Dealing with referral refusals

These include:

• The hospital has refused to accept your referral
• The patient has refused to consent to a referral
• The practice has refused to accept your internal referrals.

In the AOP’s clinical and regulatory team, we often encounter enquiries where this is the case.

What do I do if the GP or hospital trust rejects or refuses my referral?

If you, as an optometrist, have referred a patient to a medical practitioner because you have detected signs of injury, disease or abnormality, and have performed all the additional examinations that are clinically indicated and necessary, then you can reasonably assume that you have fulfilled your obligation as set out in the Opticians Act.

If the hospital eye department or GP rejects your referral then they are likely to be liable if a civil claim ever arises. We do however advise that practitioners try to find out why the referral was rejected, and try to remedy this and manage the patient appropriately. It may be that to do this you need to contact the place that you referred the patient to in order to find a way forward.

Local referral pathways can change so often that it can be hard to keep up, especially if you are a locum optometrist. Different areas will have different pathways and certain forms or ways they prefer you to refer. For example, hospital departments may prefer you to phone them first for urgent referrals, rather than send the patient directly to them. It could also be that certain hospitals only accept referrals from people outside of their immediate area on weekends and anything that can wait till the next week should go to a more local hospital. If you still believe that the referral has been rejected without good reason, you could raise this with your Local Optical Committee to see if it can provide any further advice.

If the hospital eye department or GP rejects your referral then they are likely to be liable if a civil claim ever arises

What should I do if a patient is refusing to be referred?

Sometimes you may come across a situation where a patient has rejected or refused a referral. This is a difficult situation for us optometrists as we have more insight into the consequences of refusing treatment.

In this situation, we would normally recommend writing to the patient by recorded delivery, setting out your findings and advice, and the possible consequences of not following your advice. You may wish to include a referral letter and advise the patient to take this to their GP (or A&E if the matter is urgent) if they change their mind.

Sometimes patients need time to consider their options and may be hesitant to consent to a referral until they have had time to think about it or discuss it with their family or a friend. Therefore, you should also invite the patient to contact you at the practice if they want to discuss it further.

Ultimately, if your patient decides against a referral, even after you have taken the steps above, then you must respect their right to refuse treatment. It is vital though that you keep a record of all your correspondence with them and make thorough clinical notes.

If you feel that your patient lacks the mental capacity to make decisions about their own healthcare, you may need to take further steps, however, we advise members to please contact the AOP to discuss this. We have more information on safe practice on our website.

Ultimately, if your patient decides against a referral… then you must respect their right to refuse treatment

I’m leaving a practice and my employer won’t accept internal referrals. What can I do to ensure my follow-up patients are managed appropriately?

We often receive enquiries from optometrists, particularly locums, who are concerned about the managing and following up of patients after they have left the practice. For this reason, we have developed an internal referral template, which is available on our website, along with information on how to use it.

We have had instances where employers are unwilling to accept these and we would therefore recommend sending an email to the practice owner, explaining that, as you are leaving the practice you are unable to follow up on these patients and therefore the most appropriate way to ensure they are managed properly is to internally refer to another practitioner at the practice (attach the referrals). It is not appropriate for the practice to send you patient data once your engagement with the practice has finished and therefore you should not agree to this.