I write in reply to ‘Name withheld’ in letters, November 4, concerning locum optometrists.
Having been an independent practice owner, employed optometrist with a large multiple and now a locum, I find his/her (or is that its?) view of locum optometrists extremely arrogant. Yes, there are some poor locums out there, but most of them are very good, doing the best job they can in what are often difficult circumstances. From my experience in ascending quality practices can be graded very worst are independents, then franchises, small multiple chains, large multiple chains, small multiple chains, franchises and the very best are independents.
When you have gone into a practice of a recently deceased independent who was fitting contact lenses without a slit lamp (in 2007) and records made on a 3cm strip across a postcard you might understand my grading. His desk drawer, however, had a stack of CET certificates in it – his knowledge was up to date, he just did not apply it. Then there are the franchises where the joiners’ dust from re-fitting the trial case bracket was still on the floor three months later. The practices with enough dirt in the trial case corners to plant potatoes. The near vision tests which you need a peeler to get the dirt layer off. The fixation disparity units without bulbs; the trial frames with no nose piece, sides that do not lock; ophthalmoscopes and retinoscopes without bulbs, charged batteries or leaking batteries; tonometers and field screeners with unknown or years out of date calibration and testing stickers. I have met them all so often I take anything portable myself.
Then we have the unknown local referral protocols – a different one for nearly every PCT/CCG, the practice staff not having any clue where they have been filed, the unfindable GOS18 (or substitute), the non-existent doctors list. The resident optom/owner who seems able to work from 9am to 6pm with no scheduled break and expects the locum to do the same. I presume they wear a nappy as finding time to take a ‘comfort’ break is frowned on – I did not go there again.
Then there is the equipment without operators guides which you are expected to use. How many models of field screener are there?
The ‘front of house’ staff who do not check that the record they are giving you is the one for that patient. The Mrs X sitting in front of you looks about 35, but the record you have is for Mrs X, age 80. The appointment books full of six-month under 16, asymptomatic, emmetrope repeat tests, 12-month diabetics and 12-month relatives with glaucoma, but still expected to get 75% spectacle prescription rate.
I could go on, but I am sure you have got the picture. The locum is working in a strange room, with strange staff and trying to find out what works and what does not, always that piece of equipment you only use once a day, but is essential to fully complete the test. Also you cannot be sure that a request for repeat fields and pressures in two weeks will be carried out. So referral is a management plan. You suspect that the patient has a medical eye condition, so you refer to a medical practitioner for medical investigation. That is what you are supposed to do, and in the absence of guaranteed follow-up in the practice, that is the safe thing to do.
I am also worried by ‘Name withheld’s’ assumption that extra qualifications would make any difference. Qualifications do not make a more caring professional, they just put more letters after your name. I do agree that more experience before going locum would be an advantage, in view of the variety of equipment out there and the rarity of many medical eye conditions. However, what is the newly qualified optom who is not wanted by their post-graduate training practice to do when there are no available positions in the area they live? Leave the profession? Go locum? What is needed is a reduction in the number of practices, both corporate and independent, which seem to run solely on locums, rather than employing a ‘resident’, thereby creating more resident posts. There also needs to be an improvement in the standard of maintenance in practices. Some organisation like the Care Quality Commission inspecting practices would also help to improve things.
As I shall be retiring at the end of December after 43 years in practice I am quite happy to put my name to this reply. And to ‘Name withheld’, I do not think I would want to do locum for you – but what do your patients do when you are on holiday or on GOC/College/LOC/University business? Do you have any time to practise optometry?
John H Goacher, locum optometrist, Leeds
