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Referrals – MK ICB Area

 

The information below relates to routine referrals for patients with a GP in the MK ICS area. If you’re unsure which ICB area applies, check the lists available here.

(Note that, as of 1st July 2022, MK CCG has been subsumed into NHS Bedfordshire, Luton & Milton Keynes ICS, known as ‘BLMK’. Eventually, services will be combined across this new area, but this does not as yet affect ophthalmology referrals.)

Remember that you should only email your referrals from an address ending in @nhs.net. Every health professional is personally responsible for protecting patient data, and referrals sent from other email addresses will not be secure. If your practice doesn’t have an nhs.net email address, please check our website here for information on how to get one.

 

Routine referrals

The MK Referral Management Service (RMS) service ceased to exist from 31st March 2023.  This means that Optometry Practices are no longer able to send their referrals to RMS for onward processing.

From mid-February 2023, all routine referrals, including cataract referrals,  have to be sent via the new EeRS / EyeV platform. Please note that the patient must be registered with a GP in England to be able to be referred via the  EeRS platform.

For any queries regarding EeRS in MK  please email EMMS Ltd Help desk (EeRS Provider) on   blmk-eers@eyev.health

The EeRS userguides can be found here: EyeV User Guide – Bedfordshire, Luton and Milton Keynes EeRS

 

Optometrists can email  ophthalmology.coordinators@mkuh.nhs.uk to check for dates of upcoming appointments (no clinical information) on behalf of their patients. – This is for optom use only ( not to be given out to patients) and must be from nhs.net accounts

For more detailed local information on referral pathways in Milton Keynes, please download the October 2023 Eyecare Pathways Milton Keynes document, which should be displayed in every consulting room. Please also refer regularly to other information on this page, and look out for email updates.

For a full list of providers holding a contract with BLMK (as of March 2022) to provide ophthalmology services for cataract, AMD and glaucoma see here.

 

Cataract referrals

Cataract referrals in MK should be treated as any other routine referral and emailed via EeRS on GOS18. In August 2020, a new policy document was produced by BLMK, describing revised referral criteria for cataract surgery, and it’s available here.

Patient choice for cataract referral

Providers holding a contract with MK ICS to provide cataract services (at  March 2022) include:

Milton Keynes University Hospital (default provider)

Ramsay Blakelands

Bedford Hospital

Stoke Mandeville Hospital

Northampton General Hospital

SpaMedica – Bedford site

Patients may exercise their right of choice to be referred to another provider, but that provider must be listed in the NHS electronic referral service (e-RS). To check if a hospital or clinic is listed, email blmkccg.plannedspecialist@nhs.net

 

Glaucoma

Following NICE guideline NG81 (November 2017) the criterion for referral is IOP >= 24 mm Hg (instead of the previous threshold of >21 mm Hg), in the absence of any other signs.

The view of LOCSU is that optometrists working in areas where no repeat measures scheme is in place should not be criticised for false positive referrals which are the result of a lack of commissioning. Consequently, it is recommended that the following statement is included, if referrals are made based solely on a non-contact tonometry reading: “This referral is being made based on non-contact tonometry results, due to the fact that no repeat measures service has been commissioned locally”.

We have written to MK CCG, and copied to colleagues in the HES, so that they are aware that the high rate of false positive referrals for raised IOP that they may be seeing is the result of a lack of commissioning, and not related to the competence of primary care optometrists making the referrals.

 

 Guidelines for referral of ‘Narrow Angle’ patients into MKUH Glaucoma Clinic.

Glaucoma consultants at MKUH have informed the LOC that they are inundated with unnecessary referrals and one big area is ‘narrow angles’.

Most of these patients who are  referred should not be seen in the HES and obviously take up consultants time that would be best served seeing proper glaucoma patients.

They have come up with the attached guidelines document that they have asked us to distribute to all Optometrists in the MK area. This has been drawn up from current guidelines from both the College of Optometrists and College of Ophthalmologists. Please read this document carefully so that you can make an informed decision when considering referring a patient.

Do also keep a copy of the document in the consulting room so that it is easily available to all resident and locum optoms as reference when needed.

 

Diabetic Retinopathy Screening

All patients with diabetes should be regularly screened for diabetic retinopathy by the Diabetic Retinopathy Screening Service unless they have been excluded. Please encourage your patients with diabetes to attend these appointments.

If you have any questions regarding the Diabetic Retinopathy Screening Service in MK please call 01908 996536

 

Paediatric Orthoptic Referrals 

MKUH  have issued some guidelines for optometrists to follow when referring children to the orthoptic clinic.  It would be useful to keep a copy of this document in the consulting room as reference. Please ensure that any referral to the Hospital Eye Clinic includes the name of the referring optometrist and their practice.

When specific information is required regarding children who were previously under Orthoptics clinic, please email OrthopticDepartment@mkuh.nhs.uk from an nhs.net email account (emails sent from non nhs.net accounts will not be replied to) or leave a message on 01908 995532

 

Urgent & Emergency Referrals

The hospitals have asked us to remind you not to quote to patients the timescale in which they will be seen. This decision needs to be made by the doctor who is triaging the case, and worried patients can often get quite upset if the appointment time given to them doesn’t match their expectations.

From 28th August 2021, the pathway for referral of urgent cases is the BLMK Community Urgent Eyecare Service (CUES). This service provides urgent assessment and treatment for recent and sudden onset eye problems, for children and adults registered with a GP in Bedfordshire, Luton and Milton Keynes.

Examples of cases which can be managed through the CUES include:

  • Red or painful eye or eyelids
  • Recently occurring flashes and floaters
  • Recent and sudden loss of vision
  • Foreign body in the eye

The CUES hub is open 7 days a week between 08:00 and 20:00, and it can be accessed by calling 0800 316 9200. Patients can self-refer, or be referred/signposted by a health professional.

Only patients ineligible for CUES (‘red flags’, requiring emergency assessment) should be referred to the MKUH BUS clinic, and this should be done via EeRS on the BUS referral form (available in Word and pdf versions).

  • BUS clinic runs Mon – Fri 8am-5pm
  • BUS referrals received before 3pm will be triaged the same day. After 3pm, referrals will be triaged on the next working day.
  • If a patient presents to you after 3pm Mon – Fri, or anytime on a Saturday / Sunday, and requires same day urgent care, please refer to MKUH A&E

Typical red flag conditions include:

  • Chemical or penetrating injury
  • Sudden onset of red and painful eye associated with photophobia or nausea
  • Sudden onset, severe reduction in / loss of vision
  • Sudden onset double vision or ptosis

For suspect wet AMD referrals, please download the rapid access referral form and use it to refer via EeRS/ EyeV platform  (Patients presenting with wet AMD during a CUES examination should be referred using the CUES pathway.)

The MKUH BUS email has changed from 1st October 2023.

The new email will be: bus.referrals@mkuh.nhs.uk

  • Optometrists will need to use the BUS RAS list accessed through EyeV.
  • Referrals coming in via this email address will be rejected and sent back to the referrer.
  • This email address is for enquiries only regarding a BUS referral.

 

Private ophthalmology at Stoke Mandeville Hospital 

Buckinghamshire Healthcare NHS Trust now offers private ophthalmology care at its Mandeville Wing, running evening outpatient clinics on Monday evenings, and operations on Saturdays. Download an information leaflet here.

The information on referral pathways is intended to be helpful rather than definitive, and there may be a delay in updating information when pathways change. For urgent or emergency referrals we recommend practitioners confirm the provider has received the referral and/or give clear advice to patients on what action to take if they have not been contacted within an appropriate time frame.

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