Bolton 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.

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 Bolton 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

Bolton Referrals

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.

Practices without access to Opera for referrals should send any routine referrals to their GP. Referrals should not be sent direct to RBH as these will be rejected.
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.
Emergency referrals

Emergency referrals

You can phone the Bolton Eye Unit on 01204 487 577 (Option 1) and ask for advice. You should make these referrals via Opera to:

Bolton NHS Foundation Trust
Tel: 01204 487 577
Fax Number: de-commissioned
NHSMail: Boh-tr.BoltonAcuteOphthalmicReferrals@nhs.net
Referrals should only be sent from NHS.net accounts

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.
Wet AMD

You should make these referrals using Opera. You may phone for confirmation.

Bolton NHS Foundation Trust
Tel: 01204 390 390 (ext 390112)
NHSMail: Boh-tr.BoltonAcuteOphthalmicReferrals@nhs.net Referrals should only be sent from NHS.net accounts

Patient identifiable information should only be sent by email if both ends are accredited by the NHS as secure. Usually this mean NHS.net(i.e. xx@nhs.net), although Bolton Royal FT has been accredited for the xx@boltonft.nhs.uk email domain

Practices wothout access to Opera for referrals my use this WET AMD Rapid Access form:

Download Bolton WetAMD Refrrral Form.docx
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.

Learn More Find a Practice
Referrals for Retinal Vein Occlusions

Any CRVO or BRVO should be referred by Opera and an urgent referral 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.

You can phone the Bolton Eye Unit on 01204 390 333 and ask for advice. You should make these referrals via Opera to:

Bolton NHS Foundation Trust
Tel: 01204 390 333
NHSMail: Boh-tr.BoltonAcuteOphthalmicReferrals@nhs.net Referrals should only be sent from NHS.net accounts

Practices without access to Opera for referrals may use the form below for referral. You should also advise the patient to see their GP

Download Form Electronic Referral Form

This includes the GP referral as a 2nd page which fills automatically from page 1.
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
Orthoptics

Referrals to Orthoptics should be made through Opera
Safeguarding Children & Adults
Safeguarding in the Bolton Area for Children

If you are concerned about the welfare of a child, call or contact one of the following:
Learn More Vist the Keeping Children Safe in Bolton website:

Safeguarding in the Bolton Area for Adults

If you are concerned about the welfare of an Adult, call or contact one of the following:
Learn More Visit Bolton's Safeguarding Adults at Risk website

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.

For further information see:

Learn More Stroke

The GOS contract does not allow you to discriminate between patients by, for instance, not seeing a particular age group. If an infant presents to you for a sight test and you are uncomfortable seeing them you should ensure that you find them an alternative practice that can see them.
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
Low Vision Aids

Referrals for assessment for low vision aids should go routinely through Opera or via the RBMS at:
BolCCG.gpreferrals@nhs.net Referrals should only be sent from NHS.net accounts

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

The address to which it should be sent is:

Independent Living Service, Adelaide Depot,
Adelaide Street,
Bolton,
BL3 3NY
Email: independentlivingservices@bolton.gov.uk
Tel: 01204 337020 or 01204 337900

Learn More Independent Living Website

The Sightline Directory allows you to search for support services for a patient by town or postcod, and by type of service if you wish.
Learn More Sightline Directory

Henshaws are a local service to support patients with low vision.

Henshaws336 Ainsworth lane
BL2 2QL
off Thicketford road, just behind Tong Moor Health centre
Tel: 01204 337 896

Learn More Henshaws Website

Optical practitioners
and contractors

Interested in Enhanced Services?

Bolton 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.

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.

Bolton Referrals

Referrals in general

Emergency referrals

Sight Loss Support Service (RNIB)

Low Vision Aids

Social Services

Optical practitioners and contractors

Interested in Enhanced Services?

Bolton 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.

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.

Bolton Referrals

Referrals in general

Emergency referrals

Sight Loss Support Service (RNIB)

Low Vision Aids

Social Services

Optical practitioners
and contractors