Ashton, Leigh & Wigan LOC Referrals

Referrals in Ashton, Leigh & Wigan

Opera Electronic Referral 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.

Practices outside the GM border that see GM Patients can register for the Opera GOS18 function. Where Opera is already used for extended services this will be an easy addition.

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 Wigan Borough 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.

Referrals in general

Routine referrals that are not part of an extended service (e.g. cataract,) go via the GOS18 tab on Opera. You should assume it will be up to 3 months before the patient is seen. "Soon/Urgent" is not generally recognised by GPs or by HES appointments, so for anything that you feel is more urgent you should still send your referral using the GOS18 tab on Opera but following the Emergency Eye Referrals protocol below.
Patients already under care
In 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.

An electronic GOS18 template is available on the information page for those areas without access to Opera:

Learn More Electronic GOS18 template
Emergency referrals

WWL Eye Unit Urgent Referral Clinic
Tel: 01942 822 244
Email: wwl-tr.UrgentEyes@nhs.net(only send from an NHS Mail account)

Emergency referrals should still be sent using the GOS 18 tab on OPERA but choosing “emergency” instead of “routine” in the priority section. Then, in the “speciality” section, choose emergency eye services. In the “clinic type” section, choose “Emergency Clinic Only” and finally in the “Providers” section choose your preferred location to refer to. This referral will automatically be emailed to a dedicated emergency email address at the selected location where it will be triaged and the patient contacted.

You may wish to confirm receipt of this email by phoning the relevant eye unit.

Where a patient attends with acute onset eye problems and your practice does not deliver CUES, a referral to CUES may be the most appropriate outcome for the patient. Please see the Primary Eyecare Services website CUES page for more information.

Out of hours onlyPatients can be referred to MREH Emergency Eye Department. For more information on EED see the emergency eye referral section under Manchester LOC referrals
Suspected Papilloedema Local Guidance for ALW

Please see the documents linked below for guidance on referrals for patients with suspected papilloedema in Ashton, Leigh and Wigan

Download Papilloedema Referral Guidance for ALW

Download Papilloedema Grading Scale
Paediatric Non-Orthoptic Referrals
Wrightington, Wigan & Leigh (WWL) Trust paediatric referrals for non-orthoptic appointments

Because there is not a set clinic for general paediatric patients, the option to separately select this on the OPERA GOS18 menu does not exist.

WWL have confirmed that they are happy to receive some general paediatric ophthalmology referrals for Wigan patients to their strabismus/ocular motility endpoint where these patients will be triaged and either:
- • Seen in WWL’s general clinic.
- • Referred onwards by the trust to other clinics at Liverpool and/or Manchester Royal if required.
To select WWL as your option for non-orthoptic referrals, you must select the strabismus/ocular motility clinic, but put in your referral your reason for referral, your cause for concerns (if any) and your provisional diagnosis.

You must choose either Routine/Urgent and select the following fields on your GOS18- Children & Adolescent Services / Ophthal-Strabismus-Ocular Motility / WWL CHILDREN & ADOLESCENT-CENTRAL-STRABISMUS-OCULAR MOTILITY.

Note that the “Wrightington, Wigan and Leigh Orthoptics – Paediatrics” remains only for the Orthoptist’s clinic. The Orthoptist will not be able to see general paediatric ophthalmology appointments. You must select the end point shown above for paediatric ophthalmology and surgical strabismus / surgical queries.

Advise your patients that the referral is for WWL, however their case will be reviewed, triaged and may be referred onwards by the trust to another provider in some cases.
Wet AMD
WWL Eye Unit Urgent Referral Clinic
Tel: 01942 822 244
Email: wwl-tr.UrgentEyes@nhs.net (for use if Opera is not available and only send from an NHS Mail account)

The wet AMD service is provided by the Wrightington, Wigan & Leigh NHS Trust (WWL) Eye Unit, Wet AMD Clinic. The referral criteria for the Wet AMD service are a less than 3 month history of any of the following:
- • Visual loss.
- • Spontaneously reported distortion.
- • Onset of a missing patch/blurring in the central vision.
The vision should be better than 6/96 in the affected eye. If the vision is better than the accepted treatment threshold of 6/12 you should refer them anyway so they can be diagnosed and monitored.

