different town or city, with a new practice, they will have a totally different business setup, and different expectations of their optometrists.

At Camberley, I’d stopped doing contact lens fittings, because the practice had specific contact lens practitioners. When I began locuming, I started learning about different contact lenses, and different spectacle lenses. It broadens your whole industry knowledge base. You’re not living in that one little pigeonhole anymore, where it’s easy to almost outgrow it.

On my first day of locuming...

I was scared to death. I was there an hour early to sort out the parking. I didn’t know what the traffic was going to be like, and Google Maps wasn’t around. But I’d mapped everything out the day before, so in my head I was ready.

My biggest locum challenge is…

Setting boundaries and knowing expectations. Sometimes, I’ve worked in practices where they expect too much in that 20-minute time frame. Pre-COVID-19, some practices would give you a 20-minute slot, and they would be short of staff, so you would have to pre-screen as well. You were expected to work through your lunch break, and that was just normal. And then you were expected to refer, which you would always have to do on the day.

Now, if a patient is late by more than 10 minutes, they’ve passed their allotted time. It’s about having really strict boundaries, actually sticking to them, and saying, ‘I can’t be the best optometrist I can be if I’m expected to rush through.’

With experience, you get more confident. That’s the important thing. When you’re new, you don’t want to annoy people, or worry about how you will come across. But ultimately, it’s a clinical job, so we have to be comfortable and confident with what we’re doing.

It’s about having that confidence network – someone to bounce off, so you’re not alone

As a locum, I’ve adapted my days by…

Before, I used to take anything and everything, and I didn’t know which days I would be off. Now, I print out my monthly calendar. I book three months ahead, and I put in all the days that I’m working. Because I’m such a visual person, I have them up in my bedroom, on my cupboard, so I know before the month starts what days I’m off.

I try to keep regularity. With my personality, I don't like to have one week with Sunday off, and one week with Tuesday off, and one week with Wednesday off. I like to have my fixed days. That’s a huge one for me. I can work my life around that. Otherwise, I’m just so exhausted, and I overbook so easily.

The other thing is setting targets for yourself for each month, including financial targets, so you know when you’ve overstepped the mark. If you know you’re working towards something, it’s okay. But as a locum, you can easily work too much. I used to work 10 or 12 days, sometimes, without a break. It’s really taxing on the body. You don’t want to say no, but you know you’re exhausted. It’s having that diary beforehand and booking those days off, so there’s no leverage for you to book anyone else in. Consistency is key.

Practices can make life easier for locums by…

When they make the booking, giving you the clinic times, the patient slots, your lunch break, and the time the last patient will leave – especially if you’re locuming with them for the first time, so you know what’s expected.

Practices should say, for example: ‘You will have the OCT and the fundus camera in your room, so you’re expected to do that, and you have 40 minutes. If there’s an extra walk-in, or if there’s an emergency, we expect you to see that.’ That way, the boundaries and expectations are set beforehand.

Also, let us know what equipment you have – whether it is an auto refractor, an ophthalmoscope, or about the fields machine – a list of basic things in practice.

One multiple, the first time I worked for them, sent me an hour-long video beforehand. It was fantastic, because it refreshed my mind on so many different conditions. It allowed me to speed up. If I don’t fall behind, it doesn’t then affect the clinic, the practice, and everyone that works there.

My favourite thing about being a locum is…

The flexibility of working less, or picking up extra days when I want to. At this stage of my life, I think work life balance is critical. In a healthcare role, you can burn out so quickly because you’re taking on so much of an emotional load.

It’s about having that confidence network – someone to bounce off, so you’re not alone

My advice for new locums is...

Before you leave the house, find out where the closest parking is, or where your train station is, and how long the commute is, and get there early.

If you aim to be there 40 minutes early, you’ve left yourself a comfortable buffer. Things always go wrong on the road, and on public transport. Find out where the entrance is or who you can contact when you're early. Set up, get comfortable with the equipment – try to turn everything on, and have a play with everything. It takes five minutes, but it will set you up for the rest of the day, so when you take the first patient through, you’re confident.

That confidence shows everywhere: the patients, the staff – everyone sees it. That confidence also allows your conversion to be higher, because people trust you a lot more. They trust what you’ve done in the room; they trust what you recommend. If you’re confident, it just builds out everywhere. It’s that first half an hour that’s critical. It’ll set you up for the day.

My last word on locuming is...

Around finances. One of the biggest reasons you’re locuming, as well as all the other benefits that come with it, is for the flexibility and the money. My advice is to understand your expenses, and keep a separate card where all your locum expenses are.

Keep a spreadsheet every month, of everything you're bringing in, everything you’ve spent, CPD events and how much you’ve paid for them, and your travel. All of that is claimable, and at the end of the year, you’re not going to remember any of it. If you do it on a monthly basis, it’s all fresh in your mind.