It is 8:50am and I knock on the door of my place of work for the day on a freezing cold February morning. The lights are on and I can see some movement at the back of the practice, however, no one comes to open the door for me.
Why is no one letting me in? Was the booking made in error? Am I the one who is mistaken? Did I arrive at the wrong location? I check my app for the location and start times, and sure enough, I’m supposed to start at 9am and I am exactly where I should be.
Now, I’m engulfed with another torrent of self-doubt. Should I visit the warm coffee shop that is just within my field of view or go back to my car? But if I do, the staff might say I only just arrived at 9am.
I wonder how long I will have to stand out in the freezing cold but decide that it’s best to wait just in case someone opens the door. No sooner have I made the decision to wait, I find myself smiling at the lady who joins to stand with me outside. I presume she is the 9am patient.
What on earth must she think when she realises that I am about to test her. I feel the urge to explain that I am not tardy and that I have been waiting for around 10 mins. The practice door isn’t opened to us until bang on 9am and the greeting is almost as cold as the weather. I am not shown where the kettle is or where the toilets are. I know that I am in for an awkward day.
This isn’t an isolated story, and similar variations are commonly repeated among locum circles. Thankfully, this is an exception rather than the rule. Most practices will open the door to locums around 8:50am so that we can get refreshed, lock away our valuables, and set up for the day.
The problem is that even if we, as locums, are allowed on the premises before 9am, the patient often isn’t allowed. A commonly provided reason for this is that the practice is not insured for this purpose.
To any directors, managers or owners who might be reading this, I offer an explanation of the consequences of opening the doors at 9am to the patient with a view to promote the smooth and safe running of a clinic.
If a locum’s clinic starts at 9am and the patient is given 10 minutes to allow for lateness, and pre-screening takes around 10 minutes, then the locum may already be running 20 minutes behind on a 25-minute clinic. This creates problems for every single person in this chain and mistakes, rechecks and refunds are bound to occur more frequently.
The pressure of a clinic built to run behind is stressful enough, but now some practices have altered their diaries so that the appointment right before lunch can also be booked. This is not so much of an issue if a one-hour lunch has been agreed in advance, but many practices now operate on a 30-minute lunch.
The consequence of this additional appointment is that the full 30 minutes agreed lunch time is rarely taken by the locum, as they are already running behind, through no fault of their own. An often frantic 5 to 10 minute lunch break could mean mistakes are more likely to occur.
Getting home late, the consequences for childcare and the associated spiralling costs have become a real and regular problem that causes some locums to cut down their working days.
There are obvious legal implications in not getting rest breaks, however, raising a complaint with the practice means the locum could find themselves not getting booked at that store again.
The sad reality these days is that some locums are set up to fail from the moment they make the booking, as agreed legal breaks are being broken routinely by some practices. Oversupply of optometrists may be partly responsible for this increased hostility.
Recently, several locums have reported being surprised on Sundays whereby, instead of being given a break at a traditional lunch time, they are asked upon arrival if they want to leave earlier instead.
On the surface, this looks like a reasonable offer, but this is not offered as a choice but rather an imposition, made obvious by the fact that the clinic diary may have already been booked without a lunch break.
In any case, 3:30pm does not count as a lunch break when you start work at 10am. The trouble is, even if the locum agreed to a 3:30pm finish, the clinic is already likely running behind so, the unsuspecting locum forgoes the lunch with the expectation of leaving earlier, however, this early finish may not actually materialise.
Locums may encounter quadruple clinics (or more) on a given testing day in a practice that is equipped with only one set of pre-screening machines. A repeat visual fields test request on a multiple clinic day is likely to set the entire day out of kilter for all clinicians involved.
If locums are working in a practice with paper records, some practices will have their paper records prepped and ready. The better organised practices will make a note of current contact lens prescriptions, along with the latest spectacle prescription on the contact lens aftercare records.
A day where the clinic has been prepped properly is exceptionally rare. Some practices still don’t appear to have understood that the optometrist will need all recent paper records. It is crucial that the optometrist has access to all recent records so that if a patient presents with ocular pathology or if their vision has deteriorated, further appointments for subjective refractions or a cycloplegia or a dilation can potentially be avoided.
Recent years have seen the introduction of the ‘ghost clinic’, which involves additional walk-ins being booked in an already fully booked clinic. Sometimes, this is without prior discussion to either resident or locum and, therefore, without consideration to time spent writing referrals or delays. Can any optometrist realistically comply with 20 to 30-minute testing under these conditions?
Often the practice staff are wonderful and do what they can to help locums run on time, but the numerous interruptions to manage and fit a child’s collection, check a child’s pupillary distance or oversee a child’s adjustment can make things very difficult.
By many accounts, the numerous knocks on the door while testing are not well timed and little consideration is given to the optometrist who may be in the middle of confidential and delicate history taking.
Many colleagues have experienced a handful of interruptions during one single appointment. Imagine if a dispense was interrupted a handful of times.
We could work together to encourage better patient and practitioner safety. Could clinics start at 9:10am so the 10-minute allowance for lateness is accounted for? Could we go back to blocking off the slot before lunch so that all optometrists get their pre-agreed legal breaks, especially when the lunch break is only 30 minutes long? Could the first appointment slot be reserved for a contact lens aftercare, so that if the patient arrives late, the 10 minutes of pre-screening time that would have otherwise been reserved for a sight test won’t delay the optometrist any further?
Perhaps, the rules and regulations could be tweaked? Could the General Optical Council (GOC) introduce the mandatory presence of a dispensing optician in every single practice? Would a blanket GOC-imposed 35 to 40-minute appointment slot make working conditions fairer and, above all, safer for patients, optical assistants and practitioners? Forty minutes would allow for 10 minutes of lateness, 10 minutes of pre-screening, referrals, checking for under-16 collections, adjustments and other queries.
The very first line of the new GOC Standards of Practice for Optometrists and Dispensing Opticians that came into force on January 2025 states:
‘1.1 Give patients your full attention and allow sufficient time to deal properly with their needs.’
With optical coherence tomography, triaging emergencies, under-16 supervision and increasingly complicated referral pathways, eye examinations in 2025 are not the same as eye examinations in decades gone by, when 20 to 30-minute appointment times were more realistic.
Times have changed, and we need to change with them.
