Halton & St Helens Enhanced Services

NHS  Halton & St Helens launched an Enhanced Services programme on 28th September 2010. All local contractors can apply to the PCT for a contract to provide the services.

The programme currently includes  4 elements:

1. Cataract Referral:

Where a patient has sufficient cataract and wishes to have surgery, practices refer direct to the patient's choice of provider. Each referral must be completed on the standard local Cataract referral form.

2. Acute Assessment:

Patients with cataract who present for an emergency appointment can be further assessed to rule out other conditions which may need more acute referral, e.g. Wet AMD, Vessel occlusion.

3. Glaucoma LOCSU 1a Referral Refinement:

Where the IOP is found to be over 21mmHg the measurment can be repeated up to 2 times using Goldmann Applanation Tonometer. If the IOP remains over 21mmHg, the patient is referred via the standard local form.

4. Glaucoma LOCSU 1b Referral Refinement:

If a field defect is detected after a sight test, the field is repeated. If the second field further raises suspicion of glaucoma the patient is referred using the standard direct referrral form.

Referral Forms

There are a range of local referral forms, available in  2 formats: An electronic version, which can be typed, printed  and saved; A PDF file, which can printed and hand-written.


All forms should be faxed, posted or emailed to the relavent service provider and in every case, a copy must be sent to the patient's GP. There is also a standard proforma available to give  patients written confirmation  that they have been referred.   



The form should be completed for each patient referred and faxed direct to the patient's choice of provider.

Direct Referral:

All eye conditions should be referred direct to the local HES via the standard Direct Referral form. The PCT has developed guidance on priority for referrals of various eye conditions. It would be best to  declare a provisional diagnosis and advise when you feel the patient should be seen. The electronic form has all these condtions available as a drop-down menu.

Wet AMD rapid referral:

Where Wet AMD is suspected, the patient should be referred urgently to the AMD service at St Helens or Warrington.

Low Vision:

Patients can be referred to the Low Vision service at the Millenium Centre in St Helens for assessement and rehabilitation, along with registration and LVA provision.

NHS Email Pilot

Local practices and optometrists are being invited to take part in an NHS email pilot. Each practice and optometrist  has been given  an NHS email adddress. NHS email  has  military grade  encryption, making it safer  to send emails including patient data.

It is hoped we can move towards referrals being emailed direct to the provider, with a copy email to the GP practice. This will further streamline referrals, allowing better feedback and audit.