Duty to Refer

C 1.1.1 Every registered dispensing optician has a statutory duty to immediately refer a patient to a registered medical practitioner or directly to a hospital for appropriate medical advice if it appears that a patient is suffering from disease or injury of the eye. In such cases the optician must inform the patient that s/he is referring him/her, and the reason for that referral. A referral letter must also be completed and contain enough information such that the need for referral is explained so that the correct action is taken by the recipient practitioner, including:

  • The dispensing optician’s name and qualifications,
  • The patient’s name, address and date of birth,
  • The last examination date and the visual acuities on that date (if known).
  • If possible the visual acuities at the referral date and the symptoms with the duration of the symptoms
  • The signs as observed by gross external examination of the eye or, if appropriate by slit-lamp bio-microscope examination
  • Relevant details of the patient’s history including details of current and recent patient medication
  • It must be stated that no ophthalmoscopy was performed.

C 1.2.1 A referral made directly to a hospital is necessary if the condition is potentially sight threatening. The patient must be given a referral letter and advised to attend the Accident & Emergency Department immediately. A copy of the referral letter must be sent to the patient’s GP with a covering letter. The reason for referral should be explained to the patient, and it is good practice to support this in writing. Copies of referral letters must be kept with the patient record card. In due course the patient should be contacted and the record card annotated with the result of the referral. For non-urgent referrals, a full eye examination should be recommended as soon as possible.

C1.3.1 If in the professional judgement of a registered optician there is no justification to refer a person consulting him/her to a registered medical practitioner, or that it would be impracticable or inexpedient to do so, the registered optician may at his/her discretion decide not to refer that person on that occasion; but in that event he/she shall record on the record card of the person consulting him/her:

  1. a sufficient description of the injury or disease from which the patient appears to be suffering.
  2. the reason for deciding not to refer on that occasion.
  3. details of any advice tendered to the patient.
  4. an account of any action taken; and
  5. if appropriate, and with the consent of the person consulting him/her, shall inform that person’s general medical practitioner of those matters recorded.

C1.4.1 A registered dispensing optician has the option of referring the patient to an optometrist. In that event, it will then be the optometrist’s responsibility to refer or not, but it should be recorded that the referral has been made to the optometrist together with the details of the injury or disease from which the patient appears to be suffering and of any advice tendered to the patient. The registered dispensing optician must be fully cognisant of all ocular emergencies which would necessitate referral directly to a hospital.

C1.5.1 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.  In the first instance talk to the patient, advise them they are unfit to drive and try to persuade them to stop. Remind the patient that s/he is legally responsible for informing the DVLA or DVA if they do not meet the vision standard for driving. However, if the patient has told you that they will not stop driving, you may conclude the public interest outweighs the duty of confidentiality. In this case, refer back to the prescribing optometrist. You may wish to seek the advice of your professional body.