Manchester Referrals
Opera Electronic Referrral System
All referrals by practitioners within Greater Manchester for a patient with a Greater Manchester GP should be made through the Opera electronic referral platform. This will route the referral appropriately and also enables patient demographic and GP look-up. The referral information below is for information and for the use of practitioners outside Greater Manchester who have a GM patient, or for practitioners within GM only if Opera is unavailable for some reason.
You can find information on the urgency of referrals in Greater Manchester here:
Download pdf Guidance on the Urgency of Referrals in GM
This page provides referral details for patients registered with a GP in Manchester CCG. For patients outside this area, use the GP search to find which CCG area protocols to follow and then consult that area's referral page
Click on the headings below for more information.
- Routine referrals
Routine referrals that are not part of an enhanced service (e.g. cataract, ocular hypertension) generally go via the GP.
Patients already under careIn cases where a patient is already under the care of an ophthalmologist and a new routine condition has arisen, you should write to the ophthalmologist rather than re-refer.
Remember that with routine referrals you should assume it will 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 for advice.
An electronic GOS18 template is available here for those without access to Healthi:
Learn More Electronic GOS18 template
- Emergency Eye referrals
If a patient needs to be seen due to an eyesight-threatening emergency, they can be referred to the
Manchester Royal Eye Hospital Emergency Eye Department (EED)
Patients should be sent to MREH EED only after the patient case has been discussed with the department or where the presenting complaint falls under the red section of the referral guidance document.Optometrists, who have referred a patient via Opera for an EED opinion should wait for feedback via Opera - more detail below.
Please give the the patient a referral letter to take with them.
Download pdf Guidance on the Urgency of Referrals in GM
Contact details:
08:00 - 20:00 every day including Bank Holidays
Tel: 0161 276 5597/5599 for advice onlyPlease consult this webpage frequently for updates regarding the telephone numbers as the phone system is currently under review
CUES
If you are not providing CUES in your practice you should consider whether the CUES service could meet your patient’s needs, eg. does this patient meet CUES suitability criteria and could this patient be dealt with by an Independent Prescribing Optometrist in CUES. If this is the case please refer the patient into CUES. More information is available on the ,Primary Eyecare's CUES webpage here.EED opinion via Opera,
If referring by Opera the referral will go by eRS and you should expect feedback within 1 hour, Monday-Friday 9:00-17:00. If you have not heard within 1 hour, please phone the department or CUES telephone line (if you are a CUES optometrist) to verify that the department have received the case for review via eRS. The patient can leave your practice, but you should advise the patient you will contact them once a decision has been made by the hospital and before they attend EED.EMAC
Emergency macula referrals can be made direct to the EMAC service, so the patients can have scans and images taken quickly to make a diagnosis and initiate a treatment plan.Call the EMAC team while the patient is still with you to organise an urgent appointment for that patient.
Telephone number - 0161 701 3419
Then send clinical details to the EMAC team using one of the following methods:
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• MREH EMAC referrals via Opera - for those with access to Opera you should always send EMAC referrals this way, following a phone call to arrange an appointment.
• For Optometrists without access to Opera, you should refer patients by completing the below form and send via your nhs.net email account.
Download Form EMAC Referral Fillable Form.pdf
Email: mft.macular@nhs.net - only secure if sent from an nhs.net account
The NHS has been told to remove all fax machines. MREH will not receive supporting clinical details to the EMAC fax (0161 701 0262) from 1st April 2021.
*retinal vein occlusions with macular oedema may also be sent via this pathway. All retinal vein occlusions regardless of referral pathway require a referral to GP for systemic work up.
MREH Macular
Optometrists with access to the necessary imaging equipment, who are confident of a diagnosis and that there is treatable pathology can refer via the MREH Macular pathway on Opera.This type of referral enables patients to be booked directly into a clinic for a first treatment, rather than attending initially for diagnostic imaging. In order to refer to this service optometrists must:
-
• Provide full OCT image files (not just slices) and colour fundus images for both eyes via the opera system
• Have identified wet AMD, Myopic CNV or * retinal vein occlusion with macular oedema and you are confident the pathology is treatable
If the 2 points above are not met, then send the patient to the EMAC pathway. You can still attach images to assist triage.
The clinical team can then assess the referral and images and book the patient in for treatment if criteria is met.
If the referral does not meet the criteria above, the referral will be rejected with instructions on what to do next; this may be to refer to the EMAC service with a telephone call and sharing the clinical information as above.
Please note it is sometimes decided that patients will need images repeated in EMAC if an OCT A is required or the images need repeating.
