Practice Plus Group Ophthalmology

Rochdale Ophthalmology Clinical Assessment and Treatment Service is operated by Care UK Clinical Services Ltd. Facilities include one operating theatre and outpatient facilities.

The service provides surgery and outpatients and diagnostic imaging. We inspected surgery and outpatients and diagnostic imaging.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 15 and 16 November 2016, along with an unannounced visit to the hospital on 30 November 2016.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The surgery and outpatient services worked closely together with staff working between disciplines. Where our findings on surgery – for example, management arrangements – also apply to outpatient services, we do not repeat the information but cross-refer to the surgery core service.

We rated this service as outstanding overall.

We found areas of outstanding practice in surgery:

• The service audited the outcomes of every patient who had surgery at the service. The service measured patient outcomes service wide and individually for each consultant.
• The service achieved and exceeded patient outcome professional standards for cataract surgery and age-related macular degeneration (AMD), while achieving better (lower) complication rates than recommended in professional standards. Irrespective of the low numbers, the service reviewed all complications to derive any relevant learning.
• The service proactively planned surgical and clinic sessions up to 12 months in advance and, using management information, was flexible to demand for the service. The service filled empty surgery slots by bringing surgical dates forward, thus shortening the waiting time for patients.
• The service provided a fast-track 48 hour service from referral to treatment for patients with AMD. This included a ‘one-stop-shop’ facility, where appropriate patients could undergo intravitreal injection within the same appointment, which reduced the likelihood of any further deterioration of vision.
• At the time of the inspection, the waiting time for cataract surgery was three weeks from the time of the initial consultation.

We found outstanding practice in relation to both surgery and outpatient care:

• All patients were treated by staff compassionately and their privacy and dignity was maintained. Staff treated all patients with respect and as individuals, taking into account their personal needs and, through working closely with the eye clinic liaison officer and other community professionals, ensured that social needs were met after treatment.
• The service contacted every patient who did not attend an appointment by telephone, to discuss the reasons of non-attendance and to reiterate the importance of attending appointment to prevent further deterioration of eyesight.
• The service developed two patient forums; one for AMD patients and the other for Glaucoma patients. These forums were open to any patient, or relative of a patient, with AMD or Glaucoma to discuss any concerns or anxieties they may have.

We found good practice in relation to both surgery and outpatient care:

• There were systems in place to keep people safe and safeguarded from harm. The service had procedures to investigate and learn from incidents.
• The environment was visibly clean, procedures were in place to prevent the spread of infection and equipment was well maintained and appropriate for the service.
• There were systems in place to ensure the safe storage, use and administration of medicines.
• The service held contemporaneous and fully completed patient records for every patient who used the service. As all records were electronic, these could be easily accessed by staff.
• There were adequate numbers of suitably qualified, skilled and experienced staff (doctors, nurses and health care assistants). Mandatory training completion was high and all staff had received an appraisal within the last year.
• Care was delivered in line with national and Royal College guidelines.
• The service had robust arrangements in place for obtaining consent for patients having surgery or other procedures at the service.
• The service offered a range of appointments, which meant that patients could attend at times suitable for them. A satellite clinic offered outpatient appointments, so patients did not have to travel as far and outpatient home visits were offered for patients who could not leave their own home.
• The service was responsive to patients who required additional support, such as patients living with dementia, with learning disabilities and with hearing loss.
• The service worked with the local eye clinic liaison officer and district nurses to provide additional support to patients.
• While the service received very few complaints, it had a complaints process in place and supported patients who had concerns about the service.
• Staff felt supported and confident in the management of the service. Staff worked well together and there was a positive culture. Staff engagement was good, which was demonstrated in the most recent staff survey.
• The service had a clear vision and strategy, which were understood by staff.
• The service had appropriate governance structures in place and systems to identify, manage and mitigate risks.
• The service had appropriate arrangements for laser protection advisor and supervisors.

There were no breaches of regulations. However, there were areas where the provider should make some improvements, even though a regulation had not been breached, to help the service improve. These were:

• The service should consider reminding staff to ensure that sharps bins are ‘part-closed’ as appropriate.
• The service should ensure that staff are observing hand hygiene precautions when having contact with patients.
• The service should consider how it can formalise the assessment and recording of patient pain.
• The service should ensure that a record of progress against actions taken following its bi-monthly meeting is recorded and updated.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)