Interested in Enhanced Services?
Information on how to get involved as a practice or practitioner:
Manchester 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 Manchester 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
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 careIn 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.
Remember that with routine referrals you should assume it will be up to 3 months before the patient is seen. "Soon" is not generally recognised by GPs or by HES appointments, so for anything that you feel is more urgent you should phone eye casualty for advice.
An electronic GOS18 template is available here for those areas without access to Opera for referrals:
Learn More Electronic GOS18 template
- Emergency eye referrals
If a patient needs to be seen due to an eyesight-threatening emergency, they can be referred to the Manchester Royal Eye Hospital Emergency Eye Department (EED)
Patients should be sent to MREH EED only after the patient case has been discussed with the department or where the presenting complaint falls under the red section of the referral guidance document.
Optometrists, who have referred a patient via Opera for an EED opinion should wait for feedback via Opera - more detail below.
Please give the the patient a referral letter to take with them.
Download pdf Guidance on the Urgency of Referrals in GM
Contact details:
08:00 - 20:00 every day including Bank Holidays
Tel: 0161 276 5597/5599 for advice onlyWhere 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.
Please consult this webpage frequently for updates regarding the telephone numbers as the phone system is currently under review
- Wet AMD
The referral criteria for the Wet AMD service are a less than 3 month history of any of the following:
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• Visual loss.
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• Spontaneously reported distortion.
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• Onset of scotoma (or blurred spot) in central vision.
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.
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- CUES - Urgent Eyecare Service
If your practice does not participate in this service, then eye problems such as:
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• 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
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- 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
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 2nd 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
CRVO and BRVO with haemorrhaging at the fovea should be sent urgently to the MREH Emergency Macula Service (EMAC).
EMAC Emergency macula referrals can be made direct to the EMAC service, so the patients can have scans and images taken quickly to make a diagnosis and initiate a treatment plan.
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 in Manchester
Safeguarding in the Manchester Area
If you have concerns that a child, young person or adult is at risk of or being abused or neglected you can contact the Manchester Safeguarding Children's Board to report your concern:
Manchester Contact Centre
Tel: 0161 234 5001 (open 24 hours a day, seven days a week)
Email: mcsreply@manchester.gov.uk
Web: www.manchestersafeguardingboards.co.uk/concerned
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.
Learn More See Stokes - The Children's Community Orthoptic Services
You can refer Manchester children directly to this service using Opera. If you have a child patient that you feel needs an orthoptic opinion (and they do not need an ophthalmologist opinion - for example, children that need amblyopia treatment) they will be seen more quickly in community than in hospital.
Please refer directly to the orthoptic service and not via the GP if you think a child needs amblyopia treatment.
Orthoptic email: mft.orthoptic.referral@nhs.net(only send from an NHSMail address)
This list shows where your local clinics are held. Matilda Blythe is the head of Community Orthoptic Services in Manchester and the Head Office is at Levenshulme Health Centre.
Download pdf Orthoptic Clinics 2020.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:
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• Priority: Routine
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• Speciality: Ophthalmology
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• Clinic type: Sight Loss Support Service
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• 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 BookletSocial 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
It should be sent to:
Manchester City Council Sensory Service, Manchester Deaf Centre,
Crawford House,
Booth Street East,
Manchester
M13 9GH Tel: 0161 234 5001
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
The charity Henshaws support people with sight loss and a range of other disabilities
Learn More Henshaws -