newmedica quality report 2017–18 · reporting and workflow solution to allow the migration from...

Newmedica Quality Report 2017–18

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Table of contents

About Newmedica 3

1. Managing Director’s Statement on Quality 4

2. Statement of Assurance 8

3. Review of our Quality Performance During 2017/2018 18

4. Priorities for 2018/19 29

5. Annex - Statements of support from partner organisations 33

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About Newmedica

Newmedica’s mission is to make eyecare better:

• Better for patients;

• Better for the NHS and those that fund healthcare;

• Better for our communities.

As a national provider of ophthalmology (clinical eye care) services, we deliver NHS funded and private ophthalmology

services. For NHS patients, we are commissioned by NHS Clinical Commissioning Groups, NHS Trusts and Foundation

Trusts, and other providers of NHS funded services.

In 2017/18, we delivered 97,413 patient interactions. At this level of activity, Newmedica is the 15th largest provider of NHS funded ophthalmology services, and the largest independent

sector provider by volume of patient interactions.

While our services are managed from our support office in central London, our organisation is decentralised. As at 31st

March 2018, we operate 23 contracts across 32 sites. The sites range from general hospitals, primary care centres,

standalone facilities and mobile clinical units.

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1. Managing Director’s Statement on Quality

All of those that work at and with Newmedica are fully

committed to delivering the highest quality of care,

treatment and support to people who use our services.

This is our first Quality Account, and it reflects on

the work and achievements of Newmedica and our

teams for the last year and offers insight into our

commitment and objectives for the forthcoming year.

This past year has been an exciting year for

Newmedica with changes to the Board structure,

onboarding of many new colleagues and a significant

evolution and development of our business model

to focus on partnership, local empowerment and

ownership and a continuation on our journey to make

eyecare better.

As a provider of specialist healthcare services, we

have worked hard over the last year to develop our

current structured clinical governance framework and

risk management processes across our support office

and all our services, and to continually review our

performance to drive improvements to the benefit of

all our patients.

In September and October 2017, our organisation

underwent eight CQC inspection visits and I am

pleased to report that we obtained a ‘Good’

rating overall.

I believe that delivering clinical and operational

excellence depends upon the mindset and

commitment of everyone in the organisation. All

colleagues are responsible for ensuring that they are

delivering a high level of performance and constantly

seeking to improve – and this is reflected in our CQC

inspection reports.

Across Newmedica we nurture teamwork and

professionalism, we value our people and set our

targets high, and we work hard in every aspect of

our services to provide facilities of a high order.

We believe in investing substantially in our people,

our services and our equipment to ensure care is

delivered in a consistent and safe manner at all times.

We all have a part to play in promoting quality within

the organisation so that the services provided to

patients are likewise delivered in an environment that

enables people to receive the best possible care for

their circumstances.

For Newmedica to lead and operate an organisation

successfully it is necessary to manage in a systematic,

structured and visible manner. There are key quality

management principles the organisation applies:

• Customer focus – Newmedica depend on our

customers. We need to understand their current

needs, adopt new and flexible approaches to

deliver their future need.

• Leadership – Newmedica’s management team

provide purpose and direction to the organisation

so that the internal environment delivers to the

patient’s needs.

• Involvement of people – Newmedica embrace

people at all levels to use their abilities.

• Process – Newmedica strives to improve

processes and maintain structure to the delivery

of patient services.

• Systems – Newmedica exploit systems as

technology but also combine processes into

the systematic approach at delivering patient

centric care.

• Continual improvement – Newmedica continually

review its performance for improvements,

efficiencies and effectiveness.

Newmedica periodically review the principles and

approach so that the delivery of patient care meets

or exceeds the expectations of both the patient

and commissioner.

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1.1 – Accountability Statement

To the best of my knowledge, as required by the

regulations governing the publication of this

document, the information in this report is accurate.

