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 Moorfields Eye Hospital NHS Foundation Trust, to deliver the EeRS service.

The new service will go live on 5 May 2021, register interest 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. Hospitalstoprovideadviceandguidancebacktoreferrerswith2-waycommunicationpossibleonacase-by-casebasis.

To register, the Optometry (GOS 18) Web App can be found at

Whilst each clinician registers for access, we would recommend that the practice manager (or similar) registers for access first so that they can assign locums etc within the system and have an overview of all active clinicians. No external software or data needs be imported onto PCs or practice management systems to access the app. This is a web browser application only.

Any IT departments looking to whitelist web apps should whitelist:

It is recommended that all subdomains (wildcard) of the domain are whitelisted.  However whitelisting specific domains only is preferred then the other subdomain that actively used is . You would not browse to that location, rather it is where images are located that the browser will try to access when displaying pages from and applications.

Each person registering for the app will need to prove their identity using GOC/GMC number and either DVLA issued driving licence or their passport. These details will then be checked against relevant professional registers to ensure only permitted personnel can access the service.

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.

We do not allow group mailbox or generic practice emails for user registration as these compromise security in the event of a password reset. If a user has registered an email at login, then that same email will not be available to another user at point of registration. 

Non-Clinicians will be able to sign up to the software, but the verification process will require the business owner of practice manager to support the application authorisation process. However, only clinicians on the register (inc DO Contact Lens fitters) will be able to make referrals during the pilot phase in 2021.

While the look and feel of the new EeRS service is similar to the existing GOS 18, intuitive directory and SNOMED lookups and smarter patient record information field population, should ensure no extra work is created, with fewer send-backs (rejections) from HES consultants and/or bookings teams.

The new EeRS service will reduce time spent managing lost referrals and chasing hospital appointments on behalf of patients, through direct clinic booking, better pathway identification and accurate patient details (such as NHS number) easier to populate.

Every 30 days there will be a pop-up window when you login, asking if you wish to provide any helpful feedback or suggestions to improve the app. You have the option to permanently ignore this, but it is useful to keep feeding into the ongoing design, so we are able to recognise your needs from the system and any ways in which we can continue to make it better with every product enhancement. Alternatively, you can email us at

We offer a support desk that can be accessed by email or by phoning 0203 917 3900 between the hours of 0800-1800 Monday – Saturday.

We believe the app is quite intuitive and many of you will be happy to just start using it. However, upon active registration you will have access to a training video and system walk through. We also offer instore and/or online training by individual request.

It is not compulsory at this stage to participate in the EeRS service, but this is a great opportunity for Optometry to become and work closer with the HES, both in bidirectional communication and collaborative care, but also in future commissioning opportunities and extending the scope of services Primary Care are involved with delivering. Providing HES consultants with electronic referrals and high-resolution images/diagnostics enables more efficient clinical decision making, reduced duplication of work i.e. repeated scans and significantly improved patient outcomes and experience.

Yes. This pilot will be offering an API to all PMS systems who wish to integrate, but this is part of a wider NHS X National project. If you wish to minimise double entry and re-keying during the pilot and you use a standard referral template from your PMS provider, then we can offer to integrate this template into the app. This means you can produce the referral in your PMS and then simply drag a pdf into the app to populate all possible matching fields of data.

Existing NHS data management agreements in respect of the Optometrists and the Secondary Care Providers do not change under the new service. Evolutio specific data obligations with regard to Patient Referrals is governed by the NHS under this service as a Data Processor. Referral Information and PID (Patient Identifiable Data) is sent directly under established data processing agreements of GOS Services and NHS Standard Provider Contracts, using the EeRS platform.

However, under the End User Licence Agreement of using the software (accepted or rejected at the point of registration), Evolutio will collect and process Personal Data of End Users which may include contact information, audit trails of the use of Evonnect and IP address in accordance with the Privacy Policy. Evolutio may also collect and process sensitive personal data (also known as ‘special categories of personal data’) relating to you the End User as part of Evolutio’s security processes in relation to the issue and maintenance of End User IDs and access to Evonnect in accordance with the Privacy Policy. This is all under agreement with the NHS.

