ERS pilot in North Central London

NHS X, the rapid development arm of the NHS, and NHS England London Team are testing electronic GOS referrals between primary care optometry and secondary care hospital eye services (HES) to remove the need for paper forms and improve communications back to Optometry through Advice & Guidance. The North Central London area ICS has been asked to pilot this service for London region before a wider deployment across London.

Unlike most of primary care referrals to hospital, optometry currently relies on use of the GOS 18 form to refer to secondary care. The majority of optometry referrals are sent by fax or email and do not include high resolution images such as OCT, with supporting optometry scans often repeated in hospitals, delaying clinical decision making and patient care. Furthermore, Optometry has never benefited from connection to the NHS HSCN (N3) network (IT infrastructure), meaning there has been reduced opportunity for collaboration with key stakeholders in the patient journey.

The new service aims to allow all Optometrists the ability to safely submit referrals to the NHS e-Referral (ERS) System ,ensuring that patients are directed to the right clinic first time; reducing waiting times and improving both NHS efficiency and patient eyecare outcomes.

As the pilot develops, Advice and Guidance (A&G) services will be offered by the local HES providers, enabling greater Ophthalmology input before referral, or possibly allowing patients care to be maintained in Primary care under local Ophthalmology guidance and shared care schemes

Following a competitive open tender process, Evolutio Care Innovations Ltd (Evolutio) will be working collaboratively with North Central London ICS, in partnership with NHS X, NHS England London Team and Moorfield’s Eye Hospital NHS Foundation Trust, to deliver the EeRS service.

The new service went live on 5 May 2021, there is still time to sign up by emailing or call 0203 917 3900.

There will be three key phases to the EeRS service as the technology platform develops over 9 months from May:

  1. Electronic referrals from optometry to ERS, replacing paper GOS 18 referrals, with the option to attach diagnostics, including full volumetric SD-OCT.
  2. Hospital acceptance / rejection of referrals, with access to manipulate volumetric OCT and Diagnostics.
  3. Hospitals to provide advice and guidance back to referrers with 2-way communication possible on a case-by-case basis.


EeRS is integrated directly with existing ERS interfaces so that bookings made through Evonnect [the EeRS platform] are shown in PAS in the normal way if ERS is enabled.

Access is user based, with administrator and read-only access permissions set at a Trust level.

By registering with a unique user email and phone number, reminders are generated by the system to individual users. Daily updates on progress are also sent via email. The phone number is used to reset passwords principally, though SMS can also be chosen by users for reminders and updates if preferred.

No, Evonnect is not working in real time with the Active Service Directory directly, but it does pull the list out into its own environment to build its own directory of services across each CCG. This allows both hospitals and the community services to be listed, where some may not be on ERS.

We require your personal mobile number and email as a means to reset your password should you forget it at any point during service provision or in the event that we need to notify you if  we have identified an unusual login activity under your access (similar to iOS and Android security management).

We will not use your mobile or personal email for anything other than activity directly relating to this system and your user account.

Message’s visibility is managed at a role / user level in line with normal Information Governance limits. Patient record access is typically at a care group level e.g., department or store level. In private mode only immediate care group users can see information exchanged.

The GOS 18 contract does not require Patient Choice to be offered at the point of referral. However, AOP advice to Optometrists is to do so where possible. Optometry is therefore supported in Evonnect through use of SNOMED CT decision support, to help Optometrists refer to the most suitable clinic for each patient, reducing wrong referrals in hospital clinics.

Evonnect can support direct Patient communications about the progress of their referral to hospital. However, under this procurement this is not currently specified.

Evonnect is linked to the Patient’s Summary Care Record.

No, but the bi-directional information linkage with OpenEyes and Medisoft is within the project plan, and some progress has been started.   

Each Trust CCIO needs to determine that process appropriately for each Trust, taking account of other systems and processes. Under the commissioned service, rejections before booking into ERS, are not recorded by Evonnect into ERS or PAS systems.

Referrals sent back are received at a practice level, not at individual Optometrist level so practice management can reassign this work.

You can access all historic referral submissions within Evonnect, via the ‘submitted’ button. From here, you can open any previous referral and access the ERS onward booking information, its status within the care journey, and any notes made after you submitted the referral.

Additionally, you can use the messaging service contained in Evonnect to ask anyone involved in the patients ongoing care for additional information. This leaves a record of the query [ or rejection] on the patient file.

Yes, if the referring clinician loads the diagnostics as a DICOM file on a referral (which are downloadable as required from most OCT machines), then the receiving clinician can access all the slices and manipulate the scan.

All images are DICOM standard, so image slices are available also.

At present the commissioned service is to promote referrals with scans to most suitable clinics. Information flows and Advice and Guidance between clinical staff will develop over time as use of the service grows and familiarity with information options develops similarly.

Supply of Evonnect is part of the national procurement process for all EeRS systems, so has been accredited to meet the supplier common standards. Additionally, local DTAC, DCB & IG requirements have been reviewed by the contract holder and Moorfields.

Triage can take place fully within Evonnect where supporting scans and Patient information has been provided by the referring Optometrist.

Via the local pathway as normal. In most cases this is a call to the Duty Eye Dr of your local hospital.

We plan to add this as integrated working progresses, but currently this is beyond the immediate commissioned contract requirement.

Any Hospital IT department looking to whitelist the Ophthalmology Hospital web app should whitelist:

It is recommended that all subdomains (wildcard) of the domain are whitelisted.