Take good care
Head of clinical and regulatory at the AOP, Henry Leonard, considers the importance of internal referrals, and offers tips for safe clinical practice
18 December 2020
It is a niggle that has played on the minds of many locum optometrists.
Was that worrying symptom followed up on? Did the patient receive further investigation and, if necessary, treatment?
Ensuring continuation of care can be a challenge for locums who may not be sure when they will next be back at a specific practice.
Head of clinical and regulatory at the AOP, Henry Leonard, shared that while it is always “advisable and preferable” to complete a procedure on the day of a sight test, this is not always possible.
Where a follow up test has been completed in the absence of a locum optometrist, they should review the result next time they are in practice.
“However, if you will not be in the practice again, or not within a suitable time period, then an internal referral may be appropriate,” Mr Leonard highlighted.
The AOP has developed an internal referral template that locum optometrists can use to refer patients to another practitioner within the practice for follow up tests and management.
This template enables optometrists to formally pass on responsibility for any procedures or ongoing management of the patient.
The referral can be printed off and attached to the patient’s record if the practice uses a paper-based system or imported to a patient’s record if an electronic system is in use.
A copy of the letter should be given to the resident optometrist or practice manager, while the AOP also recommends giving a copy of the internal referral to the patient – in the same way that the patient might be provided with an external referral letter.
“An internal referral completes the legal sight test for the practitioner but leaves the contractor or practice owner with a duty to carry out certain further procedures,” Mr Leonard explained.
He added that this process is generally not appropriate for urgent procedures.
“If you feel the patient needs urgent investigation which you are unable to provide yourself at the time, you should refer the patient to secondary care instead,” Mr Leonard said.
Possible reasons for an internal referral
• Patient running short of time
• Patient declining to repeat a test on the same day
• Lack of available clinic time to complete the required procedures
Practising during COVID-19
Henry Leonard shares his five tips for safe clinical practice as locums work during the pandemic
1. Familiarise yourself with the infection prevent and control measures in a practice. It’s a good idea to ask what measures have been put in place during COVID-19, so you know what’s expected of patients and staff whilst in the practice. Most practice owners are providing personal protective equipment for both employed staff and locums, but it’s worth checking this beforehand, in case you’re expected to bring your own.
2. Gather information remotely where possible before booking a face-to-face appointment. This is especially important when it comes to patients who are more vulnerable should they contract COVID-19. For those patients who do need a face-to-face appointment at the practice, if lots of information has been gathered in advance, this should reduce the time needed for history and symptoms when they attend, which helps minimise close contact time in the consulting room.
3. Streamline appointments. Provided a careful history and symptoms has been performed, it should be possible to tailor the examination to address the patient’s specific needs, whilst omitting tests which aren’t essential. It’s important to meet the minimum statutory requirements, and for a sight test this includes performing an internal and external eye examination, any additional examinations as clinically necessary, and issuing a statement or prescription, but it’s perfectly acceptable to omit tests such as ocular motility, pupil reactions, tonometry and visual fields if these aren’t essential. Slit lamp or head-mounted bio-microscopy is preferable to direct ophthalmoscopy, and it’s a good idea to make use of fundus imaging equipment if available. If patients have a good level of visual acuity and are happy with their spectacles, practitioners should also consider streamlining their refraction to reduce close contact time with patients.
4. Know the local referral pathways and criteria. These may have changed since the onset of the pandemic and it may be necessary to adopt a higher threshold when referring patients into secondary care, especially if patients are at high risk should they contract COVID-19. In this situation, it’s extremely important to ensure patients have received clear advice on what action to take if they notice any change in symptoms.
5. Reassure patients. It’s easy to forget that some patients may be anxious about the new arrangements, so it’s important to reassure them that appropriate steps have been taken. If you have any concerns yourself about this, you should discuss these with the practice promptly.