[1] Please add link to privacy policy

The Evolutio EeRS system does not require either of these to be completed by Optometry as end users are not using an open access to systems such as SCR and the IG controls within the platform limit wider accessibility.

This is not essential, but it is always good practice to have a NHS email account for the purpose of communicating securely, in any patient care regard, beyond the EeRS service.

Referrals can be viewed across the practice, regardless of who made the initial referral. This ensures that if there is a rejection or issue with a patient referral, then any clinician within a practice can complete any required actions. This is particularly important in practices with locums or lots of shift patterns.

In addition, there is a limited view (subject to IG controls) available should a patient move Optical practice from one year to another, ensuring key care information moves with the patient.

For a user to be added to a practice, they must first be setup with an active login to the EeRS app. Once their access rights and ID have been verified, they can then be added to any practice by a practice i.e. once a locum has an active login, they are then able to work across any number of practices – each practice can simply activate/deactivate practice access on the days they are working/not working.

All staff changes, including temporary staff such as locums or staff members working at a different location, can be simply added or removed by the practice account admin. Any incomplete referrals can be assigned to other optometric staff by the practice manager. Staff leavers can be de-registered by the practice manager for that location only. Similarly, practice managers can set start and end dates by staff member easily in the app.

We recommend that the Practice manager or lead clinician joins the EeRS app first, so they are the ‘practice admin’ to add and remove future clinicians.

Referrals sent back to a practice by the HES can be seen at a practice level as well as at optometrist level, so can be reassigned and completed by colleagues during holidays or if a staff member / locum has left the business. Electronic referrals ensure a Primary care clinician has full confidence a referral has been delivered to the desired Hospital Provider and it has been accepted.

The service/ pathway covers referrals from both GOS and private sight tests for patients who are being referred on for further NHS care. It is available for any patient who requires an NHS ophthalmology appointment.

Yes, the system supports the sharing and markup of full volumetric SD-OCT as a DICOM file type. You may need to speak to your OCT supplier to ensure you can export in DICOM format. Additionally, videos can also be uploaded and shared via the App. Images & videos including OCT and fields can be added to the referrals via drag and drop or upload and search from your practice system. Once added to the referral, these are then sent via the system to the hospital consultant.

Yes, either as an admin for their practice or to create referrals if they are a contact lens fitter.

If you are having difficulty wit your verification codes, please make sure you’re in an area with signal for your phone and you type in the verification code instead of copying and pasting it. If you still are having difficulty, you can email use or call 0203 917 3900.

The CCG area is based on practice location and not the patient’s location, the current pilot area is in North Central London, this area covers Islington, Camden, Haringey, Enfield and Barnet.

We ask for a headshot image and proof of identity when registering, usually either a driving licence or passport. However, there is no limit to the number of identification documents should you need to add additional attachments that you think are relevant.

In the app there is a section called referral status, it’s here you will be able to see the stage of your referral.

In the app there is a section called referral status, it’s here you will be able to see the stage of your referral.

If you would like the functionality of adding site users, you will need to choose Optom and Admin rights when registering for the app. Once this is completed, log onto your account and click the Config Home button which will take you to ‘Add sit users’. This functionality will give you the access to add additional Optoms to your account.

The GP copy gets issued by email [or post to the patient’s registered practice if no email address is found ] immediately after the referral is made.

A copy of the referral letter can be printed and handed / posted to patient or the patients email added to cc list as required.

Any Optician IT department looking to whitelist the Optometry web app should whitelist:

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

When completing a referral on the web app, the urgency selection has a radio button of (routine, urgent, info only)

If you select info only / letter to GP it gives you a warning that they should print it out and as we are not able/commissioned to be a mail system to send letters to GP for info only at this stage.