This information is for patients registered with a GP in the Wigan CCG area. You can find details of other Greater Manchester wet AMD pathways by looking at the relevant area's LOC pages. For areas outside GM look for the relevant area's LOC website for information.

The referral should be made in exactly the same way as for Emergency referrals in the above section (via Opera).

If you suspect wet AMD in a patient attending for a CUES face to face appointment, the referral can be made in the CUES section of OPERA, again selecting the emergency priority option.

An electronic referral form (a Word doc) can be downloaded here for use by out of area practices:

Download WetAmd Referral Form

This 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.
CUES - Urgent Eyecare Service
If your practice does not participate in this service, then eye problems such as:
- • 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 Primary Eyecare Services. Any patient with cataract who you feel will require surgery should be managed using the Opera online IT system. The referral will be directed automatically by the system to the chosen treatment centre.
If you do not participate in the service, or are out of the area, a practice for pre cat can be found by using OPERA GOS18 – primary care services – pre cat. You should call the practice to check they will see the patient before referring it on OPERA.

Post-operative cataract assessment and reporting is also via the Primary Eyecare service and Opera

If you do not participate in the service or are out of the area, you must send the patient to one of the accredited optometrists with a copy of the referral letter.
Referrals for Retinal Vein Occlusions

Any CRVO or BRVO should be referred by Opera. An urgent referral should also be made to the patient’s GP practice for assessment for any underlying cause of RVO. The HES referral is not normally urgent unless there is oedema or hamorrhaging at the macula. If there are any unusual features (such as the patient is unwell, optic nerve head swelling is present or the patient is of a young age, then please ring the clinic to discuss the case.

WWL Eye Unit Urgent Referral Clinic
Tel: 01942 822 244
Email: wwl-tr.UrgentEyes@nhs.net

(only send from an NHS Mail account)

An electronic referral form is available here for use by out of area practices:
Download Form RVO Referral Generic.pdf
Suspect Glaucoma / OHT

Glaucoma repeat readings (GRR) In cases of raised IOP and/or suspicious visual fields in the absence of any other signs of glaucoma the pressures or visual fields should be repeated on one or two occasions using Goldmann or Perkins tonometry or full threshold visual field testing as per the extended service provided by Primary Eyecare Services. The results are reported, and fees claimed, via the Opera online IT system.

If the pressure is still raised after the 2nd repeat, or the visual field shows repeatable glaucoma suspicion, then the patient will be referred to the HES glaucoma clinic.

If you have a patient with raised pressure or suspect visual fields, and you do not take part in the extended service, you must refer them to a GERS optometrist for further assessment. Follow the referral information for GERS detailed below.

Glaucoma Enhanced Referral Service (GERS) The Glaucoma Enhanced Referral Service now uses a Single Point of Access (SPoA) for patients. Greater Manchester patients eligible for GERS should be be referred to the PES GERS single point of access (SPoA) and NOT directly to a GERS practice. You should use the:
"PRIMARY EYECARE SERVICES – GLAUCOMA ENHANCED REFERRAL SERVICE (GERS)"
option on Opera’s GOS18 module.

Remember that hospitals may reject referrals if they have not come through the correct pathway.

Acute Angle Closure GlaucomaAcute angle closure glaucoma and/or IOPS of >32mmHg is an emergency referral and is NOT suitable for GERS.

Patients with Narrow Angles Only: These patients are not suitable for GRR/GERS. Instead, please refer to the "PACS+" guidance for appropriate management. Detailed information about PACS+ is available on the College of Optometrists website.
Learn More

Patients already under HES care for OHT or GlaucomaThese patients are not suitable for GERS.

