Using the AOP’s joint statement on referrals

The joint statement of the AOP, the Royal College of Ophthalmologists and the College of Optometrists is designed to encourage best practice and joint working to improve referral practice and reduce unnecessary referrals. It is aimed at several audiences, which means that there are several ways you can use it. 

Use one

You can use it to explain to commissioners the value of repeat readings and referral refinement.

Commissioners may complain about false positive referrals without understanding two important things.

The first of those is that referral rates are actually very good. If you come across that misunderstanding, you can use the AOP’s The Truth about False Positive Referrals factsheet to help explain about positive predictive values.

The second misunderstanding is that general ophthalmic services does not pay practices to carry out repeat measures or referral refinements that could reduce false positive referrals even further. Commissioners need to understand that it is their responsibility to commission such schemes. The statement sets that out and calls on them to commission Minor Eye Conditions Services, pre- and post-op integrated cataract care, and glaucoma referral filtering and monitoring, in line with NICE guidelines and guidance from the Clinical Council for Eye Health Commissioning.

We know that it is possible to overcome these problems because people have succeeded

Use two

You can also use it to confirm the value of feedback on referrals.

How can an optometrist know if they are making good referrals if they never receive any feedback on them? While some hospitals achieve over 90% feedback rates, the majority manage nothing like this.

The statement repeats the existing policy of all three organisations: optometrists should receive feedback on any referrals they make to hospital. This is, of course, not just a matter of courtesy.

As optometrist Professor Bruce Evans pointed out at 100% Optical 2020, providing feedback means that the referrer knows the patient has been seen, which is itself an important check for patient safety, and knows if the problem they referred them for has been addressed. It can also be a very useful learning experience for the optometrist.

The statement argues that providing feedback will not only improve referral quality, it can also contribute to a reduction in unnecessary referrals, thus freeing up hospital time for patients who have an urgent need to be seen.

The joint statement is a way of getting debate going in your local area

Use three

Finally, you can use it to discuss good referral practice in your workplace.

The statement reiterates the importance of professionals having time after consultations to complete referrals, which has been in the AOP's guidance on managing risk in practice for some time. The statement also recommends that employers support employees to improve their referral practice, including by building relationships with hospital eye service colleagues and facilitating staff to spend time with hospital colleagues as part of their professional development. 

A key message

Nobody is trying to suggest that these improvements are easy to achieve. Issues include time pressures in both primary and secondary care, and the limitations of IT systems.

Commissioners have to make difficult choices about where to spend their money. But we know that it is possible to overcome these problems because people have succeeded. There are examples of change, and Scotland and Wales have both made strides in reducing hospital pressures by funding optometrists to do more in the community. The joint statement is a way of getting debate going in your local area.


To access the joint statement by the AOP, the Royal College of Ophthalmologist and the College of Optometrists, visit the Association’s website.