As practitioners juggle work-life balance and parenting needs, it is perhaps not surprising that the number of locum optometrists has risen dramatically in the past five years.
This rise is borne out in the recent Optical Workforce Survey, carried out by the College of Optometrists (with support from a cross-sector advisory group), which places locums at 17.5% of the optometric total. That’s an increase of 7.5% from 2010.
One might assume that high daily rates are the main stimulus for the move. However, these have only recently increased and variety of work and work-life balance are other strong drivers, something also reflected in contracts for employed optometrists.
Explaining the survey findings, Mike Bowen, director of research at the College, says that although they show an increasing trend in locum work, it did not seek to answer the exact reason. ‘Flexible working was stated as the main career preference for both optometrists and dispensing opticians (45.7% and 35.6% respectively), and the flexibility and freedom which come with locum working may be a contributing factor to the increase in locum work. If so, it will suggest that this trend would continue. But because we did not ask why optometrists are increasingly choosing to locum, we cannot definitively make this connection.’
For James Gilbert of the OutsideClinic, one of the main drivers for locuming is an age-old problem of a lack of optometrists in locations such as Devon, Cornwall, Suffolk and parts of Kent. ‘These areas are gorgeous but it takes a huge commitment, which is why you’re even offered major salaries for practice-based optometry. It’s the way the profession is going – all these practices need to recruit and you make more money locuming. Optometrists have taken advantage of the fact that they can get huge daily rates and can pick and choose what they want to do, which can blow the employment package out of the water,’ he says.
He says the newly qualified prefer the security and back up of employment, but may give locuming a try after a couple of years. At the same time, employers are adapting, including OutsideClinic, which is much more open to taking on locums. ‘We try to make employment packages unique to the individual as we would rather have someone set in place. Nonetheless, we are using locums to cover areas across the south coast, with four or five per area.’
[CaptionComponent="2483"]Locuming also provides a mix for optometrists, working set days, with options for hospital or voluntary work. As locuming is becoming more popular, employed contracts are also becoming more flexible, with the chance to work weekends, or three, four or five-day weeks. There are summer and winter contracts and term-time contracts so that parents have flexibility, he says. ‘We are all up for working with employees to see what works with them.’
Gilbert recognises that demand for optometrists has risen in general as people are living longer, and staying for longer in their own homes. He points to early 2015 as the start of the rise in locum shifts; prior to that there was no issue with applications for employed positions. ‘While we would prefer to have someone employed to serve the patient in a timely manner, we are not scared of using locums.’
Suffolk sessions
Jonathan Foreman, managing director of Observatory Wardale Williams, is very happy with locums working alongside employed optometrists in the Suffolk-based group.
He describes a good locum as an asset, because optometrists have to work to the same standard regardless of their employment status, and their flexibility is beneficial for both parties. ‘We don’t drop their regular days if we are quiet, and they don’t drop theirs; it is simply that their holidays don’t affect us that much. Locums also bring a diverse mix of personalities and talent.
‘The rate has gone up and a good locum is worth that. They’re a large part of the business we are in and give up a lot of security, so the wages are fair,’ Foreman adds.
‘Locuming means people can pick and choose and one of the quality-of-life factors is not to have to travel too far. Often a good optometrist will travel further to work with someone who has the same values. There has to be a mutually beneficial situation. We have spent a lot of time and effort to make the work environment as pleasant as possible. It’s all about quality and care and that’s what good optometrists want to be involved in. If an optometrist wants to do a couple of days a week and deliver a high quality service, we’re happy with that.’
Having locums fitting into the day-to-day running of the practice is not a problem either because high quality locums know how to work with other people and are very good at building relationships, he says. ‘For their job security they are often motivated to build that relationship with the client base.’
As well as being very accomplished on the clinical side, Foreman describes his locums as being open to more commercial work, giving customer recommendations and helping dispensing opticians. ‘Though the arrangements are different, you are a professional in a people-oriented business. Perhaps we would like to integrate them more into the training and development of the business, but there’s a limit to what they can give time-wise in a day.’
Nonetheless, locums are keen to become involved in additional services, for example the company’s dry eye clinic. ‘They are key to that and will want the support to get there. They are as much a part of that as anyone else. They are a legitimate part of the business we are in,’ adds Foreman.
Northern Ireland
While locum Louise Broderick likes the freedom to work in different practices in Northern Ireland, she points out that another bonus of locuming is the ability to move if she is not happy with the work environment. ‘Many optometrists continue to work somewhere they don’t enjoy because it is their full-time job.’
Having locumed for the past six years, on return from 11 years in Liverpool, she normally works three days a week and is currently covering maternity leave at Curtis Opticians in Derry, as well as one day a week in a practice in Ballycastle, County Antrim. ‘Since I’ve had my son I’ve never been out of locuming work. It’s not the pay – which is different here and bears no comparison to the more attractive rates in England – it’s the flexibility. Childcare is not an issue either, but locuming gives me time at home.’
Broderick’s husband is also an optometrist, but he prefers working in the one practice, as optom-manager of a Vision Express store in Ballymena. ‘He likes that but I prefer the variety and the challenge of working on different computer systems and feel comfortable anywhere now. Because I’ve been doing it for a while and have been qualified since 1998, people trust me and the work comes in through word of mouth,’ she says.
