1) General Information
1.1 This document contains referral frameworks intended for use in Birmingham U.K. The guidance given is not prescriptive but is an illustration of good practice. There are clear long term benefits to patients and the health care system from reducing unnecessary referrals and ensuring that the referral process is effective.
1.2 A primary role of the optometrist in a routine eye examination is that of opportunistic case finding. Part of the practitioner’s clinical obligation to the patient lies in his duty to detect and diagnose ocular problems and refer for medical advice and/or treatment where appropriate. Referral is not a substitute for an inability to make a decision. The General Optical Council rules on referrals that came into force on 1st January 2000 allow optometrists to manage patients’ conditions and only refer when clinically necessary. The GOS terms of service were similarly amended to require referral of patients “when appropriate”. Patient management can, therefore, include monitoring in practice at suitable intervals or referral to another optometrist with specialist expertise. It is an abrogation of professional responsibility to refer the patient simply as a means of avoiding further patient management.
1.3 The process of referral is fundamentally one of decision-making. Although guidance and referral protocols will help, frequently there is no simple cut off whereby an optometrist can say that he has discharged unequivocally his responsibility on referral. The decision whether or not to refer will always be based on the patient’s personal circumstances, clinical needs and, where appropriate, local protocols.
1.4 Referral is intended to be for those sight- or health-threatening conditions that the optometrist might expect to see deteriorate within the period of time before the patient’s next optometric visit. This may necessitate reducing the time interval between optometric visits in order that the probability of the presence of the suspected condition may be established.
1.5 The categories of referral decisions that can now be made by an optometrist are:
(i) emergency referral, i.e. same day referral to an eye casualty unit, ophthalmic outpatient clinic or an Accident & Emergency unit.
(ii) urgent referral, i.e. to an ophthalmic outpatient department to be seen within a week or two.
(iii) urgent referral by fax via the wet AMD co-ordinator for wet AMD.
(iv) routine referral to an ophthalmic outpatient department
(v) cataract choice referral for cataract surgery with patient choice of venue
(vi) referral to another optometrist with special expertise
(vii) referral to a GP for suspected systemic disease or simple eye conditions not requiring input from ophthalmology
(viii) to monitor a condition in practice until referral is indicated
1.6 Repeat measurements are desirable in the interests of establishing atypical norms, confirming a diagnosis, establishing rate of change if any, as well as refining the accuracy of referrals in the interests of reducing false positives. Repeat measurements are an important ongoing part of everyday clinical practice but their importance is magnified when considering referrals.
1.7 Where, in this document, reference is made to optometrists in the masculine gender only, this is simply for ease of construction. In such cases it is understood that ‘he’, ‘him’, ‘his’ should also be read as ‘she’, ‘her’ and ‘hers’.
1.8 Sections follow on emergency/urgent referrals and specific recommendations for the referral of a few of the most common conditions found in general optometric practice. From time to time the LOC may issue further guidance for specific conditions.
1.9 These guidance notes should be kept in your clinical governance folder.