Out of AreaPatients from outside the area should be referred according to their own area's protocol.

Practices outside the area and without access to Opera for referrals can find a list of participating practices using the link below. Use a referral letter and provide full details as you would for a GP referral.

Learn More Find a Practice
Orthoptic Referrals

Routine Orthoptic Referrals The patient should be referred routinely in the normal way using the GOS 18 tab on Opera.

Orthoptic Department contact details:

Email: wwl-tr.orthopticreferrals@nhs.net(only send from an NHS Mail account)
Tel: 01942 822 310
Safeguarding Children & Adults

Wigan Council Safeguarding Websites:

Children: https://www.wigan.gov.uk/WSCB
Adults: http://wigansafeguardingadults.org/

Referrals are via the forms on the websites:

Children: https://apps.wigan.gov.uk/ChildReferral/
Adults: https://www.wigan.gov.uk/Contacts/Adult-social-care.aspx

Contact number if you need to discuss the referral:

Tel: 01942 828 300

(office hours) Out of hours: Monday to Friday, 5pm - 8pm; Saturday, 8.45am - 1pm: Tel: 01942 828 777 Monday to Friday, 8pm - 8.45am; Saturday 1pm - Monday, 8.45am: Tel: 0161 834 2436

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 Guidance 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.

See: Learn More Stroke: Act FAST
Low Vision & Sight Loss Services
Sight Loss Support Service (RNIB)

With the agreement of the patient you can refer them to the RNIB Sight Loss Support Pathway through the Opera GOS18 module:
- • Priority: Routine
- • Speciality: Ophthalmology
- • Clinic type: Sight Loss Support Service
- • Provider: RNIB advice & Support
You can access the support flow diagram here

Download Sight Loss Support Flow Diagram

The RNIB support booklet is here
Download RNIB Support Booklet
Social Services

The Low Vision Leaflet (LVL) for putting visually impaired people in touch with social services can be downloaded here.
Download Form Low Vision Leaflet.pd

The address to which it should be sent is:

Social Care
Progress House
Westwood Park Drive
Wigan
WN3 4HH

The 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

Low Vision Clinic and Eye Clinic Liason Officer (ECLO)

ECLOs form part of RNIB’s Sight Loss Advice Service, which provides practical and emotional support over the phone, face-to-face at many hospital eye clinics, or through online information.

To find out more information about ECLOs, please visit RNIB’s website: www.rnib.org.uk/eclo

Referrals to the low vision clinic or ECLO should be made via OPERA, using the following pathway:
- Priority – routine
- Speciality – ophthalmology
- Clinic type – low vision
- Provider – Wrightington, Wigan, & Leigh ECLO – low vision clinic
Please state clearly on the referral whether it is for the ECLO or the low vision clinic

Optical practitioners
and contractors

Interested in Enhanced Services?

Referrals in Ashton, Leigh & Wigan

Opera Electronic Referral 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.

Practices outside the GM border that see GM Patients can register for the Opera GOS18 function. Where Opera is already used for extended services this will be an easy addition.

Wrightington, Wigan & Leigh (WWL) Trust paediatric referrals for non-orthoptic appointments

Sight Loss Support Service (RNIB)

Social Services

Low Vision Clinic and Eye Clinic Liason Officer (ECLO)

Optical practitioners and contractors

Interested in Enhanced Services?

Referrals in Ashton, Leigh & Wigan

Opera Electronic Referral 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.

Practices outside the GM border that see GM Patients can register for the Opera GOS18 function. Where Opera is already used for extended services this will be an easy addition.

Wrightington, Wigan & Leigh (WWL) Trust paediatric referrals for non-orthoptic appointments

Sight Loss Support Service (RNIB)

Social Services

Low Vision Clinic and Eye Clinic Liason Officer (ECLO)

Optical practitioners
and contractors