Direct Referral

NHS England have commissioned an electronic Referral System (eRS) for optometry referrals and this is now active using the Opera online web-based software. The LOC advises all optometrists and contractors to utilise the GOS18 facility on Opera to refer all patients not covered by the commissioned services, such as CUES, Cataract pre-op or Glaucoma Repeat Measures. to the Hospital Eye Service. The eRS GOS18 can be used to refer patients to the Hospital Eye Service (HES), GP or fellow optometrist for further assessment and treatment.

For almost 20 years, we have had direct referral for local optometrists to refer patients to the Eye Department of St Helens hospital, part of St Helens & Knowsley NHS trust ands Warrington & Halton NHS Trust. The new eRS GOS18 process is now the standard method to refer to HES and a copy of all referrals will be sent to the GP by the Opera software.


There are Wet AMD services available locally at St Helens and Warrington eye departments. Local optometrists should refer rapidly to these services where they suspect the presence of wet AMD. This page includes versions of the AMD atlas document, which gives information on when to refer to HES.

The referral should now be done via the Opera software, either by eRS GOS18 or following a CUES appointment, where possible. The patient’s desired provider, such as AMD services at St Helens or Warrington should be chosen and it’s possible to upload and send images or OCT scan files.

The service will contact the patient and arrange an initial assessment within 2 weeks. NB The LOC does not advise referring AMD patients to the GP for onward referral.


The documents used by local optometrists are available on this page. Most of them are generic documents and could, therefore be used by optometrists in other areas.

  • Electronic GOS 18
  • Direct referrals to Warrington HES
  • Direct Referrals to St Helens and Knowsley
  • St Helens Wet AMD referral form
  • Warrington Wet AMD referral form


If you have any comments to make or want more information, please contact the LOC chair Bob Wilkes [email protected] 0151 426 2214