You are here

Newmedica Community Ophthalmology Service Good

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 17 October 2019

Newmedica Community Ophthalmology Service was operated by Lincolnshire Newmedica Limited. It was an ophthalmology clinic that provides surgical procedures in addition to pre-surgical assessment clinics. The surgical procedures mainly consist of cataract surgery, with 903 operations between January 2018 and December 2018.

The service has had a registered manager since 2017, when it was first registered with CQC. We inspected this service using our comprehensive inspection methodology on 15 May 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: were they safe, effective, caring, responsive to people's needs, and well-led? 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 main service provided by this service was a surgical service.

We have not rated this service before. We rated it as Good overall because:

  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.

  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff protected the rights of patients in their care.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • People could access the service when they needed it and received the right care in a timely way.
  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. The leadership drove continuous improvement and staff were accountable for delivering change.
  • There were high levels of staff satisfaction across all equality groups. Staff were proud of the organisation as a place to work and spoke highly of the culture.
  • There were consistently high levels of constructive engagement with patients and staff, including all equality groups.
  • Innovative approaches were used to gather feedback from people who use services and the public, including people in different equality groups.

However:

  • The sound level in the minor operations room was not compliant with HTM03-01 (Heating and ventilation of health sector buildings HTM 03-01). The 49dba (target 45 dba or below) sound level is due to the air flow within the theatre space. Ear protection is offered to staff and patients.

Following this inspection, we told the provider they should make three improvements, even though a regulation had not been breached, to help the service improve. Details were at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North)

Inspection areas

Safe

Good

Updated 17 October 2019

We rated it as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • The service controlled infection risk well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • The service had enough medical and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

However;

  • The sound level in the minor operations room was not compliant with HTM03-01 (Heating and ventilation of health sector buildings HTM 03-01). The 4dba increased sound level is due to the air flow within the theatre space. Ear protection is offered to staff and patients.

Effective

Good

Updated 17 October 2019

We rated it as Good because:

  • The service provided care and treatment based on national guidance and evidence-based practice. Staff protected the rights of patients in their care.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
  • Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions.

However;

  • The pain relief provided to patients were topical local anaesthetics to prevent pain and sensation during cataract surgery and other procedures. There were no additional pain assessments completed and the service did not collate pain and comfort during surgery data from patients. The service did not audit pain in patients post operatively. However, these have been added to the patient pathway since the inspection.

Caring

Good

Updated 17 October 2019

We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • All feedback received from patients we spoke with was positive.

  • Staff provided emotional support to patients, families and carers to minimise their distress
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 17 October 2019

We rated it as Good because:

  • The service planned and provided care in a way that met the needs of individual people and the communities served. It also worked with others in the wider system and local organisations to deliver care in a way to ensure choice and flexibility.
  • The service was inclusive and took account of patients’ individual needs and preferences. This included people with protected characteristics under the Equality Act.
  • During the inspection we observed dementia appropriate signage and signposting and identified that training had been provided for all staff who came into contact with patients. The service also provided Alzheimers events such as Alzheimers awareness days.
  • Staff made reasonable adjustments to help patients access services, including those people who are in vulnerable circumstances. They coordinated care with other services and providers.
  • People could access the service and appointments when they needed it and received the right care in a timely way that suited them. Technology was used proactively to enable those to happen.
  • Newmedica aimed to exceed the 18 week Referral to Treatment (RTT) under the NHS Constitution. Newmedicas new referral services has shown that 100% patients attend their first appointment within 8 weeks of referral
  • In addition to this Newmedica tracked all patient pathways against the relevant RTT targets (72% of patients were seen within 4 weeks).
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint. The service could demonstrate where improvements had been made as a result of learning from complaints.

Well-led

Outstanding

Updated 17 October 2019

We rated it as

Outstanding

because:

  • Leaders had the integrity, skills and abilities to run the service. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. The leadership drove continuous improvement and staff were accountable for delivering change.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy.
  • The service had shown a continually Improving culture by introducing Clinical Practice Improvement Boards within the clinic to highlight complaints, compliments, audits, and the vision of the organisation.
  • Toolbox Talks were held to continual embed good practice around MCA, Safeguarding, person-centred care delivery.

  • There were high levels of staff satisfaction across all equality groups. Staff were proud of the organisation as a place to work and spoke highly of the culture.

  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure.
  • There were consistently high levels of constructive engagement with patients and staff, including all equality groups. Innovative approaches were used to gather feedback from people who use services and the public, including people in different equality groups.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation.
Checks on specific services

Surgery

Good

Updated 17 October 2019

We found that:

  • The service had enough staff to care for patients and keep them safe.
  • Staff had training in key skills, understood how to protect patients from abuse, and managed safety well.
  • The service managed safety incidents well and learned lessons from them.
  • Managers monitored the effectiveness of the service and made sure staff were competent
  • We found good governance and audit systems.
  • Staff treated patients with compassion.
  • People could access the service when they needed it and did not have to wait long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills.
  • The leadership drove continuous improvement and staff were accountable for delivering change.
  • There were high levels of staff satisfaction across all equality groups. Staff were proud of the organisation as a place to work and spoke highly of the culture.
  • Governance and performance management arrangements are proactively reviewed and reflect best practice.
  • There were consistently high levels of constructive engagement with patients and staff, including all equality groups.
  • Innovative approaches were used to gather feedback from people who use services and the public, including people in different equality groups.

However;

  • The sound level in the minor operations room was not compliant with HTM03-01 (Heating and ventilation of health sector buildings HTM 03-01). The 4dba increased sound level is due to the air flow within the theatre space. Ear protection is offered to staff and patients.
  • The pain relief provided to patients were topical local anaesthetics to prevent pain and sensation during cataract surgery and other procedures. There were no additional pain assessments completed and the service did not collate pain and comfort during surgery data from patients. The service did not audit pain in patients post operatively. However, these have been added to the patient pathway since the inspection.