Seven habits for safe clinical practice
AOP head of clinical and regulatory, Henry Leonard, shares his thoughts on practical steps locums can take to avoid professional conduct pitfalls
10 June 2022
A morning coffee at a favourite café, a podcast at lunch or evening walk with the dog – habits can be a way of adding balance to daily life.
As a locum optometrist, developing a professional routine can help to minimise the risk of a professional conduct investigation.
From keeping thorough records to checking local referral pathways, the AOP’s Henry Leonard shares his practical tips for locums to ensure safe clinical practice.
1 Get familiar
If you haven’t worked in the practice before, make sure you have some time before your clinic starts to familiarise yourself with the practice and introduce yourself to the members of staff you’ll be working with. Well-trained support staff can be invaluable in helping your clinic run smoothly, so ask them about the patient journey in the practice. For example, will patients receive pre-screening before they see you? Which members of staff can perform delegated tasks such as visual fields and contact lens teaches?
In the consulting room, check that you know how to operate key pieces of equipment, such as the slit-lamp and letter chart. If the practice uses computerised record keeping systems, make sure you can login successfully and familiarise yourself with the system.
2 Keep a task list
It's not always possible to complete your management of the patient whilst they are with you in the consulting room, so it’s important to keep a list of any outstanding tasks. This may include writing referral letters, ordering contact lenses, or checking the results of follow-up tests, such as repeat visual fields, which have been delegated to other members of staff.
Don’t be afraid to ask for help if you need it
Some practice management software includes tools to keep track of these reminders, but you may prefer to ask for a printout or photocopy of the clinic diary and annotate this as you go along. It’s important to avoid taking any patient-identifiable data out of the practice, so if you’re using your own system to keep track of outstanding tasks for the day, you should dispose of this in the confidential waste stream before you leave.
3 Make internal referrals
Sometimes a patient will need to return on a different day for a follow-up test such as repeat fields, or dilation. If you’re not sure you’ll be able to see the patient yourself for the follow-up, you should make an internal referral, to ensure responsibility for managing the patient has been transferred to another practitioner. The AOP has published guidance on internal referrals which includes a template, and you can keep a log of internal referrals using the online AOP locum logbook.
4 Check local referral pathways
If you’re not familiar with the area, it’s a good idea to find out about referral pathways in advance. Many practices have a ‘locum folder’ which contains important information for locums who are new to the practice, and this may include information about local referral pathways. Many areas also have optical committees which publish this kind of information on their website.
5 Ask what services you’ll be expected to offer
Some practices may just want you to provide private and GOS sight testing, whilst others may expect you to fit contact lenses, dispense spectacles or supervise trainees. Ask whether the practice have contracts for any locally commissioned services which may require you to be accredited for.
6 Keep good records
If you’re not familiar with the practice record keeping system, it’s a good idea to review the records you’ve made at the end of the clinic, to check you’ve recorded the right information in the right places, and to ensure you’ve completed any outstanding tasks for each patient.
7 Build a good rapport
Practice owners are more likely to invite you back if you’ve made a good impression with their staff. Don't be afraid to ask for help if you need it, and take time to thank members of the team who’ve gone out of their way to help your clinic run smoothly.
Locums: common issues that result in a GOC investigation
The AOP’s legal and regulatory team regularly assist locum practitioners who are subject to an investigation.
Allegations around missed pathology are common where practitioners have overlooked the results of supplementary tests, such as tonometry readings, retinal imaging and visual field plots. You are ultimately responsible for the care of each patient you see, so if you’re requesting a further test, such as repeat visual fields, you should follow this up yourself; don’t rely on support staff remembering to show the results to you. Keeping a list of outstanding tasks makes it less likely you’ll overlook something.
In some cases, locums may have arranged a follow-up test, such as dilation, on another day, but without making it clear that the responsibility for managing the patient has been transferred to another practitioner. The locum assumes that the second practitioner will manage the patient, but the second practitioner thinks they are simply gathering data to help the first practitioner decide how best to manage the patient. The AOP has published guidance on internal referrals which includes a template for making internal referrals which makes it clear that you are transferring responsibility for managing the patient to another practitioner.
Another common source of complaints relates to patients who have been referred inappropriately, either because an incorrect pathway was used, or because the referral urgency was inappropriate. Locums should try to familiarise themselves with local referral pathways, especially if they’re working in an area they’re less familiar with.