1.2 – Newmedica Service Overview

• Community • Hospital • Mobile

Locations by Type

• Minor Ops • Outpatient • Surgery

OPD vs Minor Ops vs Surgery

• Newmedica • Sub-contracted

Type of Activity

• Support Office • Services

Support Office vs Services

32 Locations287 People

89,184 Interactions 89,184 Interactions

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• AMD • Cataract • Cataract Surgery

• General • Glaucoma • Minor Ops

• Oculoplastic Surgery • Paediatric

Activity by Condition

• CCG Contract

• Independent Provider Sub-contract

• NHS Trust Sub-contract

Services by Type of Contract

• Consultant Ophthalmologist • Nurse

• Orthoptist • Optometrist

• Clinical Support Staff

Clinicians by Type

• Employed • Clinical Bank

Employed vs Clinical Bank

23 Services 89,034 Activities

287 Staff 235 Staff

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2. Statement of Assurance

2.1 – Integrated Governance Framework

Newmedica operates an Integrated Governance

Framework which has been designed and

implemented to ensure that all Newmedica services

are administered and controlled in a way that

safeguards and balances the interests of all of its

stakeholders – including patients, staff, suppliers,

regulators and the community.

The Integrated Governance Framework consists

of three committees that report to the Board of

Directors on a monthly basis outlining clinical,

safety and quality, risks and trends together with

the actions being taken:

• Medical Advisory Committee is responsible for

clinical matters.

• Quality Management Committee is responsible for

operational standards.

• Information Governance Committee is responsible

for information security.

A formal risk management process is in place

throughout the governance committee structure to

ensure a clear line of sight of all risks potentially

affecting the organisation and mitigation.

Integrated Governance Framework

Newmedica’s governance structure allows us to implement an approach to fostering a positive patient safety

culture. Newmedica’s leadership team are committed to safety and as such use the below framework to

measure and monitor safety.

Visi

on, S

trat

egy,

Val

ues

Risk Managem

ent, Reporting

Medical Advisory Committee

Information Governance Committee

Quality Management Committee

Senior Management Team

Team Briefings

Executive Committee

Board

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2.2 – A framework for the measurement and monitoring of safety

Is care safe today?

Newmedica have the following in place to ensure

our care is safe:

• Freedom to Speak up culture.

• Leadership visibility across services.

• Agreed safe staffing levels.

• Designated safety leads.

Will care be safe in the future?

We manage this through:

• Risk registers.

• Safety culture analysis.

• Safety training rates.

• Sickness absence rates.

• Appraisal rates.

Are we responding and improving?

Sources of information we learn from at a

board level include:

• Dashboards and reports with indicators,

set alongside financial and access targets.

• Compliance outcomes from audits & action taken.

• Learning & acting on staff feedback.

This has been drawn from The Health Foundation

April 2014 Vincent C, Burnett S, Carthey J.

The measurement and monitoring of safety.

The framework for the measurement and monitoring

of safety is an important step to support the delivery

of high quality patient care. The framework consists

of five ‘dimensions’ and associated questions that we

use as a tool to ensure the safety of services. We use

our data to support the dimensions for discussion at

a range of forums (as outlined in section 2.1).

Has patient care been safe in the past?

Newmedica have the following systems in place to

ensure care is safe:

• Harm assessments/Risk Assessments.

• Incident Reporting.

• Feedback from patients.

• Monitoring Infection Rates.

Are our clinical systems and processes

reliable?

We can gain this assurance from our key Governance

meetings and review our:

• Quality Assurance Audits.

• Action Plans.

• Risk Assessments.

• Key performance Indicators.

• Balanced Scorecard.

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2.3 – Contracting

Newmedica contracts with NHS commissioning

organisations using the framework of the NHS

Standard Contract. In some cases where we provide

care on behalf of an acute provider bespoke contracts

and service level agreements are used. We have an

active programme in place to ensure that all services

are contracted to protect the organisation and service

users, any sub contracting arrangements we have in

place use the NHS Standard Contract requirements

as their basis.

2.4 – Reporting Systems

As the organisation has grown, a decision was

taken during 2017/18 to procure a new governance

reporting and workflow solution to allow the

migration from highly manual processes into a

scalable system environment which affords enhanced

control and reporting capabilities.

