Summary:

Ophthalmology is a huge growth area for the NHS, specifically referrals from ophthalmic practitioners. Many of these are as a result of work carried out in practice as part of the General Ophthalmic Services Contract (GOS), but a growing number are carried out privately and are not subject to the GOS. Currently there is limited guidance on what should be included in a GOS referral, although this is still rather grey and there is no guidance or standard for private referrals into the NHS.

The significant variation in quality of referrals, the information contained within them and the lack of understanding between NHS providers, primarily between primary and secondary care creates issues within the system, I believe this would be easily resolved through agreement of a county wide minimum referral standard.

The standard would be accompanied by information on the constraints within the system to ensure mutual understanding between all parties. This would ensure that secondary care is aware of constraints within ophthalmic practices under the GOS. A prime example of this being the limitations on frequency of GOS sight tests, now being more rigorously enforced by NHS England, but often not understood by Secondary care providers.

Benefits:

• Improved triage outcomes
• Better understanding between providers
• Improved referrals
• Better experience for patient
• Less issues for opticians practices
• Improved booking accuracy by DRSS
• Few queries for all

Ownership:

For the County standard to work, all parties involved must mutually agree to it.

The following organisations have signed up to the standard:

1. Devon Local Optical Committee (Devon LOC)
2. Royal Devon and Exeter (RD&E FT), University Hospitals Plymouth NHS Trust (UHP), North Devon District Hospital (NDHT), Torbay and South Devon NHS Foundation Trust (TSDFT)
3. NHS England Local Area Teams (LAT)
4. NHS Devon Clinical Commissioning Group
5. The Devon Referral Support Services (DRSS)

Referral Forms:

It is recognised that no single party is able to enforce the usage of a single referral form and that all Opticians practices are free under contract to refer using any of the following (but not limited too):

• DRSS referral form
• Their own form
• A Letter
• GOS 18

Although it is encouraged that referrals are made using the DRSS referral form, the standard this document proposes is based on a minimum information set and not on format.

The Standard:

It is agreed that the following information should be supplied as a minimum for any ophthalmic referral from any optician in Devon, with the associated exceptions.

• Opticians sending referrals by letter should ensure that they are using headed paper.
• Correct patient information, including date of birth
• GP practice name
• Reason for referral
• Visual acuities
• Optical prescription for both near and distance*
• Intraocular pressures*
• Field findings: Visual field results/ plots if visual fields found to be abnormal*
• An indication of the urgency of the referral (Routine, urgent or emergency)

*if appropriate for the referral reason

Implementation of the Standard:

Practices who consistently fail to meet this agreed standard are liable to have their referrals returned.

Clinics and additions: if appropriate

• AMD (Wet): None
• Cataract: Optical prescription
• Cornea: None
• Diabetic Medical Retina: None
• External Eye Disease: None
• Glaucoma: Intraocular pressures AND Field findings: Visual field results/ plots if visual fields found to be abnormal
• Raised IOP only: Intraocular pressures
• Laser (YAG Capsulotomy): None
• Low Vision: None
• Neuro-Ophthalmology: None
• Oculoplastic/Orbital/Lacrimal: None
• Orthoptics: Optical prescription
• Other Medical Retina: None
• Squint, Ocular Motility: None
• Paediatrics: Optical prescription
• Vitreo-Retinal; None
• Not otherwise specified (includes suspect cancer): None

If you have any questions about your referral please contact Drss.helpdesk@nhs.net

Pathway Group

This guideline has been signed off by:

John Finn Deputy Chief Operating Officer (Planned Care and Programmes) NHS Devon CCG

Max Halford Chairman, Devon LOC

Janet Newport Contract Manager, Optometry NHS England

Publication date: November 2021