In England, the NHS e-Referral Service (eRS) is a national digital platform used to refer patients from primary care into elective care services. NHS Digital, in partnership with NHS Digital and NHS Improvement, initiated a national Paper Switch-off Programme towards the end of 2016. Currently NHS eRS requires a clinician to have access to NHS SmartCard for authentication and currently, for authentication, a secure HSCN connection, which have been inhibitive to the wide scale roll out of eRs to primary care optometry, but continues to be a consideration for NHS England and the optical sector.

The OPERA platform is an NHS Digital approved system for integration in to the NHS eRS service enabling primary care optometrists to access the benefits of the service for their patients.

Referral Assessment Service (RAS)

A Referral Assessment Service (RAS) enables the receiving provider to triage the patient prior to accepting in to a booked appointment to ensure most appropriate pathway for the patient is chosen.

This may be that the provider clinician accepts the patient in to the chosen service, re-directs the patient in to an alternative service or reject the patient back to the referring clinician with advise.

Primary Eyecare Services and the EeRS team would encourage the hospital providers to use this type of eRS clinic type due to the ability for triage ahead of determining best pathway for the patient.

Directly Bookable Service (DBS)

A Directly Bookable Service enables the patient to be booked directly in to the hospital booking system. The hospital provider releases appointments to the eRS service which are then published for booking.

Due to the workflow in optical practice meaning the referral is often done without the patient present when a DBS referral is made the patient is sent a letter with a passcode and a link to the online appointment booking service and a telephone number (if online booking is not the preferred option).

It may be possible that when the patient access the appointment booking service that there are no appointments available and in this instance they can defer the appointment request to the hospital provider to contact them for an appointment.

The hospital provider will only see the patient details once they have booked an appointment (or deferred the appointment booking to them). It is possible that the hospital provider may still review the patient notes and subsequently change the patients appointment or cancel the appointment and transferred to alternative clinic.

Referrals to NHSmail end points

Some hospital providers will choose to accept some referrals via NHSmail, this is common for emergency eye clinic referrals, wet AMD referrals and referrals to community Orthoptic services.

To support the hospital providers to provide feedback on referrals as they may do in eRS they have been provided with a feedback link on the referral form received, this allows them to add feedback in the form displayed below (please see further lesson on rejection / feedback information on how this received from practice side).

NHSmail referrals are not as easily tracked as eRS referrals, however the referral mailbox used within OPERA is monitored to ensure that there are no bounce backs from the emails sent and action by the Primary Eyecare Services Hub team if required.

Referrals to other primary care optical practices (Internal referrals)

There will likely be occasion where you have a patient who needs referral to another optical practice due to your practice not delivering a commissioned service that the patient needs to have delivered, such as the Glaucoma Enhanced Referral Service.

These referrals can be processed via OPERA by selecting ‘Primary Care Service’ and the appropriate referral required e.g ‘GERS’ and then the patient choice option required.

The below image is an example selection of speciality and clinic type you would need for a GERS referral to primary care optical practice:

Once the referral has been submitted this will go through to the receiving optical practice (you have the ability to print a copy of the referral prior to submitting so you can retain a copy for yourself) and they can accept or reject should there be a reason why they can not accept the referral (please see course on referral management).

Last updated: May 2022