Ian Curtis, a partner of Curtis Opticians points out that some locums in Northern Ireland are encouraged by the money offered in more remote areas and will happily travel and stay for around a month, earning £300 a day with free accommodation. ‘I find that a lack of stability and security changes this as they enter family life. During the recession, many locums went after full-time jobs as they were worried about lack of locuming opportunities and I think they see the market improving again. I would say the 7% rise in the number of locums might be a sign of confidence in work availability.’
The chain view
Regional chain Leightons’ director of operations Rebecca Sharp, agrees that a surprising number of optometrists become locums after pre-reg rather than spending 12-18 months at a multiple on qualifying. ‘For certain young people it is about freedom and not wanting the tie of full-time employment. That could change as they find they need security and appreciate the benefits of being employed.’
Leightons uses locums to cover recruitment vacancies, fixed-terms and ad hoc around sick leave and holiday, as well as
for maternity cover. ‘We’re very flexible and take locums for regular days as long as they don’t fall foul of HMRC,’ she says.
‘We do have our fair share of maternity leave and have just had two optometrists off in the same practice within a month of each other. We also have a high proportion of part-time optometrists and can give them support so they can swap clinics
or do extra days.’
Geographical blackspots for Leightons include Swindon and Bournemouth, where it can be more difficult to employ optometrists, and she points out that pre-reg students often return to the city they have studied in.
While for Leightons the standard published locum rates may not have changed greatly, to satisfy demand there can be a variety of rates, or overnight accommodation for a block booking when it is further afield. ‘Some people travel miles for us – regulars who enjoy working with us.’
There is no question of locums not fitting in, she says, as Leightons organises thorough training sessions on the systems and locums are involved in the daily huddles and meetings.
Sharp believes locuming will continue to rise in popularity as people have different work-life balance needs. ‘Some are willing to work really hard for seven days a week for three months then have a month off, others want to work four days a week and not have to work on Saturdays.’
Parents with childcare responsibilities can benefit from the flexibility of locuming, taking time off after school or when the child is sick, however this is by no means the only driver. ‘We could probably pick five locums at random and they would have totally different reasons for doing it. It could be someone with their own business who wants to supplement that, or someone who does some hospital work as well. We’ve even heard of people locuming for three days a week in a holiday destination so they can spend time with their families,’ she adds.
[CaptionComponent="2484"]Cornwall and Scilly isles
In Penzance, Cornwall, optometrist Alison Williams, a director in Reynolds Opticians, relies on regular locum coverage, having initially set out two years ago to employ an optometrist.
‘From my own experience, recruiting competent employed optometrists has been challenging despite the higher-than-average salaries usually offered; using recruitment agencies has not necessarily widened the pool of applicants,’ she says, adding that headhunters don’t like approaching optometrists working with companies they have already recruited for.
The shortage of health professionals in Cornwall, younger ones especially, is not restricted to optometrists as, anecdotally, it extends to other professionals such as dentists, GPs who want a partnership and ophthalmologists.
Another issue with many practices relying on irregular locum cover, is that it can be difficult to provide community (enhanced) services or even consistent referral pathways, she says.
While Cornwall may seem off the beaten track, Williams has gone one step further afield in her work as a locum in an optometry clinic on the Isles of Scilly that was desperate for cover. This was set up because a significant number of people cannot travel to the mainland for eye care and it is not cost effective for private companies to offer a GOS service with little demand beyond standard spectacles.
‘The GP practice has a fully equipped consulting room and Dunelm have supplied frames on consignment so all I have to take out with me is my personal sight testing kit. I enjoy the little dispensing that is needed. What I do is appreciated, and, although it makes a change from my usual routine, it makes me appreciate “my” staff and patients even more,’ she adds.
While locuming in the Scilly Isles is an extreme example, there is little doubt that some practices and groups still find it difficult to fill employed posts in certain geographical locations, just one of the reasons for optometry’s increasing reliance on locums.
David Dixon: A locum’s view
As a locum optometrist of eight years, and having set up the eye2eyrecruitment (a free online introductory agent that puts practices in contact with locums to arrange cover directly) seven years ago, David Dixon agrees there has been a marked increase in locum numbers.
‘Certainly, our database for locums keeps on growing; we have over 2,100 registered, although not all are active. The increased number of locums registering might be a reflection of the company growing, but I feel there are more locums around nowadays.’
He describes quality of life as the biggest influence, the idea of not being ‘tied into’ working and having the choice to take extra days off when required. ‘I tend to do only four days a week in practice now and I’d imagine for mothers that would be great.’
Again he does not believe the high daily rate is the main driver. ‘I don’t believe there is too much difference once you take off the tax, the accountancy fees, the lack of holiday pay, and the lack of pension contribution for example. Also, locum optometry rates have been fairly stable over the years I’ve been working. I’ve heard of locums earning more back in the 1990s than I earn now, despite inflation, but this is also true of employed salaries.’
He suggests that the starting salary offered to newly qualified optometrists versus a locum rate is a factor in the move towards locuming. ‘While there’s not much difference in locum pay versus employed pay, I think that is only the case for an optometrist with some experience. Fresh out of university I believe the salaries offered nowadays are notably lower, which makes locum work a much more enticing opportunity.’
With locum pay often the same regardless of experience/quality, he points out that a hard working, newly qualified optometrist could earn nearly double the employed salary.