The College of Optometrists

Referrals

C176
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.


When to refer

C177
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 patients to an appropriate practitioner who is registered with a statutory regulator.
C178
You should consider national and local guidance on referrals.
C179
The National Institute for Health and Care Excellence has published evidence on the effectiveness of a repeat readings service for patients with suspect high intraocular pressure.242 The Scottish Intercollegiate Network has published guidance on glaucoma referral and safe discharge.243
C180
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.244
C181
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, and
  3. details of advice or treatment given to the patient.
C182
If you decide not to refer the patient you should inform the patient’s GP of any relevant findings, if the patient consents.
C183
The welfare of the patient must not be compromised.
C184
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 para C205a and C205b.
C185
Patients have a right to be fully involved in decisions about their care.
C186
If the patient does not wish to be referred you should:
  1. ensure the patient understands why the referral is necessary
  2. record a full account in the patient records, and
  3. obtain the patient’s signature on a declaration that they do not wish to be referred.


Whom to refer to

C187
You must only refer patients to a practitioner with the appropriate qualifications and registration.245
C188
When you refer a patient, you also transfer responsibility for the relevant part of the patient’s care.
C189
If the patient is not registered with a GP or wishes to see a doctor privately, you should give the patient 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

C190
You should write a clearly worded letter of referral and include:
  1. relevant details from the eye examination
  2. the reason for referral
  3. details of discussions with the patient and any with the practitioner to whom you are referring, and
  4. the level of urgency.
C191
If the patient is already receiving care for the observed sign of injury or disease you should notify the practitioner who is caring for the patient if you believe your findings might provide additional, useful information.
C192
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

C193
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.246, 247 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.
C194
You should ensure the patient understands the urgency of the referral.
C195
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. 
C196
You should tell the patient what to do if their symptoms get worse before they are seen.
C197
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 when the patient sees the clinician to whom they have been referred.
C198
If the patient is not legally responsible for their own care, you should copy the letter to the person who is legally responsible.
C199
You should provide copies of correspondence in large print for patients with visual impairment.
C200
You should ask young people who have the capacity to consent to treatment if they would like to receive copies of letters about them. You should also check if they prefer to collect a copy of any letter containing personal information or have it sent to their home.
C201
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), or
  3. you feel it may cause harm to the patient, although giving bad news is an insufficient reason for withholding a copy of the letter.

 
Sending the referral

C202
If you post the copy of the referral letter to the patient:
  1. check where they would like it to be sent, and
  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, to avoid confusion with other family members.
C203
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

C204
You should keep copies of all referral letters and a note of the discussions held with the patient, including the advice you gave.

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