Type and Direction of Ophthalmic Referrals

10) Type and Direction of Ophthalmic Referrals


10.1 Standard Referral


For routine, non urgent referrals requiring assessment/treatment by an ophthalmologist the optometrist should complete GOS18 or personal equivalent stationery and direct the referral to the appropriate hospital eye department by fax or post. A copy of the referral should be faxed to the patient’s GP, clearly stating that the referral to ophthalmology has already been made, that the fax is for information only and inviting the GP to forward any relevant past medical history/medication details etc to the eye department to which the referral has been made.  The original referral letter should be attached to the patient’s record and a note made of the action taken.


10.2 Expedited Standard Referral


This applies when the optometrist considers that the patient requires ophthalmological intervention sooner (urgent cases) but this does not constitute an emergency. The referral should be sent to the hospital eye department by the swiftest method possible, e.g. by fax followed by a telephone call to the eye clinic booking clerk to arrange an appointment for the patient to be seen.  Again a copy of the referral should be faxed to the GP as in 8.1 and the original referral letter attached to the patient’s record where a note should be made of the action taken.


10.3 Emergency referral


This applies when immediate ophthalmological advice is deemed clinically necessary by the optometrist. The optometrist should make all such referrals to Birmingham and Midland Eye Centre Casualty by first telephoning the eye casualty unit to inform them that the patient is on the way.  The patient should take the referral letter by hand and a copy should be faxed to the patient’s GP for information.  The original referral note should be attached to the patient’s record and a note made of the action taken.


10.4 Referral to the GP


There will frequently be circumstances when an optometrist considers that medical intervention is indicated but that referral to an ophthalmologist is not necessary e.g. a patient suspected of having undiagnosed diabetes or where hypertensive retinopathy is found. Form GOS 18 should be completed and faxed to the GP, the patient should then be asked to make an appointment to see their GP as soon as possible.


10.5 Referral of patients already under the care of an ophthalmologist.


Prior to generating a routine referral the optometrist should establish whether the patient has an outstanding appointment to see or is regularly seeing an ophthalmologist. Patients frequently attend for routine spectacle refraction whilst under the care of an ophthalmologist.  Such patients may present with a change in their eye condition (or a new one) that merits referral for an ophthalmological opinion.  In these cases the patient should always (unless in an emergency) be referred, by fax, back to their attending ophthalmologist and a copy of the referral sent to the patient’s GP.  Wherever possible the patient’s NHS number should be included in the referral letter.  Again the original referral document, or a copy of it if it has been posted, should be attached to the patient’s record and a note made of the action taken.


10.6 Private referral at patient request.


Whenever a referral to ophthalmology is being made the patient should always be asked whether they would prefer to be referred privately as opposed to via the NHS. Many optometrists refer patients directly to an ophthalmologist of their choice for a private consultation for routine matters such as cataract surgery.  In such cases it is, of course, still appropriate to refer to a named consultant, sending the referral by fax or post to their private rooms.  A copy of the referral letter should be simultaneously sent to the patient’s GP.


Many health insurance companies require a GP certification of the need for the consultation if the cost is to be born by the insurance company.


10.7 Non-medical referral


This arises in cases of referral to Social Services, Special Educational Needs departments, Occupational Therapy, etc. In the case of a visually impaired patient who would benefit from blind of partially sighted registration or from intervention by a low vision service, the new LVI should be issued with instructions to submit the completed form to Social Services.


10.8 Inter-optometric referral


It should be recognised that optometrists have different skills that may be more appropriate for some patients. The referring optometrist may consider that medical referral is not necessary, particularly where the diagnosis has already been established by an ophthalmologist, but that the patient requires expertise outside his professional competence. 


10.9 It is in the best interests of both patients and inter professional courtesy that communication with medical colleagues is encouraged wherever possible.  Communications intended to inform rather than refer should be clearly identified as such so that their intention is not misunderstood.  Such communications should be used as a positive opportunity for liaison rather than being perceived as a burden on the practitioner.


10.10 In the case of any findings that the optometrist cannot interpret with reasonable certainty, the correct course of action is to refer, either to an optometric colleague who can make a diagnosis or to the HES.