Elite Community Ultrasound

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This was our first assessment of this service. This key question was rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff used evidence-based guidance to support the delivery of care, and there were clear eligibility criteria for the services provided. The service had effective processes for managing unexpected findings and ensuring continuity of care through timely communication with referring clinicians. Staff sought and recorded consent appropriately, and people were supported to make informed decisions about their care.

However, some policies had not been fully tailored to the service, and arrangements for clinical appraisal, competency assessment and independent review of sonography practice required strengthening.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service accepted referrals from people who self-referred and from healthcare professionals through its website. An automated response acknowledged referrals, and the registered manager followed this up with a personalised response.

The service had systems in place to assess the suitability of referrals before booking appointments. The registered manager triaged all referrals to make sure the requested scan was appropriate and could be provided safely by the service . The service assessed people's needs using a medical questionnaire completed by the patient before each appointment. The questionnaire included questions about the reason for referral, medical conditions and any previous medical history. However, staff did not ask any additional questions or undertake any specific assessments for patients aged under 18 years. The service told us that staff considered factors such as the patient's clinical history, the indication for the examination, communication and capacity, privacy and dignity, safeguarding considerations, and whether the examination fell within the ultrasound practitioner's scope of practice and competence. However, the provider could not provide documented evidence to demonstrate how staff assessed or recorded these considerations for children and young people.

The service used the information provided to review patients' health needs before appointments and make sure examinations were suitable for their individual circumstances.

The registered manager reviewed patients' needs and presenting symptoms at the point of referral. Where symptoms indicated a need for urgent assessment or specialist input, patients were directed to the most appropriate healthcare service. For example, patients reporting vaginal bleeding in early pregnancy were advised to attend the local Early Pregnancy Unit (EPU) for assessment before undergoing a private scan. This helped patients access timely and appropriate care and reduced the risk of delays in treatment.

Staff supported patients to position themselves comfortably for imaging and adapted examinations where required to meet individual need.

Patients had access to drinking water as needed or required. There was a water dispenser for patient use, alongside a hot drink machine.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The service did not ensure consistent implementation of nationally recognised guidance and standards relating to quality and safety.

The provider's ultrasound audit policy stated that peer review audits of ultrasound practitioners' clinical practice should be undertaken quarterly. However, at the time of the assessment, the registered manager was the only sonographer employed by the service and no peer review audits had been completed. The provider had not made alternative arrangement for the registered manager's clinical practice to be independently reviewed by a suitably qualified professional. As a result, the provider could not be assured that clinical practice was subject to effective oversight in line with its own policies or national guidance.

The service had developed policies and procedures to support the delivery of care and treatment. However, some policies were not always specific to the service. We found policies that contained information relating to services the organisation did not provide or references to another organisation. In addition, the Referral and Escalation Policy and the Standard Operating Procedure for the Management of Suspected Miscarriage did not reference relevant national guidance. This meant that policies had not always been fully reviewed and adapted to reflect the service's activities, current national standards and governance arrangements.

However, the service followed National Screening Committee guidance when providing screening and non invasive prenatal testing (NIPT). Patients who self-referred received standard information and leaflets about the procedures, including the associated risks, to support informed decision-making.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Patients were able to self-refer to the service and, where consent was provided, sonographers shared scan reports with the relevant healthcare professional to support ongoing care and treatment. This demonstrated appropriate arrangements for information sharing and helped ensure continuity of care when patients required onward support or follow-up. The service also recognised the importance of obtaining patient consent before sharing information with external healthcare professionals.

The service consisted of a team of 5 staff, including the registered manager. Despite its small size, team meetings were held to discuss service updates, operational matters and any concerns. Staff told us these meetings, alongside day-to-day discussions, supported communication across the service.

The service operated as an independent healthcare provider and there was limited requirement for routine joint working with other healthcare services.

However, opportunities to strengthen collaborative working and information sharing with relevant healthcare providers had not been fully explored.

We did not see evidence of regular formal engagement with local healthcare services, such as the Early Pregnancy Assessment Unit (EPAU), to support continuity of care or develop established referral pathways. Although this is not a regulatory requirement for an independent diagnostic service of this type, developing and maintaining effective relationships with local providers could further support integrated care and improve patient experiences where onward referral or follow up is required.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff provided patients with information about their scan findings and appropriately signposted them to other services where further assessment, treatment or support was required. This helped patients to access the care they needed and supported informed decision-making about their health and wellbeing.

However, although the service confirmed that it also provided scans to patients aged under 18 years, the provider could not demonstrate how staff adapted information, communication or follow-up arrangements to meet the needs of children and young people. We did not see any documented evidence to show what additional considerations staff took when caring for this patient group.

The service primarily provided single-episode diagnostic appointments, and most patients were seen on a one-off appointment. As a result, the service did not routinely monitor patients’ ongoing care and treatment, which was appropriate to the nature of the service

The service signposted patients requiring further care or follow-up to the appropriate service.

2. We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider had not established a structured programme of regular audits to assess the quality of care provided. This included the absence of audits of ultrasound examinations and corresponding reports. The Society and College of Radiographers (SCoR) and the British Medical Ultrasound Society (BMUS), in their Guidelines for Professional Ultrasound Practice (2023), recommend that at least 5% of ultrasound examinations and reports are subject to peer review and audit. Without such audits, the provider could not be assured that image quality and reporting standards were consistently maintained, increasing the risk that errors or areas for improvement would not be identified and addressed.

The service had limited arrangements in place to monitor and improve patient outcomes. While the sonographer maintained professional registration and undertook continuing professional development to support their practice, the service did not have a formal clinical audit programme to review the quality, accuracy or consistency of scan reports.

The service primarily provided single-episode diagnostic appointments, and most patients were seen on a one-off basis. Consequently, the service did not routinely monitor patients' ongoing care, treatment or outcomes. Although this reflected the nature of the service, it meant there were limited opportunities to assess longer-term outcomes or use this information to drive improvement.

However, the service sought feedback from patients through online review platforms and used this information to understand people’s experiences of care. We saw the provider consistently monitored and responded to reviews, including acknowledging positive feedback and addressing any concerns raised. This demonstrated a commitment to engaging with patients and using feedback to support service improvement.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance when obtaining consent, and this was clearly recorded in patient records. Written consent was obtained for all scans and stored electronically within the patients record.

The registered manager completed a consent audit in April 2026, which reviewed 30 patient records. The audit found verbal consent had been documented in all records sampled and identified areas for improvement, relating to documentation of chaperone discussions, NHS care limitations and scan limitations. The service developed an action plan to address the findings and scheduled a re-audit to assess whether improvements had been embedded.

Staff knew how to support patients at risk of sensory overload or experiencing mental ill health. Additional time was allocated, or appointments were scheduled to a quieter part of the day, to promote a positive patient experience.

The service had a consent policy which provided guidance on obtaining consent from both adults and children. However, some supporting documentation within the policy was generic in nature and included references to treatments and procedures not provided by the service, such as blood transfusions, sedation and local anaesthetic. As a result, parts of the documentation had not been fully tailored to reflect the services delivered. In addition, sections relating to children and young people contained inaccurate terminology and contradictory information. This meant the policy did not provide staff with clear or reliable guidance on obtaining consent from patients aged under 18 years and increased the risk of inconsistent practice.

In addition, the service’s exclusion criteria stated that patients who could not provide consent could not undergo a procedure with the service and that staff were required to complete consent training in order to be able to use the exclusion criteria document. While the registered manager had completed up to date consent training the phlebotomist had not completed this training.