CUES Referral pathway

South Sefton CCG and & CCG

This pathway relates to patients that have accessed care via CUES only.

Any referrals from a GOS or private sight test should still follow the normal local referral pathways.

Patient identified as red flags at triage Patient identified as RED FLAGS on the triage form require immediate referral to the hospital eye service without proceeding with a telephone consultation or face to face appointment. The triage outcome must be record on the OPERA IT system so that the number of deflections from the service can be reported to the CCGs.

The OPERA IT platform will not generate a referral you must signpost to the emergency service.

Urgent referrals

When ‘urgent referral’ is selected as the outcome at the end of the episode, OPERA will generate an electronic referral to the urgent eye service at Hospital. This referral plus any images/OCT will be visible to the hospital clinician monitoring the urgent referrals within minutes, the clinician will check for new referral regularly during the normal working day, 9am - 5pm Monday to Friday (excluding bank holidays). If you wish to seek advice on the referral or confirm receipt, then please call 0151 529 0286 The clinician monitoring the Aintree Hospital’s urgent eye service clinic will then either: • provide the patient or practitioner with advice and guidance. • Arrange for the patient to be seen at the most appropriate location depending on where the clinic they require is available and where the patient lives. E.g. they may be seen at Royal or Southport if appropriate/more convenient for patient. • Arrange for the patient to be seen routinely – choice of hospital will be provided.

Urgent referrals from CUES will initially go to Aintree hospital as agreed with ’s hospital trusts and the CCG, although the patient may be seen in another hospital trust if the appropriate clinic is available/more convenient for the patient. *

* with the exception of retinal detachment (macula on or off), Chemical injury or penetrating injury observed at a face to face appointment, in these circumstances direct the patient to attend St Paul Primary care immediately, you may print the CUES referral letter for the patients to take with them. It is imperative you also complete the OPERA record, select “refer to HES” please select Aintree hospital so that you can complete the record and a CUES fee will be generated. PLEASE note in “Clinical Questions - appointment notes” on the OPERA referral page that “the patient has been sent directly to St Paul’s Primary Care”. This does not apply to suspected retinal detachments or patients with tears of holes where there is no elevation of the retina – these patients should NOT be directed to St Paul Primary care and should continue to access care via Aintree Hospital. .

Out of hours

If an emergency/urgent referral is required outside of office hours, please assess if the patient may wait overnight/over weekend. You may wish to use the links below as a guide: • Triage document available to download in the bottom right of the webpage; https://www.loc-net.org.uk/sefton/practitioner- info/referral-protocols/ • ‘Urgency of Referrals in GM’; (http://www.gmlocs.co.uk/GMLOCs/Information-for-Practitioners) Practitioners should always apply their clinical judgment when deciding on appropriate clinical pathway for their patient. If you assess that the patient is unable to wait overnight/over weekend, then please contact the on-call Ophthalmologist (numbers below). The on-call Ophthalmologist at Aintree may have access to view your referral/images, the on-call Ophthalmologist at Southport will not have this facility. If you refer a patient to the out of hours on-call Ophthalmologist, then please note on OPERA “PATIENT ALREADY BEEN SEEN (OUT OF HOURS ON-CALL) THIS IS FOR INFORMATION ONLY”. Aintree University Hospital: 5pm – 9am & Weekends & Bank Holidays contact switchboard 0151 525 5980 and ask for the on-call Ophthalmologist. Southport: 5pm – 10pm Weekdays & 9am-10pm Weekends Contact main switchboard 01704 547 471 and request the on-call Ophthalmologist. Alternatively, patients can be sent to A&E who will then contact the on-call ophthalmologist.

Routine referrals

When a routine referral to Ophthalmology is selected you will be presented with a choice of secondary care providers that you can offer the patient. V1.8 OCT 2920 When a routine referral to GP is required this will be sent electronically. Please print a copy of the referral off OPERA and give this to the patients advising them to contact their GP by telephone.

V1.8 Oct 2020 www.primaryeyecare.co.uk