Transformation Directorate

Secure communication between primary and secondary care for urgent advice and guidance

Oxford University Hospitals NHS Foundation Trust is made up of four hospitals - the John Radcliffe Hospital (which includes the Eye Hospital), the Churchill Hospital and the Nuffield Orthopaedic Centre, all located in Oxford, and the Horton General Hospital in Banbury, north Oxfordshire. They provide a regional tertiary referral centre and during 2019-20 the Trust had 1,471,197 patient attendances. The ophthalmology service is very busy and provides comprehensive and specialised eye care to the region.


Within the NHS, the general practitioner (GP) has usually been the first point of contact for most patients with an eye problem. However, GPs often do not have the necessary equipment, or see a large enough volume of eye emergencies, to effectively diagnose and treat more complex or higher-risk acute eye conditions. In many cases, this results in avoidable attendances of lower-risk patients to ophthalmologists working within hospital eye departments.

This increased pressure on hospital eye services creates difficulty in ensuring there is enough capacity to care for sight-threatening or long-term eye conditions. The Oxford Eye Hospital team recognised that if suitable patients could be managed in the community this would provide more rapid access to care, a better patient experience and release hospital capacity for those patients with more complex and higher risk conditions.


To be able to work more closely with primary care optometrists underpinned by the ability to communicate securely with secondary care specialists for advice and guidance.

Solution and impact

Within Oxfordshire, the Minor Eye Conditions Service (MECS), which is funded by the local commissioners, provides assessment for patients with minor and lower-risk acute eye conditions within primary care optical practices. Traditionally, primary care optometrists have not been able to routinely access basic NHS systems such as NHS email or the e-referral system.

However, optometrists can now gain access to email, which allows the secure transfer of patient information. Using a dedicated email address, a pilot scheme was set up to establish whether an electronic 'advice hotline' made available to connect optometrists and GPs to ophthalmic consultants could reduce unnecessary attendances to the Oxford Eye Hospital.

Between October 2017 and January 2018, 169 emails were received. One consultant ophthalmologist triaged and responded to each of these emails. 92.3% (156) were responded to within 24 hours of receipt. Of these, 65.7% (111) were dealt with on the same day, and 26.6% (45) within a day. 37.9% (64) of queries came from GPs and 58% (98) from optometrists. The remainder were from a combination of patients, pharmacists, and other specialty doctors.

17.8% (30) of emails related to medication queries. Others comprised queries about: anterior segment conditions - 15.4% (26); medical retina disorders - 14.8% (25); vitreo-retinal pathology - 9.5% (16); neuro-ophthalmology - 8.9% (15); retinal lesions of uncertain significance - 8.3% (14); post-operative issues - 5.9% (10) and administrative queries - 10.7% (18). The remaining few related to glaucoma - 3% (5); non-specific visual symptoms - 3% (5) and ocular motility 3% (5). The audit concluded that 71 Hospital Eye Service (HES) appointments were avoided through advice and guidance.


NHSmail is the national secure collaboration email service for health and social care in England and Scotland. It is approved by the Department of Health and Social Care for sharing patient-identifiable and sensitive information. Staff working in a trust or other NHS organisation can register for an individual email account through the trust IT department.


  • Secure email based on Microsoft exchange 2013
  • Access via desktop mail applications, outlook web access or mobile devices
  • Sending sensitive information to non-secure email addresses, including patients, via NHSmail encryption feature (this requires adding ‘[secure]’ at the beginning or end of the subject line
  • Administration portal - management, audit and reporting function
  • Directory - provides a single source of contact information for health and social care professionals
  • Instant messaging


  • The ability to send photos and messages securely from referrer to clinician for opinion
  • Can be used for advice and guidance, improved referrals, second opinions

Key figures/quotes 

“When looking for communication systems to join up primary and secondary care eye professionals, people often overlook the potential for a very simple solution – to use NHSmail. The NHS England optical services commissioning team have done an amazing job in supporting so many primary care optical practices to have access to NHSmail and getting this function for optometry practices is now much simpler.”
Melanie Hingorani, consultant ophthalmologist, Moorfields Eye Hospital, national eye care restoration and transformation clinical lead

Find out more

Find out more by visiting the NHSmail website

Key contact

Guy Mole, Eye Care Restoration and Transformation Joint Clinical Lead, NHS England.