We carried out an announced comprehensive inspection on 16 March 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led.
Our findings were:
Are services safe?
We found that this service was not providing safe care in accordance with the relevant regulations
Are services effective?
We found that this service was providing effective care in accordance with the relevant regulations
Are services caring?
We found that this service was providing caring services in accordance with the relevant regulations
Are services responsive?
We found that this service was providing responsive care in accordance with the relevant regulations
Are services well-led?
We found that this service was not providing well-led care in accordance with the relevant regulations
Background
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
East Midlands Medical Services is a community eye service specialising in the provision of on-going testing and management for patients with glaucoma, in addition to a new paediatric service specialising in the management of lazy eyes, squints and children who need glasses. These services are funded by the NHS and patients are referred to the service from a local hub following a GP assessment.
East Midlands Medical Services is registered with the Care Quality Commission to provide services from an optometrist at 190 Wollaton Road, Nottingham NG81HJ. The provider has been registered to provide services since 21 June 2013.
The staff work primarily within other services and on average work one day a week on a scheduled basis within this service, depending on demand and availability. The clinic offers appointments at the following times, this can be extended depending on demand:
- Monday to Friday 9am until 5pm
- Saturday 9am until 4.30pm
The main workforce consists of two ophthalmologists, four optometrists, two orthoptists, and two administrative staff. The service utilise a room within an opticians and have a safe storage area for records and equipment within the site. All patient treatment rooms are on the ground floor and there is an accessible disabled toilet and baby changing facilities available. There are some parking spaces available on the shop front and it is located on a bus route.
One of the optometrists is the registered manager and works within the service. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
As part of our inspection we reviewed 18 CQC comment cards where people provided feedback about the service. All of the 18 comment cards we received were extremely positive about the care and treatment received. Patients described the service as efficient, praised the location for being clean and bright, and the clinicians as professional, polite and caring. Patients also complimented the appointment system and the fact that the service always ran on time.
Our key findings were:
- There was a system in place for managing unintended incidents.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The provider followed NICE guidelines to ensure clinical practice was up to date and to drive improvement.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- Patients were positive about the care they received and the way in which it was delivered.
- The practice proactively sought feedback from patients after the consultation and on an annual basis by a telephone questionnaire.
- There were Saturday appointments available from 9am to 4.30pm for those unable to attend appointments in the week.
- There was a system in place for monitoring complaints and we saw an historic complaint, which was effectively managed, the patient responded to in a timely manner and apologies given when appropriate.
- There was a clear leadership structure and staff felt supported by the partners
We identified regulations that were not being met and the provider must:
- Ensure care and treatment is provided in a safe way to patients. (For details, please refer to the requirement notice at the end of this report)
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. (For details, please refer to the requirement notice at the end of this report)
There were areas where the provider could make improvements and should:
- Review the procedure for updating staff in relation to policy changes.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice