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PATIENT CHOICE

Introduction

As Eye Care Professionals, patients look to us for advice and guidance on a range of health matters and we are seen as trusted, primary care health professionals. 

Part of our duty of care to patients is around referrals. As GOC registrants you have a duty of care to your patients and a duty to refer when necessary. Aligned with this is the legal right of a patient to choose where they receive healthcare services- something that has been established in the NHS since its formation. Everyday thousands of patients demonstrate their choice when they book appointments in our practices for sight tests, contact lens appointments and other eyecare services both NHS funded and privately funded and they have the freedom to choose who, when and where to attend for their eyecare. 

This extends across services patients would receive from High Street Optician’s practices (primary care) to the hospital where they attend following referral (secondary care). 

Now, more than ever, patients are well informed about their rights and increasingly have a knowledge of the different providers and sometimes the clinical team or health care professional they wish to be referred to.  

This may be based on factors such as personal recommendation from a friend or relative, a previous experience, local knowledge or a search on the internet, or perhaps following a discussion with their Optometrist or Dispensing Optician. 

Devon Local Optical Committee have created this space on their website to help you- the eye care professional-support patients in receiving safe, timely care in a location of their choice. We fully endorse and support the NHS Choice Framework and its commitment to giving patients greater choice and control over how they receive their healthcare- a commitment reflected in the NHS Constitution for England1

We hope you find the following information helpful and would welcome feedback to admin@devonloc.co.uk 

  1. https://www.gov.uk/government/publications/the-nhs-constitution-for-england
Rationale

Increasingly Devon LOC are receiving concerns around referrals in their area. These cover a broad range of issues from delays, requests for re-referral for expedition, requests from secondary care to re-refer with additional information, rejected referrals and referral quality.  

The concerns have come from a range of sources- Performers, Contractors, Optometrists, Dispensing Opticians, local hospitals, Independent Sector Providers, Devon Referral Support Services (DRSS) and Devon Integrated Care Board (ICB). 

One specific area that causes enquiries into the LOC are referrals which contain details of a patient’s choice but the patient is seen at an alternative provider or is place on a waiting list somewhere else. We have also received concerns from Devon ICB that the quality of choice conversations could be both improved and detailed more clearly on patient records.

Devon LOC have now decided to proactively intervene to support the reduction of these concerns. 

The purpose of the information on this webpage is to give background information to support high quality choice conversations between clinicians and patients where appropriate, and provide concise, up to date information on providers across Devon where this is available. 

In time we intend to produce guidance for eye care professions across a range of referrable conditions, however, we are starting with cataract referrals as these are the most common, see “Cataract Choices” tab.

Please note that these choices “only apply at the point of referral (from your GP, Dentist or Optometrist) to providers that have an NHS contract to provide the service you need”2 

2 https://www.gov.uk/government/publications/the-nhs-choice-framework/the-nhs-choice-framework-what-choices-are-available-to-me-in-the-nhs

A Patient’s rights

To support the choices a patient can make the NHS states: 

 “You can talk to your GP, Dentist or Optometrist3 who is referring you for more information. You can also find more information on the NHS website about the providers you can choose from – see the NHS services  page or use the search function to find information on specific hospitals and clinics”.4 

Remember- a patient has the right to choose the provider that will deliver their care for their first outpatient appointment, this can be an NHS hospital, or an Independent Sector Provider funded by the NHS to provide services. They also have a right to choose the clinical team who will deliver the care at their chosen provider. 

This right to choose does not include urgent or emergency care. 

3. This includes dispensing opticians who have an equivalent responsibility to refer
4. https://www.nhs.uk/using-the-nhs/about-the-nhs/your-choices-in-the-nhs/

Role of the eyecare Professional

Clinicians should ensure that patients are able to make an informed choice at the point of referral or as early in the patient journey as possible. In the case of patients being referred from opticians’ practices this could be at the point of discussion between the dispensing optician or optometrist and the patient. 

The Eye Care Professional (ECP) can help support the patient in this process by: 

  • Explaining the option of NHS providers, Independent Sector Providers (ISP) funded by the NHS or private providers. 
  • Consulting the tables in the tabs to share important providers’ details (Please note that more tables will be added to cover different conditions beyond cataract). It is important to recognise that some of these details are subject to change such as waiting times and Devon LOC cannot be held liable for the accuracy of this information which is shared with us from outside parties. 
  • Explain to the patients if follow up appointments will need to be conducted at the providers premises, remotely, or are available at their local opticians.  
  • Transport options and access including provider location. 
  • Sharing any outcomes data on patient safety such as National Ophthalmic Database5 (NOD) or where appropriate CQC ratings6
  • Ensuring a patient’s preference ( “Cataract Choices” tab) is clearly indicated as such on the referral letter and informing the patient so they are aware it has been included. It may be helpful (but not mandated) to include the reason why the patient made their choice such as “waiting time or “close friend recommended this provider” etc 

The patient choice conversation can, if the patient wishes, be delegated to DRSS. If no choice is recorded on the referral letter, then it would be deemed that the patient wishes to be contacted by DRSS. 

5. https://nodaudit.org.uk/
6. https://www.cqc.org.uk/care-services

Local Process

Information on local referral processes is available on the Devon LOC website Referrals

Within Devon we utilise the services of Devon Referral Support Services (DRSS), a single point of access for referrals in the area. 

