Westmorland General Hospital
Burton Road
Kendal
LA9 7RGTel: 01539 715250
Email: by NHS.net email to cpcc.referrals@mbht.nhs.uk
Website:https://www.uhmb.nhs.uk/hospitals/westmorland-general-hospital*** From Monday 23rd May 2022 Wet AMD referrals should be sent to the CPCC via Opera selecting URGENT – WET AMD – UNIVERSITY HOSPITAL MORECAMBE BAY as the end point ***
(Note: you can still use the below pathway if you have yet to complete onboarding to Opera)
Westmorland General Hospital (part of University Hospitals of Morecambe Bay NHS Foundation trust) is involved in the management and treatment of wet AMD. In order for referrals to be accurately processed the hospital uses the RCOphth. Referral form.
Wet AMD Referrals should be sent for the attention of the Macula Unit and need to be marked, “Rapid Access Wet AMD”. This will ensure that referrals for wet AMD are clearly visible to the triage staff to prevent delay.
Please note that any co-pathology (e.g. glaucoma) should be referred separately.
Royal Lancaster Infirmary
Ashton Road
Lancaster
Lancashire
LA1 4RPSwitchboard: 01524 65944
Mon – Fri: 9.00am – 5.30pm
Weekend: 9.30am – 3.00pmFurness General Hospital
Dalton Lane
Barrow-In-Furness
Cumbria
LA14 4LFSwitchboard: 01229 870870
Mon – Fri: 8.30am – 5.00pm
Weekend: ClosedCommunity Patient Contact Centre (CPCC)
CPCC
Westmorland General Hospital,
Burton Road
Kendal
LA9 7RGPhone: 01539 716998
Email: by NHS.net email to cpcc.referrals@mbht.nhs.uk*** From Monday 23rd May 2022 Routine & Urgent referrals should be sent to the CPCC via Opera selecting URGENT – UNIVERSITY HOSPITAL MORECAMBE BAY or ROUTINE – UNIVERSITY HOSPITAL MORECAMBE BAY as the end point ***
(Note: you can still use the below pathway if you have yet to complete onboarding to Opera)
Routine and Urgent referrals should be sent to CPCC by NHS.net email. GOS18 template.
Referrals will be triaged within 48 hours and assigned to clinics with appropriate urgency.
Conditions such as BRVO and CRVO which need prompt assessment in Medical Retina should be sent to CPCC unless there are emergency complications such as high IOP.
Suspected ocular cancers requiring 2 week assessment are also sent to CPCC.
A detailed referral guidance document is being prepared in collaboration with UHMB.
Routine referrals for optometrists who don’t have NHS.net email accounts can still go by post to the CPCC (with copy to GP).
Contact the LOC to obtain an NHS.net email address if you do not have one.
Royal Lancaster Infirmary
Ashton Road
Lancaster
Lancashire
LA1 4RPSwitchboard: 01524 65944
Mon – Fri: 9.00am – 5.30pm
Weekend: 9.30am – 3.00pm
Ophthalmology: 01524 583094
Email: by NHS.net email to rli.ophthalmicemergencies@mbht.nhs.ukFurness General Hospital
Dalton Lane
Barrow-In-Furness
Cumbria
LA14 4LFSwitchboard: 01229 870870
Mon – Fri: 8.30am – 5.00pm
Weekend: Closed
Ophthalmology: 01229 491179
Email: by NHS.net email to FGH.UrgentEyeReferrals@mbht.nhs.ukOutside clinic times, if the patient needs immediate medical assessment then phone the hospital switchboard and speak to the 1st on call eye doctor (Usually an Associate Specialist or Specialist Registrar, not a Consultant) to make arrangements. You will usually also be asked to email referral details.
Westmorland General does not have an Emergency Eye Clinic – do not send urgent cases.
Telephone Lancaster, Kendal or Barrow-in-Furness hospital depending on where the patient lives.
Practices without NHS.net email, please use 7Zip encryption (click link for user guide) and contact the LOC secretary or the eye department for an agreed password.
Community Patient Contact Centre (CPCC)
Email:cpcc.referrals@mbht.NHS.uk
Tel:01539 716998*** From Monday 23rd May 2022 Cataract referrals should be sent to the patients choice of provider via Opera ***
(Note: you can still use the below pathway if you have yet to complete onboarding to Opera)
Cataract referrals should be sent direct to the patients preferred provider. This can be via the Community Patient Contact Centre (CPCC) for referrals to University Hospital Morecambe Bay Trust or direct to SpaMedica or another preferred provider. GOS18 template
IES and BCT www.primaryeyecare.co.uk
Better Care Together commissioned via Primary Eyecare Services.
