The treatment of cataracts faces significant challenges due to rising demand, costs, and system inefficiencies. Variability in service specifications, referral processes, treatment pathways and post-operative care has created health inequalities, and there are limitations in available audit/outcome data to enact effective pathway transformation.

The Humber and North Yorkshire (HNY) Integrated Care Board (ICB) proposes implementing a Single Point of Access (SPoA) for cataract pathway management delivered through the HNY Referral Support Service (RSS – locally known as the Patient Choice Office) across NY&Y for all NHS cataract patients across the six HNY Places to deliver the benefits required for patients, clinicians and the wider system.

The SPoA is supported by the ICB’s Referral Support Service. Optoms across NY&Y have been referring to the RSS via NHS Mail since pre-2012. A digital solution allows the expansion of the service and to streamline processes and turnaround time. The RSS team will process referrals and contact patients to offer appropriate Choice of secondary care providers based on the Patient Questionnaire (see q10) outcomes.

All patients will be provided with a consistent offer across HNY with an easy-to-use referral system for Optometrists and the same informed conversation for all patients regardless of geography. All patients will be offered a choice conversation regarding their preferred care provider, with access to both NHS Acute and Independent Sector (ISP) waiting times.
There will also be improved patient understanding and transparency around access to secondary care providers through the information held by the SPOA team. Lastly, there will be a reduction in inappropriate referrals into secondary care related to specific care pathways e.g. comorbidities, which can lead to delays to the patient pathway

A digital solution eliminates the NHS Mail referral mechanism and via the Gateway system, allows referrers better access to referral outcomes oversight. Additionally, a reduction of inappropriate referrals leading to secondary care rejections is expected – reducing Primary Care re-work and queries from patients.

The SPoA ensures equity of access for all patients through ensuring informed patient Choice to appropriate providers. The SPoA offers opportunities for increased efficiencies through standardisation of system and clinical pathways. The programme of work will provide an overarching view of cataract activity to support future strategic commissioning decisions and enable joined up thinking around downstream care and help with post operative checks.

 Although a physical smartcard is not required, a smartcard profile is. The ICB’s IT support team (N3i) can support your request at the following link:

CareID onboarding registration form

This is a national NHS England requirement for anyone accessing patient identifiable data via a 'Smartcard'/ Apply for Care ID.

This is the same national process for all NHS clinicians and staff who have a smartcard profile. All staff are required to provide the same information (this includes NI number).

The data goes directly to the national team and meets all IG standards.

Further information regarding how the data is processed can be found here: https://digital.nhs.uk/services/care-identity-service/privacy-notice

Gateway® provided by Accenda is a referral and advice & guidance platform that streamlines referral processes. Gateway connects with Primary Care clinical systems and e-RS to provide a total wraparound solution, improving the quality of referrals and advice requests. The Gateway system has been utilised for GP referrals into secondary care across York and Scarborough since 2013-14.

Gateway registration link for referrers (once CareID process is completed)
Gateway – Optom cataract referral demo

Once your CareID and Gateway registrations are completed, the following video demonstrates how a cataract referral is generated and submitted via the Gateway system:
Gateway – Optom cataract referral demo

Please also see the following video to see how to manage returned referrals:
HNY - Accenda Gateway® - Optician Tasks

Accenda has been working with the NHS for 17 years and are ISO27001, CE+, DSPT (YGM93), NHS England Accredited. The Gateway® platform is also DCB0129/DCB0160 Clinical Safety Compliant. For more information regarding Accenda, please contact the Referral Support Service (Patient Choice Office) hnyicb-voy.rsservice@nhs.net.

 

Following guidance from the LOCs and LON, we have developed the solution to ensure the Optometrist is the named referrer in eRS instead of the patient's GP Practice, which is the default.

To register on Gateway as the named referrer, please provide your Practice ODS information via this link. This will allow the RSS team to transfer your referral request to the eReferral Service and process to secondary care.

Please also be aware that registering your Practice to be the named referrer requires eRS worklist management. Ensuring unbooked/rejected referrals are monitored closely and secondary care responses are actioned in a timely manner. Guidance on managing your eRS worklist can be found here under 'Managing Worklists'.

The SPoA patient questionnaire, delivered to all patients can be located on the ICB website here.
 

The ICB’s new Cataract policy can be located here on the ICB website

Optoms across Humber & North Yorkshire can generate and submit referrals via Gateway. Referral progress, including the patient’s chosen provider can be tracked, ensuring oversight of referral outcomes. The following video highlights some of the key actions within the Digital Solution.

HNY - Accenda Gateway® - Optician Tasks

The process can be located here on the ICB website.

If you need to update your email address or phone number that is linked to your CareID profile, please email N3i.support@nhs.net

Please see the Cataract SPoA webinar from 02/10/2025