Greater Manchester Eye Care Navigation Service
Introduction
The Greater Manchester Eye Care Navigation Service has been established to provide clinical triage of GOS 18 referrals followed by an informed patient choice process. This applies to all 10 localities of Greater Manchester.
This applies to all routine and urgent ophthalmology referrals, but NOT Emergency referrals. Emergency referrals should continue to be sent unchanged, through established local emergency pathways.
This navigation directs to the most appropriate services both in primary and secondary care.
Greater Manchester Eye Care Navigation Service Launch
The launch of the Greater Manchester Eye Care Navigation Service will be in two phases:
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Phase 1- 18/08/2025
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Referrers should continue to select a provider endpoint of the patient’s choice on the IT referral platform OPERA.
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Information around phase two will be made available in Autumn/Winter 2025
Eligibility Criteria
- Patients of all ages registered with a GP in Greater Manchester ICB
- Routine and Urgent referrals for patients originating from Optometry or General Practice will undergo clinical triage within the Eye Care Navigation Service
- Emergency referrals should not be sent to this service, they should continue to be referred through established emergency pathways
- Adult routine referrals will be provided with access to informed Patient Choice via SMS or letter
Clinical Triage Process
Referrals received into the Greater Manchester Eye Care Navigation Service will be triaged by Primary Eyecare Services’ team of experienced optometrists with one of the following outcomes:
- Referred on to HES as requested (vast majority)
- Referred to a locally commissioned service (e.g. Community Urgent Eyecare Service (CUES) or Glaucoma Enhanced Referral Service (GERS))
- Returned to the referrer requesting more information (e.g. IOPs have been missed off a glaucoma referral or images stated as attached have not been uploaded)
- Returned to the referrer as local guidance suggests an NHS referral is not presently required at this time.
Patient Choice Process
The Greater Manchester Eye Care Navigation Service will provide a centralised patient choice process. Please see table below as to which patients will be eligible for patient choice:
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Patients Eligible for Patient Choice
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Patients Ineligible for Patient Choice
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If you feel that a patient is not suitable for Patient Choice or will be unable to action the choice SMS/letter please indicate the reason for this clearly within your referral.
If the patient is already under the care of a provider, please be sure to note exactly which provider e.g. not just ‘Rochdale’, use ‘Rochdale Infirmary’ or ‘Practice Plus Group Rochdale’.
Patient Choice communication is now sent via SMS text message, as the latestdata shows mobile phone ownership has increased to almost 100% among younger generations, and over 80% among the over 65s.We kindly ask for your help in ensuring that up-to-date mobile phone numbers are included in your referrals. For patients that do not have a mobile phone number on file they will receive patient choice communication via a letter.
The Patient Choice SMS will come from ‘NHS EYECARE’. The SMS will contain a link to the Patient Choice Portal (shown below) and a reference and passcode for patients to access their personal referral within the portal.
The Patient Choice SMS will come from ‘NHS EYECARE’. The SMS will contain a link to the Patient Choice Portal (shown below) and a reference and passcode for patients to access their personal referral within the portal. If the patient is being referred for cataract surgery they will also get a link to the Primary Eye Care Services ‘Find a Hospital’ tool to find out more information about local providers prior to making a choice.
Patient Choice communication will also provide a phone number to Primary Eyecare Services Hub team who can facilitate choice if required.
O nce patients access the Provider Choice Portal, they enter their personal reference and passcode and then have an option to choose between 10 of their most local providers. The providers are listed in geographical distance from the patients home address.
If patients wish to choose a provider outside of that list, there is telephone number the patient can phone to discuss their choice.
Please tell your patients that when they receive a patient choice SMS from ‘NHS EYECARE’ or a Patient Choice letter that they must respond to it. Until the patient actions their choice communication, the referral will not be sent.
Primary Eyecare Services will manage the Fail to Engage (FTE) processes of the Patient Choice process.
Patients will receive an initial SMS, a follow-up SMS reminder at 2 weeks, a letter sent at 4 weeks and then a phone call at 6 weeks. If none of these communications are actioned, then Primary Eyecare Services will inform the patients original referrer and the patient’s GP.
Practice Guide
Service Summary - LINK
Training
Launch Event Recording - LINK
Launch Event Slides - LINK
Greater Manchester Eye Care Navigation Service – FAQ
Who is this available to?
Adult Patients with a GP registered within Greater Manchester requiring:
- a routine or urgent GOS18 referral to ophthalmology
- a routine or urgent referral to ophthalmology from General Practice
- a cataract referral from the Enhanced Pre Cataract Referral service
Does this apply to Glossop patients?
Glossop falls within Derbyshire ICB. These patients will not receive triage or patient choice letters and will continue the current arrangements. Other surrounding ICBs such as Cheshire & Merseyside, Lancs and South Cumbria and Derbyshire will maintain their current service provision.
What about for emergency referrals?
Emergency referrals will not come to the Navigation Service. Continue to follow your local protocols. That may be:
- Calling the emergency department first to discuss and then referring on OPERA
- Referring directly on OPERA with no phone call
- Referring directly on OPERA and giving the patient a printout of their referral to present at the emergency eye department.
Please check your local HES protocols found here: www.gmlocs.co.uk to ensure you are following local protocol.
