Locum digest

Making referrals: safety-netting, record keeping, and resources

Henry Leonard, the AOP’s head of clinical and regulatory, shares guidance and resources for making internal referrals when locuming in a practice, and OT hears how a practice developed an information pack for locums

5 min read

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Kimberley Young

23 February 2025

The AOP’s clinical and regulatory team assist around 300 members each year following a patient complaint or concern, and problems with referrals are a common issue we encounter.

AOP

Locum optometrists are more likely to need to make an ‘internal referral’ within the practice for a follow-up test (eg dilation), so there needs to be a robust mechanism in place to ensure these patients aren’t overlooked. In addition, there is often confusion about which practitioner is ultimately responsible for managing the patient – in most cases this will be the practitioner who completes the examination – and we recommend using an ‘internal referral’ form to make it clear that the first practitioner is transferring this responsibility to the second practitioner.

The AOP has published an internal referral template which practitioners can use for this purpose. The template allows for practitioners to clearly record what the patient has been asked to return for, whether an appointment has been made, and includes a space for other notes or explanations.

We also encourage locums to make use of their online AOP locum logbook to keep track of referrals they have made. Some practices will already have their own mechanism in place for managing internal referrals, so it’s important to find out what system you should be using when you start working at a new practice.

Making external referrals

There are also lots of issues with external referrals to other healthcare providers, such as GPs and the hospital eye service. If you are writing to a patient’s GP, it’s important to make it clear whether you are simply providing information, or whether the GP is expected to take some form of action, such as arrange blood tests.

The urgency of the referral should always be clear and easily identifiable to avoid confusion. The letter should be concise but include enough information to explain what you have found, why you are referring the patient, and what you expect the GP to do. Most GPs are not eye specialists, so you should avoid using language and abbreviations which may not be familiar to them.

In most areas, it’s not appropriate to refer patients for investigation of eye conditions via the GP, especially if they require urgent or emergency evaluation. You should take steps to identify the correct referral pathways for each area where you work. In many areas, the local optical committee or regional optical committee will publish up-to-date information on referral pathways on their website, but not all practices participate in every pathway, or have access to the necessary systems to access them, so you should check this with the practice directly, before making the referral.

We generally recommend following the College of Optometrists’ guidance on referral urgency (which is often referred to in fitness to practise investigations and within civil claims for clinical negligence), but practitioners should be mindful that local protocols may override these. If you are in doubt about an urgent or emergency referral, you should telephone the local eye department for advice.

Barriers to safe referrals

The AOP is aware that there are significant barriers to referring patients safely, especially in England, and these barriers are often outside the control of locum optometrists. For example, if the area you are working in does not have an electronic referral platform (or you do not have access to it), you may need to rely on NHSmail. Locum optometrists are not currently able to obtain a personal NHSmail account, and many practices do not have their own NHSmail account that locums can use.

Even if locums have a personal NHSmail account, referring a patient via this route is not ideal, because the practice (the ‘data controller’) has no visibility over the referral, and won’t necessarily know if the referral has been rejected, or needs to be redirected, or requires further information.

In addition, each referral pathway in a particular area may have specific criteria which need to be met. For example, some pathways won’t accept children, or some require the patient’s GP practice to be located in a certain area, making it extremely difficult and complex for practitioners to refer patients accurately. When referral pathways change, the information isn’t always communicated properly or updated promptly, so it can be very difficult to be certain you are referring patients correctly, even if you have checked the latest published information on referral pathways.

Unfortunately, there are a multitude of ways in which patients can come to harm due to the current lack of a clear, simple mechanism for referring patients, and this increases the likelihood of a patient complaint or concern being raised against the referring optometrist. The AOP is continuing to raise these issues at the highest levels and will robustly defend members who are the subject of a complaint in these circumstances.

Introduce a safety net

In the meantime, we recommend giving clear ‘safety-netting’ advice when you refer patients. This could include recommending patients contact the practice if they haven’t heard from the hospital within a certain timeframe. This information should be given in writing to the patient on their prescription or information/referral letter, as well as recorded clearly in the clinical records. This is why providing safety netting advice is crucial and the AOP have developed a template for that as well.

Although practitioners should be able to rely on referral systems ‘just working’ the reality is that this is a significant source of issues and complaints in our sector. For peace of mind, practitioners may wish to keep their own log of urgent and emergency referrals, such as in the AOP locum logbook, and follow these up with the practice, within an appropriate timeframe.

Further guidance on referring patients safely can be found on the AOP website.

The practice perspective: making the process smoother for locums

Gemma Westall, practice manager and dispensing optician (DO) at James Bryan Opticians, a Hakim Group independent practice, described a resource the practice has put in place to support locum optometrists when making referrals.

“Before I became a practice manager, I used to do some locum DO work, so I knew what it was like to walk into a practice that I had never been to before and not know any of the systems. With that perspective, I put together a folder for any locum DOs who work here, and it grew from there,” Westall explained.

“We needed something more stringent in place for optometrists,” Westall said, adding: “We had basic things on a Google Drive, but if you have a patient who you need to refer as an emergency, you don’t want to be hunting through to find the information you need.”

Emergency referrals are made by calling the hospital eye service at the local hospital. The practice has developed a physical folder of information, including the local optical committee document on making emergency referrals in the area, what numbers to call, who to speak to, and where to send emails.

Resident optometrist, Deepa Wadhwa, has supported the creation of the resources for locum optometrists, including recording videos on how to use the practice systems, top tips and pitfalls to avoid.

The practice director, Zahir-Ally Kanji, is introducing the resource across the other practices in the group.

Westall siad: “We’re always trying to take on board feedback, because locums might have seen something great that has worked really well at another practice they’ve been to.”

The practice arranges a video or phone call induction with locum optometrists ahead of time, and on the first day in the practice, will block out an appointment to run through information.

We’re always trying to take on board feedback, because locums might have seen something great that has worked really well at another practice they’ve been to

“Myself and the other DO in practice can answer any simple questions, but if there is anything more in-depth, the residents and optometrists in our other practices are really forthcoming and happy to answer any questions, which is really helpful because it builds a support network,” Westall said.

The practice uses the Opera platform for the majority of referrals, which Westall suggests is more streamlined and easy to set up if a locum has not used the system before.

“We’ve set up an egress email for our practice, so if the locum isn’t already on Opera and needs to send something by secure email, we have it set up so we can track any responses,” she shared.

The practice uses a Task List function of its Optics PMS for internal referrals and remarks on patient records.

Westall said: “We’re quite lucky because we’re a small and close-knit team, so those of us on the shopfloor are quite happy to keep an eye on referrals to make sure they are flagged with the resident optometrist when they are next in.”

Offering advice to other practices on how they can start creating resources for locum optometrists, Westall said: “I would recommend talking to your resident optometrist to build a document of information – they will know what should be included, and what would be helpful to have.”