Title Guidance Frequency Standard Compliance

Cataract: posterior

capsular ruptureNICE/RCOphth Monthly <1.8% 0.44%

Cataract: endophthalmitis

post cataract surgeryNICE/RCOphth Monthly < 0.08% <0.05%

Cataract: biometry accuracy

in cataract surgeryNICE/RCOphth Monthly

85% of patients

within +/-1D to

target refraction

91.2%

Medical Retina: visual stability

after injections for macular

degeneration

NICE Monthly >80% 92.3%

2.5 – Participation in Clinical Audits and National Confidential Enquiries

Due to the single specialty nature of Newmedica,

there are a limited number of national audits that

are relevant. Newmedica does not currently

participate in national clinical audits or national

confidential enquiries.

A regular programme of internal audits is undertaken

as part of our quality assurance strategy. The

findings are used to benchmark against standards

and guidelines set by relevant national bodies such

as the Royal College of Ophthalmologists (RCOphth)

and National Institute for Health and Care Excellence

(NICE). All audits are presented and discussed at the

Medical Advisory Committee.

Below is the list of the clinical audits that have been

identified and are now being carried out.

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The below are local operational audits carried out within our Services, the standard percentage is based

on national guidance. Service compliance reports are submitted to our monthly Quality Management

Committee for review.

Title Frequency Standard

Theatre: WHO Checklist Monthly 100%

Theatre: Consent Quarterly 100%

Infection Prevention Control Annually 95%

Hand Hygiene Audit Monthly 100%

Theatre Scrub Audit tool Monthly 100%

Cleaning Audit Monthly 90%

Health and Safety Audit Yearly 100%

Laser Compliance Audit Yearly 100%

Equality Access Audit Yearly 100%

A number of process improvements have been

implemented in 2017/18 as a result of process review

and audit:

• A text message is now being sent by surgeons

following each surgical list to identify if there

have been any complications (this is especially

important in hosted services where the surgeon is

the only Newmedica colleague on site).

• Patients pathway has become more robust – any

patient that does not achieve 6/12 vison or better

following cataract surgery will now automatically

receive further investigation.

• An amendment to our cataract pathway

document has been made to ensure co-morbidities

are being documented as it was unclear from our

audits whether Doctors had discussed this with

the patient.

• A laser audit has been introduced following the

feedback of our CQC inspection.

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As part of our improvement plan for audits, the

Governance team have oversight of the audits and are

ensuring that:

• Learning from the audits is shared with the

relevant staff groups.

• Services are implementing change in processes as

identified within each audit.

• Services carry out follow-up audits to ensure

that changes have occurred and are reflected

in practice.

• Monitoring the compliance of audits and analysing

the data derived to help create reports that will

inform and benchmark the service against

quality indicators.

The reports of the local clinical audits were reviewed

by the provider in 2017/18 and Newmedica intends to

take the following actions to improve the quality of

healthcare provided:

• Adhere to the WHO recommendations on Safer

Cataract Surgery.

• Ensure audits are relevant and comply with

National guidance and standards.

2.6 – Research

Newmedica currently does not undertake research.

2.7 – Commissioning for Quality and Innovation (CQUIN) Framework

The CQUIN payment framework enables

commissioners to reward providers by linking

a proportion of the provider’s income to the

achievement of national and local quality

improvement goals. 2.5% of Newmedica’s contract

value is conditional on achieving the three quality

improvement goals. For 2017/18, Newmedica had

CQUINs specified in five out of eight CCG contracts.

Newmedica’s agreed CQUINs for 2017/18 were:

• Improvement of Staff Health and Wellbeing.

• Achieving an uptake of flu vaccinations by

frontline clinical staff.

• Availability of services and appointments to be

published on the NHS e-Referral Service.

Newmedica has achieved a positive level of

attainment in each of the five CCG contracts that

have CQUINs specified.

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Safe Effective Caring ResponsiveWell

Led

Overall

Rating

Newmedica - Overall and

Services Managed from

London Support Office

Outpatients and

Diagnostic imagingGood Good Good Good Good Good

North Derbyshire

Community Ophthalmology

Service

Outpatients and

Diagnostic imaging

Requires

ImprovementN/A Good Good Good Good

North Derbyshire

Community Ophthalmology

Service

Surgical Good Good Good Good Good Good

Bristol Community

Ophthalmology ServiceSurgical Good Good Good Good Good Good

2.8 – Registration with the Care Quality Commission

Newmedica has been registered with the Care Quality

Commission (CQC) since 2012. During 2017/18, the

CQC conducted a comprehensive inspection of

Newmedica’s services. The following service

locations underwent a series of announced and

unannounced inspections:

• North Derbyshire Community Ophthalmology

Service.

