Referral Procedures and Protocols

in Stockport

See the bottom of the page for information on referrals outside Stockport

Waiting times

Details of local providers, their consultants and waiting times can be found here

Waiting times Jan 15.pdf

A letter from the Stockport CCG lead for eye care Services gives more information on general referrals:

Referrals Jan 15.pdf

Referrals in general

Routine referrals that are not part of an enhanced service (e.g. cataract, ocular hypertension) generally go via the GP. An electronic fillable template can be found on the practitioner documents page. Remember that only routine referrals go to the GP and you should assume around 3 months. 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 for advice.

Referrals for Wet AMD

The wet AMD service has been contracted out in Stockport and with effect from 3rd August 2015 is provided from the Optegra Eye Hospital in Didsbury. The referral criteria for the Wet AMD service are a less than 3 month history of any of the following:

The vision should be better than 6/96 in the affected eye. If the vision is better than the accepted treatment threshold you should refer them anyway so they can be diagnosed and monitored.

If your patient meets the criteria for potential wet AMD treatment, then you should fax the referral to the the Optegra on 0161 240 0799 using the referral form.

You may request confirmation of receipt by phoning 0161 240 0700.

It is important to note that this service is only for patients registered with a Stockport GP. If the patient does not have a Stockport Gp then the referral will be returned to you. You can find details of out of area wet AMD pathways by looking at the relevant area's LOC website via the links below.

The Word file below can be filled electronically or printed. To edit the form if you wish to add your practice details as a template choose 'Tools' or 'Review' then 'Unprotect'. In protected mode use TAB to move between fields.

WetAmd July 2015.doc

Information for patients about the referral process and what to expect can be found here:

WetAMD Px info sheet for referred patients.pdf

Referrals for Retinal Vein Occlusions

Any CRVO or BRVO should be referred urgently for assessment at Stepping Hill. Referrals should be faxed to 0161 419 4263 for the attention of Mr Desai. The Word file below can be filled electronically or printed. To edit the form if you wish to add your practice details as a template choose 'Tools' then 'Unprotect'. In protected mode use TAB to move between fields.

RVO Referrral July 2015 V2.docx

You can phone 0161 419 4018 (Mr Desai's secretary) to confirm receipt of the fax.

Urgent Referrals - Ocular Emergency Hotline

If you feel a patient requires to be seen urgently you can phone the Stepping Hill Ophthalmic Urgency Service on 0161 419 5689 and speak to one of the nurse practitioners. They will issue an appointment time. You should give a referral letter to the patient to take with them. If you need to fax a letter the number to use is 0161 419 4979

Cataract Referrals

Any patient with cataract felt to require surgery should be booked a further appointment for dilated fundoscopy and discussion of the risks and benefits. If they wish to proceed with surgery they should be referred using the online IT system. The referral will be faxed automatically by the system to the chosen treatment centre. Current choices are:

Stepping Hill Hospital
Tel: 0161 419 4010

Macclesfield General Hospital
Tel: 01625 663 333

Withington hospital
Withington Hospital Cataract Centre Tel: 0161 217 3299

Optegra Manchester Eye Hospital
Tel: 0161 240 0700

SpaMedica Eye Hospital Manchester
Tel: 0161 838 0870

Any cataract referrals sent by non-accredited optometrists without assessment will be asked to attend an accredited optometrist for assessment.

There is a general information leaflet on cataract for all patients, referred or not:

Cataract Gen Info A5.pdf
Cataract Gen Info A4.pdf


The information to be given with the Health Questionnaire to assist the patient in making a decision is:

Should I have cataract surgery (Assessment) A5.pdf
Should I have cataract surgery (Assessment) A4.pdf

The information to be given to those patients being referred is:

Cataract Referral A4 (Choice) Final June 2015.pdf

If a patient returns because they have not heard about their referral, contact the appropriate treatment centre and be prepared to send a copy of all paperwork if it has been lost.

Children

You can refer a child directly to the orthoptic department at Stepping Hill if you believe a full orthoptic assessment is required. Use this form:

Referral to Orthoptics April 13.pdf

If a young child is referred to you for a sight test and you are unable to see them, please ensure that you find them an alternative practice that can see them.

Suspect Ocular Hypertension

In cases of raised IOP in the absence of any other signs of glaucoma the pressures should be repeated on one or two occasions using Goldmann or Perkins tonometry. The results are reported via the www.servicepact.co.uk website for which all Stockport practices have a login. Practices can add new practitioners themselves but anyone new to the area who would like a refresher in contact tonometry should contact admin@stockportloc.co.uk. There is distance learning from LOCSU available on CD covering glaucoma, visual fields, discs, SLBIO etc. This is free and attracts 8 CET points. For details contact admin@stockportloc.co.uk.

There is patient information available:

Repeating Pressure Measurements.pdf

Safeguarding Children & Adults

The Optical Confederation has guidance on safeguarding:

Guidance on Safeguarding and the Prevent strategy - Protecting Children and Vulnerable Adults. Updated September 2014

Confirmation of reading this OC guidance is equivalent to Level 1 training for non-professional practice staff.

Stockport has websites dedicated to safeguarding:

Children: www.safeguardingchildreninstockport.org.uk

Adults: http://www.stockport.gov.uk/services/socialcarehealth/adultsocialcare/safeguardingadults

Stockport CCG Head of Safeguarding and children is Sue Gaskell 0161 426 5057

All Stockport local contacts and information are contained in the following document from page 64 onwards. The earlier pages contain a lot of general information and resources related to safeguarding.

(Stockport) GM Primary Care Safeguarding resource Dec 2014 FINAL v3.pdf

NICE link for child maltreatment quick reference guide is:

www.nice.org.uk/nicemedia/pdf/CG89QuickRefGuide.pdf

Online training packages for both children and adults are available from DOCET free of charge for all practitioners with GOC registration:

http://www.docet.info/cms/safeguarding/index.cfm

The Optical Confederation have advice on safeguarding:

Localised OC Safeguarding guidance Jan 2012.pdf

Female Genital Mutilation

As of 31 October 2015, the Department of Health has introduced a duty for all healthcare professionals to report any case of female genital mutilation in girls (FGM) under the age of 18 to the police.

FGM is considered as child abuse, and is illegal under UK law. It is now a legal duty for healthcare professionals to report any cases they may suspect or be made aware of. For optometrists and dispensing opticians, one scenario in which FGM could come to their attention is if a child tells them that it has happened to them.

Full guidance, posters and other resources can be found on the GOC website at: https://www.optical.org/en/Standards/Standards_for_optometrists_dispensing_opticians.cfm#FGM, or on the Department's website, where you can also find a video guide:
https://www.gov.uk/government/publications/fgm-mandatory-reporting-in-healthcare

Low Vision

The Low Vision Leaflet (LVL) for putting visually impaired people in touch with social services can be downloaded here. Note that the address for Disability Services has been updated (September 2015).

Low Vision Leaflet.pdf

Strokes and TIAs

Current symptoms of an acute stroke or acute TIA require a 999 call and emergency transfer of the patient to hospital.

Where a patient has a past history of a TIA, with symptoms that have fully resolved, they should be advised to consult their GP as soon as possible.
See: www.nhs.uk/actfast/Pages/stroke.aspx

Referrals for patients registered with GPs outside the area

LOC websites will often contain details of local referral routes and contacts. The following links will take you to wesites for:

Manchester

Salford & Trafford

Cheshire

Bolton

Ashton, Leigh & Wigan

Heywood, Middleton, Rochdale & Bury

West Pennine

or the LOCSU host site for LOCs at www.loc-net.org.uk lists many more.