DRSS will contact patients in regard to their referral and we suggest that should you wish them to undertake the “choice conversation” with the patient you make this clear on the referral- brief wording such as “DRSS to contact patient to choose provider” should suffice. 

If however, you wish to have a choice conversation with your patient then utilizing the information in the choice’s tables tab please highlight to patients the appropriate providers available to them. Conversations may include details of the distance to the nearest provider, average waiting times, data on quality and outcomes and access. 

Having had a conversation with the patient utilising the choices table in this guidance, you must note their provider choice on the referral we recommend that you annotate the referral “Choice conversation undertaken at referring practice” and note this on the patient’s records. 

Following this we would not expect a patient’s choice to be amended in any way by DRSS unless there were extenuating reasons and the referrer was contacted along with the patient. 

Key Point: It is the intention of Devon LOC to provide data to support referrals to multiple specialities i.e. cataract, glaucoma, AMD. At present, we have focused on cataract referrals as these make up most referrals from ECPs where choice conversations take place. 

Cataracts Choice

Provider data for: 

Cataract referrals. 

The data below is provided from a range of sources to support ECP’s- the ERS system utilized across healthcare, the National Ophthalmic database and Care & Quality commission reports plus other sources. Such information is widely used by healthcare professionals in supporting patients to make referral decisions. The data is checked by Devon LOCs administrator on a regular basis and updated. Any queries regarding this information please contact admin@devonloc.co.uk 


NHS Cataract Providers

Hospital
First Outpatient  appointment
Average waiting time for treatment
NOD* data on vision loss available
Post-op follow up available at community opticians?
CQC Rating
Transport Options
Exeter Aces
**Limited availability
20 weeks
(Direct arrangement with practices)
No data
Unknown
Nightingale
**Limited availability
14 weeks
PIFU only
Not yet inspected
Shuttle bus from park & ride
Exeter Newmedica
3 weeks
6 weeks
Good
Offer free door to door transport
Royal Devon (N. Devon & Exeter)
Not known
18 weeks
PIFU only
Requires improvement
Pay and display car park
Exeter Spamedica
7 days
5 weeks
Not yet inspected
Offer free door to door transport
North District
No data
18 weeks
Not yet inspected
Pay & display car park
Plymouth Newmedica
3 days
4 weeks
Not yet inspected
Offer free door to door transport
Plymouth Practice Plus
8 days
28 weeks
Good
Free parking on site
Plymouth University (REI)
**Limited availability
20 weeks
Requires improvement
Pay and display & bus service
Torbay
**Limited availability
20 weeks
Requires improvement
Pay & display car park
Torbay Mount Stuart
**Limited availability
20 weeks
Good
Free parking on site

Updated: 10th May 2024

* National Ophthalmic Data base https://nodaudit.org.uk/ “
** Limited availability refers to there being too few appointments available for data to be shared


To use the interactive map, please use the filters to select the criteria required. Remember to unclick the filters when re-searching and refresh the page to get back to the list of hospitals.

FAQ

How do I ensure I have met the guidance for a “choice conversation” with my patient? 

Using the provider information provided above, please discuss all appropriate options with your patient and note this has occurred, along with the patient’s provider choice on the referral. 

We suggest it is helpful to include a short explanation of why the patient has chosen a provider such as “patient wants to be seen as soon as possible” or “provider recommended by family friend” to give an indication of why the choice was made- this is for audit purposes. 

Please remember to also record on the patient’s record that a conversation about provider choice has taken place- this can be as simple as noting “Provider choice conversation undertaken”. 

Is it my responsibility to offer a “choice conversation” to every patient I see? 

As a ECP in Devon, you can choose whether you wish to have a “choice conversation” with your patient or utilize the service offered by DRSS.  

However, the LOC is committed to ensuring that you, as the clinician, have the information available to you to support the best decisions for your patients. 

 Remember every patient has the right to choose the provider they are being referred to (subject to the rules outlined previously). However, as a clinician, the decision on whether to undertake choice sits with you and not DRSS or Devon ICB.  

My patient is on a waiting list for a provider and now realises they can be seen much quicker elsewhere. What can they do? 

Patients are entitled to change providers and should contact DRSS on tel 01626 883888 to request this. 

I have been contacted by a patient who has been told  to come back to me to “expedite” their referral-what should I do? 

Referrals cannot be expedited – this is unfair on everyone else on the waiting list and is an improper request to a primary care clinician. You can look at the data on the LOCs “Choices Tables” and see if an alternative provider may be able to see the patient sooner and they can contact DRSS to request a transfer to this new provider. Alternatively sign post the patient to DRSS with a request to be transferred to a new provider if available. 

 My patient has been placed on a different provider’s waiting list than the one they chose and that was outlined in their original referral. What should I do?  

NHS England guidance clarifies that patient choice should occur as early as possible in the patient journey. Therefore, if the patient has decided on a provider (subject to the rules outlined previously) and this has been included in your referral and noted on the patient records, DRSS should not change this without contacting both the patient and you prior to making any changes. Devon LOC should be contacted in all cases to ensure this is bought to the attention of local commissioners.