• Bristol Community Ophthalmology Service.

• Glaucoma Monitoring Service at Kingston Hospital

NHS Foundation Trust.

• Glaucoma Monitoring Service at the Western Eye

Hospital, Imperial College Healthcare NHS Trust.

• Ipswich and East Suffolk Community Glaucoma

Monitoring Service.

• Warwickshire North Community Macular Service.

• Glaucoma Monitoring Service at Lancashire

Teaching Hospital NHS Foundation Trust.

• Newmedica Support Office.

CQC has not taken any enforcement action against

Newmedica in 2017/18, nor at any time. Newmedica

has not participated in any special reviews or

investigations by the CQC during the reporting period.

Due to the nature of our services and how they are

classified by the CQC, the output of the inspections

is split across three formal inspections. The overall

ratings received were as follows:

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Findings from the Inspections

The CQC identified an area of outstanding practice:

• The effective use of telemedicine in the glaucoma

service meant that all clinical decisions were

considered by both an optometrist and a

consultant, with a consultant making all clinical

decisions. Further, the use of an electronic

system allowed the support office to review the

effectiveness of this process, and the performance

of individual staff regularly, as well as

benchmarking all of the hubs against each other

to drive improvement.

The CQC identified many areas of good practice,

for example:

• The service had processes in place which

monitored safe care and treatment provided at

this location.

• The service had policies, procedures, and

guidelines, which were based on current

legislation, evidence-based care and treatment

and nationally considered best practice. These

were regularly reviewed at the medical advisory

committee (MAC) meetings.

• The service followed robust processes when

it came to seeking out consent from patients.

We observed best practice with the quality of

information patients received to enable them to

make fully informed decisions. We also observed

staff adhering to the two-week cooling off for

patients who underwent oculoplastics procedures.

• Staff were aware of the vision and strategy of

the service to provide ‘better eye care for all’.

Progress against delivering the strategy was

regularly monitored within the Newmedica team

and alongside the clinical commissioning groups.

• Senior staff welcomed the CQC inspection as a

learning opportunity and provided information

we requested promptly. They were open and

transparent about the service, including any

challenges it faced.

The CQC did identify some areas that required

improvement. Below are some identified in

the inspections:

• The service must ensure prompt action to address

concerns identified in relation to the operation

of the class four laser and the lack of onsite

supervisor to ensure safe usage. (North Derbyshire

Community Ophthalmology)

• The service should ensure the sepsis identification

and management policy is implemented at

the earliest opportunity. (North Derbyshire

Community Ophthalmology)

• The provider should ensure that it has oversight

of the World Health Organisation Surgical Safety

Checklist and hand hygiene audit and that this

should be added into the overall compliance

dashboards. (Bristol Community Ophthalmology

Service)

• The provider should have contract monitoring

review dates in place. (Bristol Community

Ophthalmology Service)

An action plan has been developed in partnership

with senior service leads to address the issues.

Newmedica has also identified some additional

improvements based on comments within the CQC

report and which have been incorporated in the

action plan.

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2.9 – Information Governance Assessments

2.9.1 – IG Toolkit

The information governance assessment report

overall score for 2017/18 as submitted 31 March 2018

was 83% and was graded green. This represents an

improved performance compared to the previous

year’s score of 75%. During 2018/19, the IG Toolkit

has been replaced by the Data Security &

Protection Toolkit.

2.9.2 – GDPR

The European Union “General Data Protection

Regulation” has come in to force on 25th May 2018.

Newmedica is compliant with the legislation which

is designed to harmonise data privacy laws across

Europe as well as give greater protection and rights

to individuals, including but not withstanding:

• The right to be informed.

• The right of access.

• The right to rectification.

• The right to restrict processing.

• The right to data portability.

• The right to object.