Info for non-accredited Optoms – this relates to Glaucoma Repeat Readings and MECS for those in MB who are not part of the services.
If you are considering HES referral for any of the following conditions then please consider referral to a MECS provider as an alternative:
- Flashes & Floaters / visual aura (eg if it is not possible to perform dilation during your clinic)
- Red eye – Eye infections, Allergic eye conditions
- Corneal abrasions and foreign body removal (non-penetrating)
- Lid Lumps, blepharitis & dry eye
Of course, you are likely to manage the majority of these conditions in your own clinic, without onward referral. This route is only for those patients who you consider require additional care.
MECS does not usually deal with diplopia, ptosis, severe pain, severe or complete loss of vision.
Find a Practice – Search for your nearest participating optical practice (primaryeyecare.co.uk)
Please give a written referral to the patient stating that they require a MECS appointment, not a full eye exam.
Emergencies must get referred direct to ophthalmology (see Emergency referrals section).
*** From Monday 23rd May 2022 GRR referrals should be sent to an accredited practice via Opera ***
(Note: you can still use the below pathway if you have yet to complete onboarding to Opera)
Info for non-accredited Optoms – this relates to Glaucoma Repeat Readings for those in MBay who are not part of the services.
Please do not refer any patient into HES on the basis of raised IOP alone.
GRR is used if you detect raised IOP (>23mmHg) or a visual field defect suggestive of glaucoma without glaucomatous disc changes or narrow angles.
Find a Practice – Search for your nearest participating optical practice (primaryeyecare.co.uk)
Please send a written referral with the patient explaining that you require GRR. Include your initial IOP measures (and method), field plots and assessment of discs & angles.
All glaucomatous discs and angles-closure risk patients go to HES as usual.
Information for those referring to North Lancashire and South Cumbria Low Vision Service
What is a Low Vision Service?
The low vision service will help people make the most of their vision. The assessment will look at low vision aids, such as magnifiers and eye shields and provide guidance to help with everyday tasks like reading or help reduce glare outside.
What happens during the assessment?
A Low Vision Practitioner will discuss the patient’s vision and assess how well they see in the distance and at near. They will measure which magnification works best and the patient will be able to try out equipment that may make everyday tasks easier.
Each patient will receive one low vision aid on long term loan. There will be an option to purchase additional equipment. The Practitioner will help patients learn how to use the magnifying devices prescribed.
How to refer
Complete the electronic referral form and send it to our secure email account Galloways.lowvision@nhs.net
If the patient has not received sight advice Galloway’s will liaise with the local sight loss charity to make sure this is in place before a low vision assessment as this delivers better outcomes for the patient.
What is the process?
- Within 14 days of receiving a referral form, Galloway’s will book the patient into the next available clinic. Galloway’s will post an appointment letter, information about the service and Covid safety measures and a questionnaire for them to complete and bring with them to the appointment.
- Galloway’s will contact the patient to obtain their consent to store and share their information.
- The patient will be assessed by a Low Vision Practitioner at the clinic and a suitable low vision aid will be prescribed.
- With patient consent, Galloway’s will send assessment results to the patient’s optometrist and their local sight loss charity.
- Galloway’s will complete a follow up phone call with the patient one month after the clinic has taken place.
- With patient’s consent, sharing low vision assessment information with the Galloway’s team, the patient’s optometrist and local sight loss charity.
Your contact at Galloway’s is Nia Greer Nia.greer@galloways.org.uk 01772 744148 or speak to Galloway’s reception on the same number.
Is this a domiciliary service?
Ideally assessments will take place within the venue. In circumstances where an individual is unable to attend clinic they will be contacted by Low Vision Assessor, Nia Greer, to discuss an alternative. In exceptional circumstances, we will arrange a domiciliary visit. Please contact Nia Greer in this instance.
What will local sight loss charities do?
These standards are based on UK Ophthalmology Alliance patient quality standards.
Before any low vision assessment referral, local sight loss charities will provide the patient with information, advice and guidance, usually delivered by a Sight Loss Adviser (SLA). The SLA assesses the persons concerns about independence, engaging in activities, family interactions, fears, emotional support, visual impairment registration and Charles Bonnet Syndrome. After discussing services and support the person might need, the SLA and the person agree a plan. This may include help for family and carers. If this plan includes support for low vision the sight loss charity completes a referral form and sends it to Galloway’s.
During and after the low vision process the local sight loss charity provides ongoing contact and support to the patient to respond to changes in circumstances.
