Death of the handwritten referral

But the decisions that optometrists make are often recorded with an implement invented in the 1930s and with a price tag of less than a pound: the humble ballpoint pen.

In Cambridgeshire, the anxiety of deciphering handwritten referrals is a thing of the past following the introduction of a new digital platform that enhances communication between primary and secondary care.

The referral system enables optometrists to safely and quickly transfer referrals to secondary care, as well as supporting information such as images, documents, complete optical coherence tomography scans and videos.

Optometrists can also seek guidance from ophthalmologists working in secondary care – often receiving a response within a 24-hour timeframe.

Commissioning lead at Cambridgeshire Local Optical Committee, Alison Lask, explained to OT that there has been much discussion about the need for patients to come out of hospitals as part of the transformation of NHS care. A key challenge within this is the archaic and disjointed systems that are used for communication and referral between primary and secondary care.

“The technology wasn’t there – that was really what triggered it,” she shared. “We are in an electronic age. The idea of people still physically writing a referral that then couldn’t be read by the hospital because they couldn’t read the handwriting was a major issue.”

The optometrist, who owns A & I Lask Opticians in Cambridge, shared with OT that before the rollout of the Cinapsis SmartReferrals platform there were different referral processes for each of the three hospitals in her area. “It was piecemeal. The idea of the platform is to standardise everything and to provide very specific pathways for referral,” she shared with OT.

The issue of outdated equipment within the NHS is not unique to optometry and ophthalmology.

We are in an electronic age. The idea of people still physically writing a referral that then couldn’t be read by the hospital because they couldn’t read the handwriting was a major issue

In 2019, around 130,000 pagers – equivalent to one in 10 pagers worldwide – were NHS property. The annual cost of the devices to the health service was £6.6 million.

The Royal College of Surgeons revealed in 2018 that NHS trusts owned more than 8000 fax machines.

The Cinapsis SmartReferrals system provides guidance for practitioners who are unsure whether a patient should be referred to hospital.

For each patient referred to hospital, optometrists receive feedback about whether the patient has been accepted into the relevant clinic.

“I know exactly what is happening with my patients and when. It gives the confidence that you know something is being done,” she said, adding that the platform has the potential to improve the quality of referrals.

“I think being able to ask questions about individual patients helps to keep people out of the hospital unnecessarily. This ability to deflect patients from the hospital back into the community for treatment and monitoring has to be good for patients, the hospital and practices,” she said.