* All retinal vein occlusions regardless of referral pathway require a referral to GP for systemic work up.
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- Wet AMD
The referral criteria for the Wet AMD service are a less than 3 month history of any of the following:
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• Visual loss.
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• Spontaneously reported distortion.
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• Onset of scotoma (or blurred spot) in central vision.
EMAC
If your patient meets the criteria for potential wet AMD treatment, then you can refer to the MREH Emergency Macula Service (EMAC). You should phone to make the patient an appointment so the patients can have scans and images taken quickly to make a diagnosis and initiate a treatment plan.Call the EMAC team while the patient is still with you to organise an urgent appointment for that patient.
Telephone number - 0161 701 3419
Then send clinical details to the EMAC team using one of the following methods:
-
• MREH EMAC referrals via Opera - for those with access to Opera you should always send EMAC referrals this way, following a phone call to arrange an appointment.
• For Optometrists without access to Opera, you should refer patients by completing the below form and send via your nhs.net email account.
Download Form EMAC Referral Fillable Form.pdf
Email: mft.macular@nhs.net - only secure if sent from an nhs.net account
The NHS has been told to remove all fax machines. MREH will not receive supporting clinical details to the EMAC fax (0161 701 0262) from 1st April 2021.
*retinal vein occlusions with macular oedema may also be sent via this pathway. All retinal vein occlusions regardless of referral pathway require a referral to GP for systemic work up.
MREH Macular
Optometrists with access to the necessary imaging equipment, who are confident of a diagnosis and that there is treatable pathology can refer via the MREH Macular pathway on Opera.This type of referral enables patients to be booked directly into a clinic for a first treatment, rather than attending initially for diagnostic imaging. In order to refer to this service optometrists must:
-
• Provide full OCT image files (not just slices) and colour fundus images for both eyes via the opera system
• Have identified wet AMD, Myopic CNV or * retinal vein occlusion with macular oedema and you are confident the pathology is treatable
If the 2 points above are not met, then send the patient to the EMAC pathway. You can still attach images to assist triage.
The clinical team can then assess the referral and images and book the patient in for treatment if criteria is met.
If the referral does not meet the criteria above, the referral will be rejected with instructions on what to do next; this may be to refer to the EMAC service with a telephone call and sharing the clinical information as above.
Please note it is sometimes decided that patients will need images repeated in EMAC if an OCT A is required or the images need repeating.
-
- CUES - Urgent Eyecare Service
If your practice does not participate in this service, then eye problems such as:
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• Red or painful eye or eyelids
• Recently occurring flashes and floaters
• Recent and sudden loss of vision
• Foreign body in the eye
should be referred to one of the CUES accredited optometry practices.
Full details and a practice search are available on the Primary Eyecare Services website CUES page here
-
- Cataract
Cataract referral is via the extended service provided by GM Primary Eyecare. Any patient with cataract who you feel will require surgery should be managed using the Optomanager online IT system. The referral will be directed automatically by the system to the chosen treatment centre.
Effective Use of Resource Policy
Unless the patient was originally referred for bilateral cataract surgery (where both eyes fit the criteria) they will require re-referral for the 2nd eye which it does meet the criteria.
Download Form WetAmd July 2015.doc
Post-operative cataract assessment and reporting is also via the GMPEC service and Optomanager
If you do not participate in the service or are out of the area, please send the patient to one of the accredited optometrists with a copy of the referral letter.
For further information see the GMPEC website.
Learn More Electronic GOS18 template
- Referrals for Retinal Vein Occlusions
CRVO and BRVO with haemorrhaging at the fovea should be sent urgently to the MREH Emergency Macula Service (EMAC).
EMAC
Emergency macula referrals can be made direct to the EMAC service, so the patients can have scans and images taken quickly to make a diagnosis and initiate a treatment plan.Call the EMAC team while the patient is still with you to organise an urgent appointment for that patient.
Telephone number - 0161 701 3419
Then send clinical details to the EMAC team using one of the following methods:
-
• MREH EMAC referrals via Opera - for those with access to Opera you should always send EMAC referrals this way, following a phone call to arrange an appointment.
• For Optometrists without access to Opera, you should refer patients by completing the below form and send via your nhs.net email account.
Download Form EMAC Referral Fillable Form.pdf
Email: mft.macular@nhs.net - only secure if sent from an nhs.net account
The NHS has been told to remove all fax machines. MREH will not receive supporting clinical details to the EMAC fax (0161 701 0262) from 1st April 2021.
