HEREFORDSHIRE LOCAL OPTOMETRIC COMMITTEE
CATARACT DIRECT REFERRAL SCHEME PROTOCOL
- Started February 2005
- Optometrist decides there is a cataract worth removing
- Determines the patient will accept an operation if offered by the Eye Department
- Proceeds to a dilated examination and completes the referral form (see form)
- Discusses advantages and risks of an operation – gives an explanatory booklet
- Faxes or e-mails form to the ophthalmology secretaries who then send an appointment to the patient.
- Optometrist notifies the GP with a request to send on relevant medical details and medication. (see form) Patient does not visit GP
As all this is within the optometrist’s normal sphere of practice, accreditation is not required and there are no indemnity issues.
All optometrists in the county are asked to refer according to the new scheme and most do.
The fee is £500 plus the normal examination fee.
Ophthalmology is now prepared to accept referrals with co-existing pathology provided the pathology is not serious.
Ophthalmology now prefers patients be referred using this pathway i.e. via optometrists where possible. If the optometrist considers the cataract is not “ready” for an operation they will continue to monitor the patient for as long as is necessary.
Patient must be registered with a Herefordshire GP
Other PCTs run similar schemes
## Prior to the scheme starting only 65% of patients referred were ultimately listed for an operation i.e. 35% were seen by the VEU unnecessarily. Now the optometrist does a “work-up” to ensure an operation would be beneficial and the patient is given all the pros and cons the 65% conversion rate has changed to 95%.