Newmedica has undergone the necessary process and

policy change to enable the General Data Protection

Regulations. Training, process mapping, policy

review and due process to make sure compliance at

all levels throughout the business has taken place,

is monitored through the Information Governance

Committee and reported to the Board who take a

keen interest.

2.10 – Workforce and Development

2.10.1 – Revalidation

Newmedica have a Responsible Officer (RO) and

Appraisal Leads. The RO and appraisers are

supported by Newmedica’s Human Resources team.

Our appraisers are appropriately trained and

doctors have access to their RO for advice around

revalidation requirements and CPD, if required. The

RO also monitors revalidation dates and reviews

annual appraisals.

We maintain a database of our nurses’ registration

and revalidation dates and we are currently reviewing

our processes to support nurses through revalidation.

2.10.2 – Freedom to Speak Up

Newmedica have a nominated Freedom to Speak Up

Guardian and an associated policy. In 2017/18 there

were no concerns raised under the policy.

2.10.3 – Equality & Diversity

Newmedica is committed to the principle and practice

of equal opportunity. We aim to ensure that all

employees, customers, patients and suppliers are

valued as individuals, and treated fairly and with

respect, regardless of age, disability, employment

status, gender, health, marital status, nationality,

race, religion, domestic circumstances, membership

of a trade union, sexual orientation, ethnic or national

origin, beliefs or faith, social & employment status,

HIV status, or gender re-assignment.

No person working for Newmedica, seeking

employment with us, or any member of the public,

patients or customers using our premises or services,

will receive less favourable treatment on any of

the above grounds or will be disadvantaged by

requirements or conditions that cannot be shown to

be justifiable.

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Newmedica’s objective is to eliminate unfair

discrimination. Failure by any member of staff to

abide by this policy may be grounds for disciplinary

action to be taken. Equality & Diversity training is

included in Newmedica’s mandatory training matrix

for employees and bank staff.

In 2017/18 we have been working towards improving

the collection of equality and diversity data alongside

our work on the Workforce Race Equality Standard

(WRES). In 2018/19 we plan to produce an annual

equality & diversity report and action plan.

2.10.4 – Staff Induction, Training & Appraisal & Supervision

Newmedica provides a structured induction plan

for key roles within services. For other roles, the

Human Resource team work closely with line

managers to plan and deliver a bespoke induction

plan. All employees attend face to face induction on

Introduction to Newmedica/ Corporate structure,

Human Resources Induction and Information

Governance training. The completion rate for this

training by employees is 100%.

Our bank staff receive a local induction at every site

they work in.

Our appraisals are conducted twice a year in March

and October. Our overall completion rate was 95%.

2.10.5 – Workforce Planning

Our workforce planning is planned and monitored an

ongoing basis through our annual planning, people

review and service modelling to ensure appropriate

staffing levels both within services and support

functions. At a service level, managers also monitor

staffing levels in line with their capacity and demand

planning. Forecasting takes place bi-annually where

capacity, demand and workforce are reviewed to

ensure sufficient trained individuals are in post to

provide safe and sustainable services.

2.10.6 – Workforce Race Equality Standard & Compliance with the Equality Act 2010

Newmedica is committed to providing the best service

possible to all of our patients and to enabling all

of our employees to carry out their best work and

develop rewarding careers.

The Workforce Race Equality Standard is now

mandated through the NHS standard contract 2017/18

and in the CCG Assurance Framework 2017/18.

Newmedica have submitted the mandatory WRES

action plan during 2017 and will be drawing actions

into an overall Equality Strategy for action during

2018/19.

2.10.7 – Celebrating & Showcasing Success

A key part of our approach to engaging our people

is through events where the leadership team

communicates significant change, the long-term

strategy and to receive real time feedback

from employees.

We hold a Company Day periodically, where all senior

managers, clinic and support staff from across the

company meet in an off-site environment, this has

a formal meeting element followed by an informal

networking opportunity for all members of staff to

meet the wider team. Topics at these events have

included: defining vision & values, announcement

of our partnership with Specsavers, organisational

structural changes and employee survey results.

The Managing Director and other senior directors visit

all services a number of times over the year to meet

the teams on the ground, gain feedback, discuss any

issues and seek resolution.