*retinal vein occlusions with macular oedema may also be sent via this pathway. All retinal vein occlusions regardless of referral pathway require a referral to GP for systemic work up.
MREH Macular
Optometrists with access to the necessary imaging equipment, who are confident of a diagnosis and that there is treatable pathology can refer via the MREH Macular pathway on Opera.This type of referral enables patients to be booked directly into a clinic for a first treatment, rather than attending initially for diagnostic imaging. In order to refer to this service optometrists must:
-
• Provide full OCT image files (not just slices) and colour fundus images for both eyes via the opera system
• Have identified wet AMD, Myopic CNV or * retinal vein occlusion with macular oedema and you are confident the pathology is treatable
If the 2 points above are not met, then send the patient to the EMAC pathway. You can still attach images to assist triage.
The clinical team can then assess the referral and images and book the patient in for treatment if criteria is met.
If the referral does not meet the criteria above, the referral will be rejected with instructions on what to do next; this may be to refer to the EMAC service with a telephone call and sharing the clinical information as above.
Please note it is sometimes decided that patients will need images repeated in EMAC if an OCT A is required or the images need repeating.
* All retinal vein occlusions regardless of referral pathway require a referral to GP for systemic work up.
-
- Suspect Glaucoma / OHT
Glaucoma repeat readings 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 as per the extended service provided by GM Primary Eyecare. The results are reported, and fees claimed, via the Optomanager online IT system.
If the pressure is still raised after repeat then the patient will be referred to the Glaucoma referral Refinement Service (GERS).
For further information see the GMPEC website.Learn More Electronic GOS18 template
Glaucoma Where there are signs of glaucoma, with or without raised IOP, Manchester patients should be referred directly to the GERS service with a supporting letter and a copy of their visual fields where performed. You can search for a local practice providing the service on the GMPEC website:
Learn More Find a practice
Acute closed angle glaucoma is an urgent referral.
Patients from areas outside Manchester should be referred according to their area's protocol.
Practices outside the area should refer Manchester patients to GERS.
- Safeguarding Children & Adults in Manchester
Safeguarding in the Manchester Area
If you have concerns that a child, young person or adult is at risk of or being abused or neglected you can contact the Manchester Safeguarding Children's Board to report your concern:
Manchester Contact Centre
Tel: 0161 234 5001 (open 24 hours a day, seven days a week)
Email: mcsreply@manchester.gov.uk
Web: www.manchestersafeguardingboards.co.uk/concerned
The Optical Confederation has guidance on safeguarding:
Download Guidance on Safeguarding
Confirmation of reading this OC guidance is equivalent to Level 1 training for non-professional practice staff.
The NICE link for a child maltreatment quick reference guide is:
Learn More Child Maltreatment Guidance
Online training packages for both children and adults are available from DOCET free of charge for all practitioners with GOC registration at
Learn More Enrol Children Safeguarding Level 2
Learn More Enrol Adults Safeguarding Level 2
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 Department of Health's website at:
Learn More FGM Mandatory Reporting-in-Healthcare
- Strokes & 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.
Learn More See Stokes - The Children's Community Orthoptic Services
You can refer Manchester children directly to this service. If you have a child patient that you feel needs an orthoptic opinion (and they do not need an ophthalmologist opinion - for example, children that need amblyopia treatment) they will be seen more quickly in community than in hospital. They accept NHSemail referrals which reduces waiting times further (Healthi referrals go to this address).
Please refer directly to the orthoptic service and not via the GP if you think a child needs amblyopia treatment.
Orthoptic email: mft.orthoptic.referral@nhs.net(only send from an NHSMail address)
Please look at this list so you know where your local clinics are held. Matilda Blythe is the head of Community Orthoptic Services in Manchester. You can address referrals FAO The Orthoptist. The Head Office is at Levenshulme Health Centre but referrals to the clinic that is most convenient for the patient will reduce waiting times.
Download pdf Orthoptic Clinics 2021.pdf
- Low Vision
The Low Vision Leaflet (LVL) for putting visually impaired people in touch with social services can be downloaded here:
Download Form Low Vision Leaflet
It should be sent to:
Manchester City Council Sensory Service, Manchester Deaf Centre,
Crawford House,
Booth Street East,
Manchester
M13 9GH Tel: 0161 234 5001The Sightline Directory allows you to search for support services for a patient by town or postcode, and by type of service if you wish.
Learn More Sightline Directory
The charity Henshaws support people with sight loss and a range of other disabilities
Learn More Henshaws