Stockport Referrals

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 Stockport 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

Contact details for Optegra and SpaMedica can be found here.

Click on the headings below for more information.

Routine referrals

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 here for those areas without access to Opera:

Learn More Electronic GOS18 template
Emergency Eye referrals

Stepping Hill Eye Ophthalmology Emergency Eye Clinic This is not a walk in service,it is by appointment only

Same day emergency Tel: 0161 419 5689 to speak to triage staff. Send the referral on Opera.

Other emergency referrals send on Opera or by secure email (send from NHSMail) to: casualtyophthalmology@stockport.nhs.uk

Out of hours if it cannot wait until the next working day or over the weekend, please phone 0161 483 1010 and ask for the on-call ophthalmology registrar.

As a failsafe, ask the patient to contact you if they don’t hear from the hospital in a reasonable timeframe.

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
Referrals for Wet AMD can be sent using OPERA.

Patients with a Stockport GP must be sent to Optegra

Patients with a Manchester GP should be sent to EMAC (see below).

Any patient over the age of 50 suspected of having wet AMD should be referred. If the patient is under the age of 50 and macular pathology is suspected, please urgently refer them to NHS Stockport FT (Stepping Hill).

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 scotoma (or blurred spot) in central vision.
The vision should be better than 6/96 in the affected eye.

EMAC If your patient meets the criteria for potencial wet AMD treatment then you can refer to the MREH Emergency Macula Service (EMAC). Please refer via Opera and include a phone number for the patient so the administration team at MREH can contact them with an appointment. Please print off a copy of the patient information form and give this to the patient.

If you don’t have Opera access. Please refer by completing the form below and send via your “nhs.net” email account.

Download Form EMAC Referral Form.pdf

Download Form EMAC Patient Information Form.pdf

Email: mft.macular@nhs.net - only secure if sent from an nhs.net account

*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.
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. A list of practices is available here:

Learn More Find a Practice
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.

The PDF file below can be used by practices outside the area without access to Opera when referring a patient with a Stockport GP. It should be emailed to:
Stepping Hill: casualtyophthalmology@stockport.nhs.uk
Download Form RVO Referral Form.pdf

You can phone 0161 419 5689 to confirm receipt of the email.x.

The Adobe Acrobat pdf file above can be filled electronically or printed. Use the Tab Key to move between fields.

EMAC
Please refer via Opera and include a phone number for the patient so the administration team at MREH can contact them with an appointment. Please print off a copy of the patient information form and give this to the patient

If you don’t have Opera access. Please refer by completing the form below and send via your “nhs.net” email account.

Download Form EMAC Referral Form.pdf

Download Form Emac patient information form.pdf

Email: mft.macular@nhs.net - only secure if sent from an nhs.net account

*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.
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 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
Safeguarding Children & Adults

Stockport has websites dedicated to safeguarding:
Learn More Safeguarding Children:

Learn More Safeguarding Adults:

The Stockport designated lead nurse for safeguarding can be contacted on 0161 426 9095. For further local information see the website links above.

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.

See: Learn More Stroke: Act FAST
Children

You can refer a child directly to the orthoptic department at Stepping Hill using Opera if you believe a full orthoptic assessment is required. Practices outside the area and without access to opera referrals can use this form:
Download Form Referral to Orthoptics.pdf

If a young child is referred to you for a sight test and you are unable to see them, please ensure that you find them an alternative practice that can see them. Young children are screened for poor vision and squints at the local community clinics by orthoptists. If they suspect a problem they are seen by the optometrists at Stepping Hill Hospital. They may later be discharged for refraction in community practices under GOS, with follow up at the hospital. It is helpful to provide a report to the orthoptists following a sight test and the following form may be used:
Download Form Children's Follow Up Form.pdf
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 preferred method of referring visually impaired people to social services, whether self-referral by the patient or by a health professional, is by use of this on-line form:

On-line Referral Form for Stockport patients only

Alternatively, the Low Vision Leaflet (LVL) can be used and can be downloaded here.

Download Form Low Vision Leaflet for Stockport Patients

The address to send it to is:

Stockport Council

Services to People
Fourth Floor
Stopford House
Piccadilly
Stockport
SK1 3XE

Tel: 0161 217 6029
Fax: 0161 474 4666

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

Optical practitioners
and contractors

Interested in Enhanced Services?

Stockport Referrals

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.

Sight Loss Support Service (RNIB)

Social Services

Optical practitioners and contractors

Interested in Enhanced Services?

Stockport Referrals

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.

Sight Loss Support Service (RNIB)

Social Services

Optical practitioners
and contractors