Referral Refinement/Direct Referral

This section contains information on enhanced services which are not easily categorised in the way that "cataract referral", "glaucoma monitoring" and "diabetic screening" are.  Arguably however the skills of optometrists are utilised more fully in these diverse schemes and now that optometrists have prescribing rights (click on 'Prescribing' to the left of your screen for more information), this will allow practitioners to manage the care of their patients to a much greater degree.

In general GPs do not have the equipment, the experience or the time to diagnose many eye conditions, particularly those associated with a red eye.  Optometrists have the equipment, the experience and the basic training to undertake this task.  Raising the knowledge to the required level is well within the capabilities of community optometrists.  By cutting down on unnecessary referrals to the HES, by paying for referral refinement, or using an accredited optometrist as a triage resource, the GP can provide a better standard of care for patients, which is quicker and more convenient.

A simple approach to this is for all patients with suspect eye disease to be referred to an optometrist for preliminary screening.  The results of this screening could be:

 

Optometrist Action		Example
No further action required		There is nothing wrong
Optometrist can advise patient		Early cataract
Optometrist can recommend non prescription medication		Lid care product in blepharitis
Optometrist can refer back to GP for medical reasons		Undiagnosed diabetic changes
Optometrist can refer back to GP for prescription medication		Conjunctivitis
Optometrist can refer to HES as routine		Cataract
Optometrist can refer to HES as urgent		Retinal detachment

 A variation of this can be where the GP, optometrist and pharmacist work as a team, with the optometrist recommending appropriate medication to the pharmacist, who then obtains the signed prescription from the GP.

Whilst the majority of patients at risk of glaucoma are seen under the GOS there is no opportunity within GOS for optometrists to undertake further diagnostic tests. Thus referrals to the HES continues to be on the basis of investigations which may be clinically inadequate.

By working to an agreed protocol optometrists can refine these referrals so that only those who are shown to have a high probability of glaucoma are referred to the ophthalmologist.  This refinement of the referral would be identical to that undertaken within the HES, but would cut back on unnecessary hospital visits.

For example, regarding the Colchester scheme (see pdf document at the end of this page), 90% of patients are dealt with within a week; many within two days; 90% need no hospital or secondary care treatment. Details of other local schemesn are in the pdf documents at the end of this page. Audits of the North Staffordshire, Manchester, Bro-Taff and Greater Glasgow schemes can be viewed in the audit section, under 'Clinical Governance'.

AOP Guidance on Referrals

The AOP's guidance on referrals, updated in December 2006, can be viewed in a pdf document at the end of this page.

College of Optometrists' Framework for Optometric Referrals       

The College of Optometrists produced guidance entitled 'Framework for Optometric Referrals'  (April 2005). This is freely available to College members but it is also available to non-members for a fee - click here for details     

 

 

 

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