The importance of having formal internal systems in place to ensure there is clear responsibility for care through the patient journey has been highlighted by the AOP’s head of clinical and regulatory, Henry Leonard.
Speaking at the AOP’s Locum Clinical Skills Conference, held in Birmingham in March, Leonard’s Help! I’m a locum and… workshop explored a range of common clinical, ethical and regulatory scenarios that are encountered by locum optometrists, and how to manage them effectively in practice.
Breaking down what an internal referral is, Leonard described it as, “when you refer your patient to another practitioner within the practice.”
“The idea is that you’re transferring responsibility for that patient’s care in much the same way that you would if you referred them to hospital,” he said.
Leonard emphasised during his workshop that a formal transfer of care is essential for all practitioners, especially locums.
“[Locums] may not know when they’re next going to be at the practice, so they may not have any option but to refer the patient to somebody else,” he said, adding: “It underlines that they have transferred the care for that patient.”
The optometrist informed delegates that the AOP’s regulatory team has previous overseen cases where an internal referral has not been clear and has resulted in patient harm.
He said: “It’s a very important step because we have seen cases in the past where patients have come to harm because it wasn’t clear which practitioner was responsible for that patient’s care.”
A formal system can reduce risk, he added.
Leonard said that visual field testing is a common example. He explained: “The first practitioner might assume that the person reviewing the fields is going to be the one managing the patient, whereas the second practitioner assumes they’re just acting as a data gatherer, and the information is going to get back to the first practitioner. Unfortunately, we have seen cases where patients have fallen through the cracks and come to harm.”
Leonard highlighted that responsibility rests with the practitioner who accepts the referral.
“If you receive an internal referral, you are then responsible for managing that patient. If you need to, you could always go back to the practitioner who referred them to you, but ultimately you are responsible for that patient's care,” he explained.
To support all practitioners in making clear internal referrals, the AOP has produced an internal referral template, which is available to download from its website.
The template “should make it quick and easy” for practitioners to make an internal referral, Leonard said.
He encouraged locums to “carry several of these when they work so that they can easily transfer care to another practitioner.”
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