On 1st April 2005 the wording of the GOS regulations relating to referral were changed, the change remaining in place when the GOS contract was renewed in 2008.


The major change was that the old requirement to refer patients to a ‘medical practitioner’ changed to a requirement that optometrists should refer patients “found to have injury, disease or abnormality in the eye direct to a hospital eye department where appropriate”.


For your information the actual wording of paragraph 31 of the contract is as follows:


31. Where the Contractor or an ophthalmic practitioner employed or engaged by it to perform the Contract is of the opinion that a patient whose sight has been tested pursuant to clause 30—

31.1.       shows on examination signs of injury, disease or abnormality in the eye or elsewhere which may require medical treatment; or

31.2.       is not likely to attain a satisfactory standard of vision notwithstanding the application of corrective lenses,

s/he shall, if appropriate, and with the consent of the patient—

     31.3.       refer the patient to an ophthalmic hospital, which includes an ophthalmic department of a hospital,

     31.4.       inform the patient’s doctor or GP practice that s/he has done so, and

     31.5.       give the patient a written statement that s/he has done so, with details of the referral.


Reasons for referral, obviously, remain unchanged and the change applies to all referrals where the optometrist might previously have referred via the patient’s GP expecting him or her to refer the patient on to a hospital eye department. Referral of such conditions via the GP is no longer appropriate.


Birmingham Local Medical Committee welcomed the change and advised GPs to return eye referrals intended for the hospital eye service to the referring optometrist should any be sent to them in error.


It is, of course, still appropriate to refer signs of systemic conditions such as hypertensive retinopathy or non sight threatening diabetic retinopathy in an undiagnosed diabetic patient to the GP since treatment to lower blood pressure or commence diabetic control is more appropriately administered by a GP than by an ophthalmologist. Dry eyes is another condition best referred to the GP with appropriate advice so that lubricant drops can be put on prescription.


For the time being all referrals to the HES will have to be made by fax or post, except in the case of emergency referrals which should be made by telephone with a written letter of referral given to patient to take with them to eye casualty at BMEC. Referrals should not be made by email until optometry has been given access to NHS net and all secondary care providers have a suitable address to which referrals can be sent.


NB Referrals should be made to a hospital eye department with reference being made to the particular clinic that it would be most appropriate for the patient to attend (e.g. Birmingham Heartlands Hospital ophthalmology glaucoma clinic).  Where you know of a particular consultant, whose team you would like your patient to be seen by it is now quite acceptable to name the consultant.


The preferred referral route is by fax with a copy of the referral letter being faxed to the patient’s GP for information. The copy sent to the GP should clearly state that it is for information only and that the patient has already been referred.  It will also be useful to invite the GP to forward any pertinent medical history to the eye department to which the patient has been referred.  Alternatively, if you can obtain full details of current medication and conditions being treated you should include that information in your referral.


Once faxed, the original referral document should be retained with the patient’s record and a note made in the record stating to whom the referral has been sent and copied.


Updated information on optometric referral can be found in this guidance and is based on that issued by the College of Optometrists but has been brought up to date to allow for current best practice expected in the Birmingham area.


You may feel that some of the suggestions made are above and beyond the remit of a GOS practitioner and, indeed, the document is merely “guidance” so it is entirely your own choice whether you heed the advice included or not. It has, however, been written and modified with the best interests of the profession at heart and having taken into account various comments made by the GOC in recent years following cases brought against optometrists where serious professional misconduct has been alleged.


Finally I would urge you not to confuse general direct referral with “patient choice in cataract”, OHT repeat readings or PEARS where these services are commissioned by the relevant CCG. All conditions requiring assessment by an ophthalmologist should, from now onwards, be referred direct to an eye department.  You are all aware of the eye departments to which your patients have previously been referred when going via their GP and you should continue to refer to the same hospital(s).  It is perfectly acceptable to ask the patient which hospital or ophthalmology community clinic they would like to attend.  Cataract choice information is also included.


You will also find a list of useful fax numbers for use when referring, hospital and GP addresses can be obtained from the internet using Google or other search engines, from telephone directories or from the Birmingham medical list should you be fortunate enough to have a copy.