REFERRAL GUIDELINES (RCHT)

General Referrals to GPs

Referrals are made through the GP unless they are an emergency.  Referral letters, which are sent to the patient’s GP are very often scanned then forwarded electronically with a covering letter to the Ophthalmology Department at the Hospital Eye Service.  Typed letters are more legible than hand-written ones.
The following information will enable the GP and the hospital to process the referral efficiently;

  • Full patient’s details including full name, date of birth, address, post code and  phone       number (and NHS number, if known).
  • Full optometrist’s details including name of referring optometrist (this is more likely to result in a reply), and date of consultation/referral.
  • Signs, symptoms, how long symptoms have been present, previous ocular history, suspected diagnosis, VAs including monocular near VAs and previous VAs if possible, and results of supplementary tests such as visual fields where appropriate.
  • A clear indication to the GP as to whether it is a report requiring no further action, or a referral.
  • If it is a referral, what action is required by the GP and the patient?  E.g. ‘The patient has been asked to contact you soon.’
  • It is good practice to state if the referral is emergency (to A & E), urgent, or routine.
  • The GP should be notified if a patient has been directly referred.
  • If malignant changes are suspected mark the referral clearly so the patient can be prioritised.

You are now required to give written information about the referral to the patient if they require it. This can be a copy of the referral letter.

Cornwall LOC Referral letter Guidelines

Hospital eye departments are now increasingly using triage of referral communications to direct patients into the correct clinic type and with the appropriate level of urgency. Therefore it is important that all referral communications contain as much information as possible.

These should include:

  •  Practice name and address (including telephone + fax number and e-mail address if available)
  • Patient name, date of birth and address (including home and work telephone numbers if possible)
  • Patient GPs name & address
  • One sentence summary of reason for referral (eg  ‘Reduced right vision due to cataract.’ or ‘High IOP – outside NICE guidelines.’)
  •  Further in depth summary of symptoms/history including any signs and test results.
  • Patients prescription (if possible with pinhole acuities if reduced VA and near acuities with a +4.00 add if referring for low vision)
  • Advice to patients GP on which clinic to refer into and urgency of referral.

Example Outline of Referral Letter

GPs name
GPs Address

Date

Dear ‘GPs name’

Ref: Patient Name, Date of Birth, Address (inc. Postcode), Work Tel no, Home/mobile Tel no. NHS no (if known)

Reason for referral: (one line triage summary)

Symptoms/History:

Clinical Details of eye exam (e.g. Pupil responses, Adnexa, Retina, discs etc.)

IOP: R. mmHg; L. mmHg (instrument, time).

Field Results (if appropriate)

Refraction Results

Vis Sph Cyl Axis D Prism VA PH Add N Prism NVA
R
L

Advice: including where to refer and urgency of referral.

Yours sincerely

Optometrist