Referral Guide
This page provides a summary of referral routes for patients who have a Gloucestershire-based GP. To refer patients with a GP outside Gloucestershire please see our guidance page here
Routine
Referrals that are not urgent and not part of an extended primary eyecare service (see later) generally go via the GP. You should assume that it may be up to 3 months before the patient is seen. “Soon” is not generally recognised by GPs or by HES appointments, so for anything that you feel is more urgent you should phone eye casualty/triage line for advice.
If you wish to refer routine cases direct to the Central Booking Office the secure NHS e-mail is ghn-tr.cboreferrals@nhs.net
Gloucestershire Hospitals NHSFT Eye Casualty/ Triage
Open 8am-6pm Monday-Friday; 8am-1pm Saturday; Closed 1pm-2pm; 0300 422 3578
Currently based at Cheltenham General Hospital only.
If you feel a patient needs to be seen urgently you can phone the Triage Line on 0300 422 3578 and speak to one of the nurse practitioners. They will discuss with you and if required issue an appointment time for the patient to attend. You should give a referral letter to the patient to take with them. Always phone before sending the patient.
Outside of these hours contact CGH Switchboard 0300 422 2222 and ask for on-call Ophthalmologist. Patients will be seen in general Accident & Emergency Department.
Wet AMD/ new macular oedema
If you suspect the presence of recent (<3months) onset wet AMD or another condition that might benefit from urgent anti-VEGF treatment then refer urgently by secure nhs.net email to ghn-tr.AMDteam@nhs.net using the Urgent Medical Retina referral form here. FAX TRANSMISSION OF THE FORM IS NO LONGER AVAILABLE. If you have no access to nhs.net then please telephone the ARMD Co-ordinator on 0300 4228533 to register the referral and send the form by first class post as soon as possible.
This pathway and form may also be used if signs and symptoms suggest new macular oedema as a result of new CRVO or BRVO. In these cases please state clearly on the referral form your suspected diagnosis and include an OCT scan wherever possible.
Patients will be sent an appointment letter via first class post, unless short notice appointments become available and thus a phone call is more appropriate. Patients should be advised that they will receive a letter within 10 working days of referral, if not they should contact the referring Optometrist for further advice. In these circumstances contact the ARMD Co-ordinator on 0300 4228533 to confirm the referral has been received.
More information here
Extended Primary Care (Optometry) Services managed by Primary Eyecare Services
Cataract
Referral is via the extended service provided by Primary Eyecare Services (PES). Use the Gloucestershire Cataract Assessment Questionnaire to assess for suitability for surgery. Any patient with cataract who you feel will require surgery should be managed using the Opera online IT system. The referral will be directed automatically by the system to the chosen treatment centre.
Post-operative cataract assessment and reporting is also available through PES and Opera.
More information here
Glaucoma Repeat Readings (GRR)
In cases of raised IOP or visual fields suspicious for glaucoma but in the absence of any other signs of glaucoma the measurements should be repeated on one or two occasions as per the scheme protocol. If you do not take part on the extended service, you must refer the patient to a participating optometrist for further assessment.
More information here
Glaucoma Enhanced Case Finding (GECF)
These are extended services provided by Primary Eyecare Services. The results are reported, and fees claimed, via the Opera online IT system.
Glaucoma Enhanced Case Finding (GECF) is to be used for patients who have disc changes suggestive of glaucoma. The aim of the ECF service is provide for a fully informed referral to be made to the hospital eye service for those patients where suspicious optic nerve appearance has been identified. This may be accompanied with raised IOPs and/or glaucomatous visual field defects. Optometrists must be accredited to provide this service within Gloucestershire. Non-participating practices should refer to an accredited colleague.
More information here
Children`s Vision Screening
A school vision screening service was introduced in the county in 2013. The service uses a computer-generated logMAR based vision testing system to screen children in their reception year.
Children who fail the school vision screening service are referred for further assessment and management. Since January 2017 some categories of screening failures will be seen by accredited community optometrists under the scheme managed by Primary Eyecare Services.
More information here
Flashes and Floaters (Superseded by the CUES Service from 1st September 2020)
This Primary Eyecare extended service is designed to allow optometrists to effectively examine, manage and (where appropriate) refer patients with recent onset symptoms of flashes and/or floaters. Reporting and fee claims are managed via Optomanager.
If the patient is found to have no signs of retinal tear/detachment (including tobacco dust) it is expected that the patient is discharged from the service with appropriate advice. This should be supplemented with a Flashes and Floaters Information Sheet and the College of Optometrists – Flashes and Floaters leaflet. This makes sure that the patient seeks attention if new symptoms occur at a later time. There is the option for follow up within the service after 4 to 6 weeks. HOWEVER – if the patient has previous ocular history and/or symptoms that suggest a higher risk of retinal tear/detachment (see here) the protocol is to refer the patient directly within to the HES service (via the triage phone line) without performing a clinical examination.
More information here