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 Casualty clinic Tel: 0161 419 5689 Secure email (send from NHSMail): casualtyophthalmology@stockport.nhs.uk

  If you feel a patient requires to be seen urgently you can phone the Stepping Hill Ophthalmic Urgency Service on 0161 419 5689 and speak to one of the nurse practitioners. They will issue an appointment time. You should refer the patient using Opera and give a copy referral letter to the patient to take with them. Always phone before sending the patient.

• Wet AMD

  Referrals for WetAMD can be sent using Opera to either Optegra or EMAC (see further down the page).

  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), please see Urgent referral information. 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.

  • and

  • • The patient should be over the age of 50.

  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.

  Optegra
  Send the referral to Optegra using Opera.
  For confirmation of receipt you may phone 0161 240 0700

  A referral form is available here for practices outside the area and without access to Opera for referrals.

  Download Form WetAmd July 2018.doc

  Where opera is not available use NHS email to Optegra at optegra.urgent@nhs.net using the referral form.

  Request confirmation of receipt by asking the recipient to acknowledge by return email or add a read receipt to your email.

  It is important to note that this service is only for patients registered with a Stockport GP. If the patient does not have a Stockport Gp then the referral will be returned to you. You can find details of other Greater Manchester wet AMD pathways by looking at the relevant area's LOC pages. For other areas look for the relevant area's LOC website for information.

  Information for patients about the referral process in Stockport and what to expect can be found here:
  
  Download Form Optegra WetAMD Px info sheet for referred patients.pdf

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  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 for referrals, 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.

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  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:

  • • 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. For further information

  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, you must send the patient to one of the accredited optometrists with a copy of the referral letter. You can search for an accredited practice using the link below.

  Learn More Find a Practice

  (Contact details for Optegra and SpaMedica can be found here)

• 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 for referrals. It should be emailed to:

  Stepping Hill: NHSMail: snt-tr.casualtyophthalmology@nhs.net

  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.

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  EMAC
  CRVO and BRVO with haemorrhaging at the fovea should be sent urgently to the MREH Emergency Macula Service (EMAC).

  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 (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 do not participate in the service or are out of the area, you must send the patient to one of the accredited GERS optometrists with a copy of the referral letter. You can search for an accredited practice using the link below.

  Learn More Find a Practice

  Glaucoma Enhanced Referral Service (GERS) Where there are signs of glaucoma, with or without raised IOP and/or suspicious fields, patients should be referred directly to the GERS service via a GOS18 referral on OPERA, detailing reasons for glaucoma suspicion and with a supporting letter and a copy of their visual fields where performed. You can search for a local practice providing the service using the same link above.
  

  Acute Angle Closure GlaucomaAcute angle closure glaucoma and/or IOPS of >32mmHg is an emergency referral.

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

  Practices outside the area should refer patients to GERS with a supporting letter and a copy of their visual fields where performed. You can search for a local practice providing the service using the same link above

• 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.

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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 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

  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