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3. Review of our Quality Performance During 2017/18

3.1.1 – Incidents, Serious Incidents and Never Events

Incidents 2014/15 2015/16 2016/17 2017/18

Activity 51,950 57,493 73,113 97,413

Incidents 58 56 202 249

Serious Incidents 0 1 1 0

Never Events 0 0 0 0

Total 58 57 203 249

Incidents % 0.111 0.097 0.276 0.255

Serious Incidents % 0 0.001 0.001 0

Never Events % 0 0 0 0

Total % 0.111 0.099 0.277 0.255

Complaints 2014/15 2015/16 2016/17 2017/18

Activity 51,950 57,493 73,113 97,413

Complaints 33 32 40 29

Complaints % 0.064 0.056 0.055 0.029

3.1 – Safety

In 2017/18 Newmedica had 249 incidents reported to

the Governance team across our services. Forty of the

incidents were patient safety incidents. There have

been no incidents that have resulted in severe harm

or the death of a patient.

The number of incidents reported have increased

over the last four years in line with activity. The

percentage of incidents against activity has remained

the same compared to the previous year showing

consistency in our reporting culture.

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All incidents undergo a formal investigation. Service

Managers are supported by the Governance Team

and the Lead Clinician for that service. All incidents

are discussed at the local service governance

meeting to help identify root cause and prevention on

recurrence. Clinical incidents are also discussed at the

Medical Advisory Committee, operational incidents

at the Quality Management Committee and data

incidents at the Information Governance Committee.

Dissemination of learning is key to ongoing learning

and prevention and facilitated through Operational

Management Group meetings as well as a Medical

Advisory Committee bulletin and a monthly

Governance Newsletter.

3.1.2 – Statement on Duty of Candour

The Duty of Candour is a legal duty on all health care

professionals to inform and apologise to patients if

there has been mistakes in their care that have led

to significant harm or a potential for significant

harm. Duty of Candour aims to help patients

receive accurate and truthful information from

health providers.

There have been ten incidents resulting in Duty of

Candour during 2017/18. Nine of the incidents did not

result in significant harm however it was recognised

mistakes had been made and therefore Duty of

Candour was evoked.

The tenth incident was part due to Newmedica’s

failing in care for the patient, working as a

subcontractor for an NHS Trust. The NHS Trust are

leading on the Duty of Candour with the patient.

3.1.3 – Complaints

It is Newmedica’s policy that all complaints are

investigated thoroughly. Any necessary actions are

taken to respond to failings, wherever possible, in a

way that is open, transparent, fair, and satisfactory

to all parties involved with the aim that Newmedica

learn and improve the quality of care for patients

and carers. As such, we adhere to Parliamentary

and Health Ombudsman (PHSO) Principles of Good

Complaint Handling, the Being Open principles and

the Duty of Candour.

During 2017/18 we have had 29 complaints compared

to 40 in 2016/17. We believe that listening to our

patients and acting upon their suggestions has helped

with continual improvement throughout 2017/18

and is fundamental in providing the highest quality

ophthalmic care which has had an impact on the

reduction of complaints from the previous

reporting year.

Reasons for Complaints April 2017 - March 2018

Clinical

Communications

Other

Patient Safety

Personal Injury

Staff Behaviour

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Although small numbers, the top three reasons for

complaints are due to clinical issues, communication

and staff behaviours.

All clinical complaints are reviewed by a Lead

Consultant to ensure each point has been addressed

accurately and honestly.

Complaints regarding staff attitude, behaviours and

communication are often due to staff’s lack of self-

awareness. Staff are always encouraged to reflect on

their behaviour and reminded of the correct process

and procedure.

Our ongoing target is to respond to complaints within

20 working days. Staff are supported with their

investigations and the complaint process from the

Governance team. Learning from complaints is shared

across all services.

3.1.4 – Safeguarding of Vulnerable Adults and Children

Newmedica are fully committed to providing the

highest standards in protecting vulnerable adults and

children. Newmedica achieve this by:

• Meeting the statutory requirements in relation to

the Disclosure Barring Service and maintain safer

recruitment practices.

• Having safeguarding policies and systems in place

which are up-to-date and robust.

