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 guidance on the urgency of referrals here:

Download pdf Guidance on the Urgency of Referrals in GM (updated Dec 2025)

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.

•   Routine referrals

  Referrals in general

  Referrals that are not part of an extended service (e.g. cataract) go via the GOS18 tab on Opera. Routine and urgent GOS 18 referrals will now come automatically to the Greater Manchester Eye Care Navigation Service for clinical triaging and an informed patient choice process (further information below).

  You should assume it will be up to 3 months before the patient is seen following a routine referral. "Soon/Urgent" is not generally recognised by GPs or by HES appointments, so for anything that you feel requires assessment within the next few days you should send your referral using the GOS18 tab on Opera but following the Emergency Eye Referrals protocol below. 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.

  It is recommended to use OPERA for all Greater Manchester referrals. However if you do not have access to the OPERA GOS18 module in practice, please send your routine and urgent GOS18 referrals to the Greater Manchester Eye Care Navigation Service directly via NHS mail to [email protected] email for triage by the Eye Care Navigation Service.

  DO NOT use this route for Emergency and same day Referrals. These should be sent via the channel described below.

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

  Learn More Electronic GOS18 template

  Patients already under care

  In cases where a patient is already under the care of an ophthalmologist and a new condition in a different subspeciality has arisen, you should send a new referral for the second condition to the same secondary care provider where possible.

  However optometrists can now use OPERA to update hospitals with new clinical information in regard to patients’ pre-existing ocular conditions.

  We have created new secretary endpoints within OPERA and they are currently available for four Greater Manchester trusts:

  • Manchester Royal Eye Hospital – listed as SECRETARIES – MREH – EXISTING PATIENT INFO ONLY – NOT NEW REFERRALS
  • Stepping Hill Hospital – listed as SECRETARIES – STEPPING HILL – EXISTING PATIENT INFO ONLY – NOT FOR NEW REFERRALS
  • Royal Bolton Hospital – listed as SECRETARIES – ROYAL BOLTON HOSPITAL – EXISTING PATIENT INFO ONLY – NOT FOR NEW REFERRALS
  • Wrightington, Wigan and Leigh (WWL) – listed as SECRETARIES – WRIGHTINGTON, WIGAN AND LEIGH (WWL) – EXISTING PATIENT INFO ONLY – NOT FOR NEW REFERRALS

  Please use these new endpoints on OPERA if you want to update a hospital around a patient with an existing condition under their care - this is not for new referrals.

  When sending an update to these endpoints please make it clear what action you require by providing a titled heading above your update e.g. *PRE-EXISTING PATIENT LOST TO FOLLOW UP* or *PRE-EXISTING GLAUCOMA PATIENT RISE IN IOPS, ADVICE REQUIRED*

  If the triage team receive any referrals that are more appropriate to be sent via these endpoints the Eye Care Navigation Service will also redirect as needed with feedback to the referring practitioner.

•   Emergency referrals

  WWL Eye Unit Urgent Referral Clinic
  Tel: 01942 822 244
  Email: [email protected](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

•   Greater Manchester Eye Care Navigation Service

  The Greater Manchester Eye Care Navigation Service has been established to provide clinical triage of ophthalmology referrals followed by an informed patient choice process via SMS or letter for adult routine referrals. This navigation directs to the most appropriate services both in primary and secondary care.

  Patients of all ages registered with a GP within the 10 localities of Greater Manchester will enter the Greater Manchester Eye Care Navigation Service.

  Clinical Triage applies to all routine and urgent ophthalmology referrals from both optometrists and GPs, but NOT Emergency referrals. Emergency referrals should continue to be sent unchanged, through established local emergency pathways.

  The Greater Manchester Eye Care Navigation Service was launched on 18/08/2025:

  Phase 1 – 18/08/2025

  Referrers should continue to select a provider endpoint of the patient’s choice on the IT referral platform OPERA.

  Clinical Triage : Routine and urgent GOS 18 referrals Patient Choice : Routine adult GOS 18 referrals and Enhanced Cataract Service Referrals Item B

  Please tell your patients that when they receive a patient choice SMS from ‘NHS EYECARE’ or a Patient Choice letter that they must respond to it. Until the patient actions their choice communication, the referral will not be sent.

  For further information around the Greater Manchester Eye Care Navigation Service, please see the Primary Eyecare Services help page HERE.

  IF A PATIENT WANTS TO CHASE/HAS LOST THEIR TEXT ETC THEY CAN RING 0330 128 1599.

•   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

  Referrals for Wet AMD should also go via the OPERA GOS18 module using the Urgent > Wet AMD option. If you do not have access to OPERA then you need to NHS email your referral to the Eye Care Navigation Service at [email protected].

  The below details can be used if you need to speak to the trust about a referral you’ve done for wet AMD, but referrals should not go via this route directly

  WWL Eye Unit Urgent Referral Clinic
  Tel: 01942 822 244
  

  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.

  Once your referral has been completed please choose the ‘WRIGHTINGTON, WIGAN AND LEIGH (WWL) – WET AMD REFERRALS’ endpoint on OPERA which will come through to the GM Eye Care Navigation Service for clinical triage. If you do not have OPERA access please send your referral directly via NHS mail to [email protected] email for clinical triage by the Eye Care Navigation Service.

• . 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 then diverted to the GM Eye Care Navigation service to issue patient choice. Once the patient has confirmed their choice of provider, their referral will be directed automatically to the chosen treatment centre.

  If you do not participate in the service, or are out of the area, please continue to send a GOS 18 cataract referral that will be triaged by the GM Eye Care Navigation Service. Please send these referrals via OPERA or if you do not have OPERA access please send your referral directly via NHS mail to [email protected] email for clinical triage by the Eye Care Navigation Service.

  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.

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  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 second eye when it does meet the criteria. You can find the EUR policies at the bottom of the following page:

  Learn More Practitioner Information

• . Referrals for Retinal Vein Occlusions

  Any CRVO or BRVO should be referred via Opera. Two referrals are required, one to the hospital and a second 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 haemorrhaging 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: [email protected] (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

  Both routine and urgent OPERA GOS 18 referrals for retinal vein occlusions will now come to the GM Eye Care Navigation Service automatically for clinical triage.

  It is recommended to use OPERA for all Greater Manchester referrals where possible. However if you do not have access to the OPERA GOS18 module in practice, please send your routine and urgent GOS18 referrals to the Greater Manchester Eye Care Navigation Service directly via NHS mail to [email protected] email for triage by the Eye Care Navigation Service.

• . 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: [email protected](only send from an NHS Mail account)
  Tel: 01942 822 310

  All orthoptic GOS 18 OPERA referrals will now come to the GM Eye Care Navigation Service automatically for clinical triage.

  It is recommended to use OPERA for all Greater Manchester referrals where possible. However if you do not have access to the OPERA GOS18 module in practice, please send your routine and urgent GOS18 referrals to the Greater Manchester Eye Care Navigation Service directly via NHS mail to [email protected] email for triage by the Eye Care Navigation Service.

• . 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

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  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.

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  The NICE link for a child maltreatment quick reference guide is:

  Learn More Child Maltreatment Guidance
  

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  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

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  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.

  For further information 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

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  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

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  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

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