If a patient lets the referrer know they wish to cancel their appointment, please encourage the patient to contact Nia Greer or Galloway’s reception on 01772 744148 to rearrange the appointment or do this on their behalf.
Service Quality
In line with UK Ophthalmology Alliance patient quality standards, North Lancashire and South Lakes Low Vision Service will:
- Provide support early to prevent loss of skills, confidence and motivation.
- Will be open to people beyond those who meet specific visual thresholds or have a CVI.
- Help people to regain or maintain as much independence as possible.
Low vision assessments are carried out by a low vision professional, typically an optometrist or dispensing optician.
Hydroxychloroquine Retinal Monitoring
The RCOphth guidelines¹ regarding retinal monitoring for hydroxychloroquine retinopathy were updated again in December 2020 and no longer recommend baseline ‘screening’.
It is for the drug prescriber, commonly a Rheumatologist, Dermatologist or GP, to determine the patient’s risk and refer to the local ophthalmology department for HCQ monitoring.The need for referral is based on the following:
- Duration of treatment
- Low risk patients require monitoring after 5 years
- High risk patients require monitoring after 1 year
- High risk factors:
- Dose >5mg per kg
- Concomitant tamoxifen use
- Reduced eGFR (less than 60ml/min)
- Taking chloroquine
Local Medical Retina teams need all the information above in any referral. The LOC recommends that Optometrists who consider their patients need to be referred for monitoring write to the drug prescriber requesting consideration of the above clinical detail. If the Optometrist feels that a direct referral is more appropriate it would be helpful to establish that a referral has not already been made by another clinician (eg GP) in order to avoid duplication.
HCQ monitoring in the HES does not replace regular sight testing and will not assess for any other pathology. Refer via the usual channels for all other conditions.Local hospital optometry colleagues may be able to assist with queries:
UHMB: Sophie Grisenthwaite s.grisenthwaite@mbht.nhs.uk¹Royal College of Ophthalmologists Guidance https://www.rcophth.ac.uk/wpcontent/uploads/2020/12/Hydroxychloroquine-and-Chloroquine-Retinopathy-Monitoring-Guideline.pdf
- Duration of treatment
These services are commissioned by NHS England and NHS Improvement and will be provided by local optical practices via the optometry federation and Primary Eyecare Services Ltd (PES) with the support of the Local Optical Committee. It is for patients registered with a GP practice in the following CCGs:
Morecambe Bay- Blackpool
- Fylde & Wyre
- Greater Preston
- East Lancashire
- West Lancashire
- Chorley and South Ribble
- Blackburn with Darwen
The purpose of the Learning disabilities and autism Eye Care Pathway is to increase the number of sight tests in patients diagnosed with learning disabilities and autism.
People with learning disabilities and autism are ten times more likely to have eye problems but are less likely to receive timely and appropriate care, than the rest of the population.
This commissioned service is a service with reasonable adjustments for someone who would not be able to use a standard eye test. This includes pre-appointment visits, completion of a functional vision assessment if needed, longer appointment time with an accredited practitioner in learning disabilities and autism and feedback forms completed by the optometrist. The results of the examination are reported using the agreed appropriate format. Only accredited practitioners (optometrists or OMPs) would provide this service.
If a Practice wants to provide these services, what should they do?
Practices that wish to deliver this service will need to complete the expression of interest form linked here EOI PwLD NHSE
Already on OPERA?Once the practice has expressed an interest on the above form, this will provide PES with the required information to enable practices access to the service modules as they go live. Practices will need to ensure that their practitioners have uploaded their WOPEC certificates to their practitioner profile so they can deliver the services. Not sure how to do this – guide linked here.
No WOPEC certification?If you have practitioners that haven’t delivered these services previously, and therefore have no certification to date, they will need to complete the WOPEC accreditation for the service. All practices who wish to deliver the services must ensure that the optometrists complete the Local Optical Committee Support Unit Optometry Postgraduate Education Centre (LOCSU/WOPEC) training and accreditation programme for patients with learning disabilities and autism.
Not signed up to OPERA?If the Practice has completed the expression of interest but has not registered on the OPERA platform to date, please read the guide linked Practice Onboarding – OPERA (optom-referrals.org) and onboard your practice. The Practice will need to complete this process and be approved by PES. Once this has been completed, they too will gain access to the service module once the service goes live in their area, and they can then register their practitioners to enable service delivery using Inviting a Practitioner to access your Practice Opera account – OPERA (optom-referrals.org) guidance.
If you require any further information or have any queries regarding the service, please contact us on our hello@referral.support email address and a member of our team will be in touch.