Dealing with referral refusals
AOP clinical and regulatory adviser, Roshni Kanabar, advises on how to deal with referral refusals
30 July 2021
There are a few instances in practice where an optometrist may find themselves in a situation where their referral may be refused.
- 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.
Three steps to success
- Find out why a referral has been refused and try to remedy the reasons for rejection
- If a patient refuses a referral, write to them explaining the reasons for it and the consequences of refusing or delaying referral
- When you are leaving a practice, internally refer any outstanding patients that require follow ups and send an email to the practice owner explaining this if required.
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.
The legal basis
The legal background that is relevant to these enquires:
Under Part 4, Section 26(1) of the Opticians Act, optometrists have a duty “to perform such examinations of the eye for the purpose of detecting injury, disease or abnormality in the eye or elsewhere as the regulations may require.”
Furthermore, Section 3(1) of The Sight Testing (Examination and Prescription) (No.2) Regulations 1989 states that optometrists have a duty to perform “such additional examinations as appear to the doctor or optometrist to be clinically necessary.”
Under the GOC rules relating to injury or disease of the eye, 1999: “Where it appears to a registered optometrist or registered dispensing optician that a person consulting him is suffering from an injury or disease of the eye the registered optometrist or registered dispensing optician shall, subject to rules 5 to 8 below, refer that person to a registered medical practitioner.” Rules 5–8 explain the circumstances where an optometrist may choose not to refer a patient to a medical practitioner (even if they appear to be suffering from an injury or disease of the eye), but this is at the discretion of the optometrist; practitioners are not obliged to manage these patients themselves if they don’t feel comfortable doing so.”
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