How long will it take for patients to receive their letters?
The majority of patients will receive a text/SMS providing there is a mobile number on the referral. It’s important for the practitioner to ensure when completing the referral that this is the most up to date number. The SMS will arrive as soon as the triage has been completed (usually within 24 hours of the referral being sent).
For patients without a mobile number the letter will be sent in the post and usually takes 2-3 days to arrive by Royal Mail.
If a patient doesn't have a mobile telephone, if we specify this, would they receive a letter?
They would receive a letter in the first instance within 2-3 days.
Are there any exceptions to patients receiving a choice letter?
There are some agreed exceptions where a choice letter may not be required:
- Domiciliary (where the patient hasn’t capacity/ability to respond
- Paediatric Referrals
- Patients already under the care of a provider (these will be sent to the same provider automatically to ensure continuity of care)
- Lost to follow up
- Other exceptions (see below)
At what age is the cut off for children?
Patients 18 years of age and above will receive a choice letter for routine referrals.
What about patients who have visual impairments, learning disabilities, language barriers or those without capacity to respond the choice letter?
For other exceptional circumstances, clinicians can detail in their referral if they feel the patient may struggle to provide a choice. We would recommend that clinicians describe any challenges the patient may have in deciding and which is the patient’s preferred language.
Who triages the referrals?
An experience team of optometrists who have been specially trained in triaging for services across England. They have access to local guidelines alongside guidance issued by sector bodies (i.e. College of Optometrist’s Clinical Management Guidelines)
How do you decide which service the patients get referred to?
There are a few factors that may influence:
- Local guidance
- National guidance (e.g. College CMGs)
- Availability of sub specialty clinics in locations (HES and ISP sites)
- Whether the patient is already under the care of a provider
Can you see on the patient’s Summary Care Record (SCR) if they are already under a provider for a condition?
The Summary Care Record (SCR) will detail the patient’s existing diagnoses e.g. hypertension, glaucoma, diabetes etc. When conducting a referral, please ask if the patient is happy for their Summary Care Record to be shared with optometry colleagues in the interest of their referral. The permission statement is on page 3 of the GOS referral module:
The Summary Care Record is only a summary however and it will not detail which provider the patient is under. Where possible do try and find out from the patient which hospital they are under for their condition.
What about if there’s only one provider available for the co-morbidities/sub-speciality the patient requires?
In these cases the patient will not need a choice letter they will be directed to the only appropriate provider available.
Should the referring clinician want to query a triaging decision (e.g. the reason for a downgrade from urgent to routine) how can this be raised?
The reasons for triaging decisions are detailed on the referral episode documentation, however should further discussion be required, the referring clinician can speak to the Primary Eyecare Services Clinical Leads via the blue bubble or hello@referral.support
Who is clinically responsible once a referral has been triaged?
When you ask for further information within a referral how do we action this?
The slide bundle shows detailed screenshots related to this, but you do not need to complete a brand new referral, you will click the red tab on the episode to provide the further information/imaging required.
If your triage team rejects a referral, are we still able to respond and return via a red button?
If you are querying a rejected referral in the first instance you are best to discuss with the Clinical Team via the Blue Bubble or by emailing hello@referral.support
Should we refrain from discussing the hospital options with the patients anymore?
Patients will likely continue to ask clinician advice around providers. You can continue to give patients an ideas of available providers in the area and an idea of the waiting times, and advise the patient they have some time to consider their options before replying to the SMS/letter. For cataract referrals, you can also direct the patient to www.primaryeyecare.co.uk/find-a-hospitalto view cataract waiting times.
For Cataract Referrals, will we still do the Enhanced Pre Cataract Referral Service for these patients?
In areas where this is commissioned (Bolton, Bury, Manchester, Oldham, Salford, Stockport, Tameside, Trafford and Wigan), you will continue to do a Pre Cataract Enhanced Referral assessment, the only difference will be that the patient will receive a choice letter post-appointment.
How does this work for GERS (Glaucoma Enhanced Referral Service) referrals?
If your practice is GERS accredited, you continue to see your own GERS patients as usual and book these internally within your practice. If your practice does not provide GERS, continue to refer these to the Primary Eyecare Services – GERS endpoint within OPERA. See HERE for more information.
For urgent referrals e.g. Wet AMD confirmed with OCT - do these go through as urgent and therefore go through the eye care navigation?
Yes, they will be triaged and the urgency and sub specialty clinic confirmed, but not sent a choice letter, the triager will confirm the provider chosen is appropriate - remember to attach the OCT as this will really help the triager.
What are the benefits of having an eye care navigation service such as this in an area?
- Ensures a full and independent patient choice
- Ensures that referrals contain all relevant information to enable hospital colleagues to streamline internal triaging to make sure the patient gets to the right clinic in the appropriate timescale
- Ensure that locally commissioned enhanced services are utilised to the fullest
- Reduce duplication of referrals (from GP colleagues vs optometry colleagues)
- Provide an opportunity for feedback and professional development
- Reduce the number of unnecessary referrals to secondary care reducing overall waiting times
Ongoing Support
If you need support or have any questions, please contact us via email at hello@referral.support with ‘GM Eye Care Navigation Service’ in the subject header.