Locum digest

“It’s helping the kids who have never received that help before”

OT  asked two locum optometrists about their experiences of delivering the Special Schools Eye Care Service

Optometrist Janki Vadgama leans forward and performs an eye test on a mixed-race male student with special needs

At Pentland Field School in Ickenham, west London, locum optometrist Kilpa Patel has been testing the sight of pupils between the ages of four and 19 since 2022.

As a locum who also works for High Street multiples, Patel is passionate about the variety that working in a special school offers.

“I see the little ones, in reception, and then all the way up to the leavers. I get to see a range of different ages and abilities,” Patel said.

She added: “I also locum locally, seeing a whole range of ages. I’m seeing patients over 60, working people, and some children as well. I like the variety of patients I see.”

Optometrist Janki Vadgama, who facilitates the Special Schools Eye Care Service (SSECS) across a handful of schools in south west London and Greenwich, agrees that adding the service to her locum roster has ensured that her week stays interesting.

“I’ve been qualified for 13 years, and it only took COVID-19 to happen, to think, ‘do you know what? I don’t want to be sat in a dark testing room from nine o’clock until five o’clock every day,’ she said.

Vadgama explains that she looked into the independent prescribing qualification and considered paediatrics, before coming across an email about the SSECS.

She describes taking on special schools work as “the best decision I’ve made – getting out of practice, and not being bored, because every single day is different.”

The childcare juggle

Patel and Vadgama both facilitate the SSECS on behalf of SeeAbility, a learning disability charity that holds contracts to perform sight tests for 3000 children in special needs schools in London.

Both have young children, and are quick to highlight how working in schools fits around their lives.

“I’ve had two regular days every week for the past two years,” Vadgama said. “Because it’s working around school hours, being a mum, it is just so beneficial. You’re doing a specialist job, but you’re also doing it within hours that fit around your life.”

She added: “I know exactly what my schedule is going to be. We do 10 o’clock until three o’clock, and it works perfectly.”

When the schools that she works in are closed during half term or the summer, Vadgama has the flexibility to take up more shifts in High Street practice – or not, if childcare or holidays take priority.

Patel agrees. “I only work during the school term,” she said. “It works well with my own children – when they’re at school, I’m working at my school, and when they’re off, I’m off as well.”

You’re doing a specialist job, but you’re also doing it within hours that fit around your life

Janki Vadgama, locum optometrist

Introduction to the SSECS

Patel completed her SSECS training with SeeAbility during lockdown, before taking on a maternity cover contract at Pentland Field School.

Growing up, Patel explained that she would spend time every summer at the play centre that her mother ran, which catered to children with varying levels of need. Because of this, she said, “going into a special needs school wasn’t so daunting for me.”

Still, she explained that the training provided by SeeAbility made her feel secure in committing to work that was vastly different to that which she would undertake in a High Street practice.

Patel was able to undertake two full shadow days at different schools before she accepted the contract with SeeAbility, and she wants to emphasise to others how confident she was allowed to feel before she accepted the contract.

“You can do shadow days, if you’re not sure whether it would suit you or not,” she said.

“I’d like to reassure new locums that they do provide full training, before you actually go in, so you have a full idea of what it involves before you say that you want to do it.”

She added: “Most of the children at my school have autism. A lot of them know their letters, or they know pictures, so I’m able to get good results from them.

“Generally, I’m quite patient. You might not finish one eye test in one clinic – you might need to do half a test this week and then finish it off next week, depending on how well the child is concentrating. It’s been a really good experience, away from the usual locum days I do. It’s very rewarding.”

Patel added that SeeAbility has also been supportive with the administration side of things, including the individual reports that need to be written up for every child.

“When we work in High Street practices, we’ve got the parents in the room, so we can explain all the results to them in person,” she said. “When you’re in a special needs school, you’ve only got the child with the teacher or teaching assistant, so you have to write a report for each child that you see.”

“It was like testing a different child”

OT asked Vadgama and Patel for their best experience whilst contracting with the SSECS.

“In a nutshell, it’s helping the kids who have never received that help before,” Vadgama said. “There have been stories where parents would assume that, because they have so many other things going on, their children’s eyes are not a priority.

“Being able to be in the school to offer that service, without the parents having to take them to the hospital, is the best thing about it.”

Vadgama emphasised that providing eye care within a school environment, where children feel safe and comfortable, is key.

“There have been stories where children haven’t had glasses, ever, and they’ve got such a high prescription,” she said. “One girl had a plus eight prescription, and it was picked up for the first time when she was 11 or 12.

“I see her wearing her glasses all the time now. It just makes me feel happy to be able help someone who wouldn’t necessarily have been helped in mainstream eye care.”

Patel recalled a specific experience, with a young child who was new to the school when SeeAbility visited.

“One of my little ones at Pentland Field School was brand new, and was refusing to enter the classroom,” she said.

“Initially, he was not having any of it. We managed to take a few pictures and play a few games. After another 10 or 15 minutes, he calmed down, and we did the full eye test in the corridor.”

The change when she next visited was remarkable, Patel said: “I saw him again three months later, and he was like a different child completely. He knew who we were; he was confident to say all the letters and pictures with us.

“Within a few months of settling into a new school and seeing us once or twice, walking around the corridors, he was quite happy to do an eye test with us.”

She added: “From the initial assessment we did for him, and then three months after, it was like testing a different child. He was so cooperative. He’d settled into the school. He did wonderfully.”

Success lies in getting to know the children in order to increase their confidence, Patel explained, adding that trust is key when providing eye care to a child with a learning disability.

“If they went to a normal High Street practice, the optometrist might not have the time or the patience to be able to build that rapport with that child,” she said.

“In a school service, you can pop into their classroom and say hello, or they come and see when you’re fitting another child's glasses. It’s a familiar face, and they get to know you. They wave at you in the corridors when they see you walking past. It’s completely different to working in a High Street practice.”

A singular mission

There is a common thread that underpins the day-to-day tasks of every optometrist, whichever setting they’re in: the overarching desire to support patients towards better eye health as a whole. Do Vadgama and Patel feel that working for the SSECS contributes to that goal?

“Oh my gosh, massively,” Vadgama said.

When it comes to eye care, she explained, “a high percentage of people who have special needs have gone amiss. Around 45–50% of those kids need help with eye care. So, it contributes massively.”

Parents of special needs children are often worried that SSECS contractors will be unable to test their children’s eyes, especially if they are non-verbal, Vadgama explained – so the fact that those facilitating the service have had specialised training is vital.

It “makes a world of a difference to these kids, to have everything done in-house,” she said.

Patel said: “It’s a fantastic service. It needs to be rolled out across the whole country. There are not enough optometrists who are trained up to work in special needs schools, but I think there’s such a big demand.”

She noted that, because a special needs child is unlikely to be able to access a High Street practice, their very first eye test will probably be at school, with a supportive teacher or teaching assistant by their side – something that she finds extremely rewarding.

She added: “It’s a tiring day, but it’s a very rewarding day as well, when you see a child collect their new glasses, and they can see, and they feel so much more confident. It really will change a child’s life.”