The College of Optometrists

Referrals

C188
You may refer a patient or you may receive a referral from a colleague. If you receive a referral, you should address the reasons for referral and advise the patient to consult their regular practitioner for routine eye care (refer to COVID-19 guidance).


When to refer

C189
If you observe a sign or symptom of injury or disease which you cannot manage within your competence or scope of practice, you should refer the patient to an appropriate practitioner who is registered with a statutory regulator.
C190
You should consider national and local guidance on referrals.
C191
The National Institute for Health and Care Excellence recommends that patients with signs of possible glaucoma or related conditions, identified during  a routine sight test, should have additional tests before they are referred for a diagnosis.281 The Scottish Intercollegiate Guidelines Network has published guidance on glaucoma referral and safe discharge.282 
C192
If, in your professional judgement, you do not need to refer the patient, or it is impractical to do so, you may decide to manage the condition yourself.283
C193
If you decide not to refer the patient you must record:
  1. a sufficient description of the condition
  2. the reason for deciding not to refer on this occasion
  3. details of advice or treatment given to the patient.
C194
If you decide not to refer the patient you should inform the patient’s GP of any relevant findings, if the patient consents.
C195
The welfare of the patient must not be compromised.
C196
You must refer patients with appropriate urgency. If there are local protocols in place for referrals, including emergency or urgent referrals, you should follow these. If in doubt, you should seek advice from the on-call ophthalmologist to determine the most appropriate pathway for the patient. Where there are no local protocols, guidance on which conditions are considered an emergency and which are considered urgent can be found in Annex 4 Urgency of referrals table.
C197
Patients have a right to be fully involved in decisions about their care.
C198
If the patient does not wish to be referred you should:
  1. ensure they understand why the referral is necessary
  2. record a full account in the patient records
  3. obtain the patient’s signature on a declaration that they do not wish to be referred.


Whom to refer to

C199
You must only refer patients to a practitioner with the appropriate qualifications and registration.284
C200
When you refer a patient, you also transfer responsibility for the relevant part of the patient’s care.
C201
If the patient is not registered with a GP, or wishes to see a doctor privately, you should give them the referral letter and tell them to register with a GP or to arrange a private appointment with an appropriate doctor, for example an ophthalmologist. Alternatively, you can send your advice by recorded delivery to the patient and enclose the referral letter.


Telling the practitioner

C202
You should write a clearly worded referral and include:
  1. relevant details from the eye examination
  2. the reason for referral, including images where appropriate
  3. details of discussions with the patient and any with the practitioner to whom you are referring
  4. the level of urgency.
C203
If the patient is already receiving care for the observed sign of injury or disease you should notify the practitioner who is caring for them if you believe your findings might provide additional, useful information.
C204
If you send the referral letter directly to the practitioner to whom you are referring, you should ensure that the patient’s GP is kept informed. This may be relevant in an emergency or where you use a referral centre.


Telling the patient

C205
If you are referring the patient to a doctor, the law says you must give the patient a written statement of the reasons for referral, immediately following the sight test.285, 286 If you cannot write the referral letter immediately following the sight test, you can write the reason for referral elsewhere, for example on the patient’s prescription.
C206
You should ensure that the patient understands the urgency of the referral.
C207
You should tell the patient when they should expect to hear about their referral and what to do if they do not hear within that timescale. 
C208
You should tell the patient what to do if their symptoms get worse before they are seen.
C209
You should give patients copies of any correspondence relating to them so that they are clear about their condition and the care they are receiving. This can also be useful in case the original correspondence goes astray.
C210
If the patient is not legally responsible for their own care, you should copy the letter to the person who is legally responsible.
C211
You should provide copies of correspondence in an accessible format.
C212
You should ask young people who have the capacity to consent to treatment whether they would like to receive copies of information about themselves, and how they would like to receive this.
C213
You should not copy a letter to a patient if:
  1. they decline a copy
  2. the letter contains information about another person who has not given their consent for you to disclose this information (other than if the patient originally provided this information or if you remove this information from the copy letter)
  3. you feel it may cause harm to the patient. Giving bad news is an insufficient reason for withholding a copy of the letter.

 
Sending the referral

C214
If you post the copy of the referral letter to the patient:
  1. find out where they would like it to be sent
  2. use the patient’s full name in the address and check with them if they share the same name as someone else at that address, and how to avoid confusion with other family members.
C215
When you send a referral, make sure it is sent by a secure method or the patient has given consent for it to be sent by an alternative method.


Recording the referral

C216
You should keep copies of all referral letters and a note of the discussions held with the patient, including the advice you gave.

Winner of Memcom 2016 award for best microsite

Tel: +44 (0) 20 7839 6000

Email: info@college-optometrists.org

Web: www.college-optometrists.org

Website developed by NetXtra