• All employed staff have undertaken and are up to

date with safeguarding training at level 2 and an

introduction to PREVENT training is being rolled

out to all staff for completion by the end

of 2018/19.

• Designated safeguarding leads are clear about

their role and have sufficient time and support

to undertake it. Additional training is provided to

these staff members.

• All reports of safeguarding concerns are reported

to Medical Advisory Committee for discussion.

• The Board receives an annual safeguarding report

to review safeguarding across Newmedica.

3.1.5 – NHS Safety Thermometer

NHS Safety Thermometer is a local improvement

tool for measuring, monitoring and analysing patient

harms and ‘harm free’ care. The tool measures

incidents of pressure ulcers, falls, urinary tract

infections, catheters and Venous Thromboembolism

risks (VTE). VTE is the only relevant measurement for

Newmedica services.

Due to the nature of our services where surgery is

less than 90 minutes in duration, the need to assess

for VTE risk is minimal. A series of elimination

questions are used by the pre-assessment staff to

determine any likely risk.

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3.1.6 – Infection Control

Newmedica comply with mandatory reporting of

all alert organisms including MRSA, MSSA and

Clostridium Difficile. There have been nil reported

cases of MRSA, MSSA or Clostridium Difficile within

the Newmedica services during 2017/18.

Infection Control audits are carried out as part of our

ongoing audit programme which include monthly

hand hygiene audits across all our services. Education

of staff is paramount, staff undertake mandatory

infection control training through e-learning or via

face to face training. All our clinical staff receive an

infection control annual update and office staff are

required to attend updates every three years.

3.1.7 – Antibiotic Stewardship

As a single speciality organisation, the use of

antibiotics is minimal. Antibiotics are used as the

core treatment for our perioperative cataract

surgery regime in line with best practice. Additional

postoperative antibiotic eye drops are only prescribed

on a case by case basis.

3.1.8 – Medicines Management

Given the single speciality delivered Newmedica

prescribe a very limited range of medication, all

of which comply with national guidance for the

specific condition and local formulary requirements.

Newmedica have recently appointed Ashtons Hospital

Pharmacy Services in an advisory and supply

capacity. The advisory services will include pharmacy

audits, procurement support, Patient Group

Directions/prescriptions and technical advice.

3.1.9 – Central Alerting System (CAS)

The Central Alerting System (CAS) is a web-based

cascading system for issuing patient safety alerts,

important public health messages and other safety

critical information and guidance to the NHS and

others, including independent providers of health

and social care

Newmedica has received 12 relevant alerts in

this reporting period. All CAS alert information is

disseminated to the services via to the Governance

department as well discussed at the Operational

Management Group Meeting and at the Medical

Advisory Committee.

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Notice Date

Notice Reference

ReportAction

RequiredEvidence of Compliance

Completion Date

Mar- 18MDA/

2018/009

Bag valve mask (BVM) manual resuscitation system – risk of

damage to lungs by delivery of excessive pressure

Cascade to all staff

Nil stock, action complete

Mar- 18

Jan-18NHS/

PSA/W/ 2018/001

Portable oxygen cylinders, staff failure to operate correctly

Cascade to all staff

Instructions cascaded to all staff, evidence of

competence held locallyJan-18

Nov-17EFA/

2017/ 00Unbranded Christmas LED lights

remove from circulationCascade to all staff, Nil returns required


Dec-17

Nov-17Company Advisory

Notice

Xstar Safety Knives, blade cover retracted

Cascade to all staff, Nil returns required

Grimsby stock removed & destroyed, action

completeNov-17

Sep-17Manufacturer Code 28732

Alert for Gallipots containing debris



Oct-17

Sep-17EFA/

2017/ 003Guidance for Disposal of Batteries in

Health and Social Care EquipmentCascade to

all staffNil stock,

action completeSep-17

Jun-17Company Advisory

Notice

Solus Flexible Wire Reinforced Laryngeal Mask Airway – risk of hypoxia due to partial or total

occlusion of the airway tube after inflating the cuff



Jun-17

Jun-17FSN

170124Bvm (Bag-Valve-Mask) Manual

Resuscitation Systems valve checksCascade to all staff, Nil returns required


Jun-17

Jun-17Company Advisory

Notice

LX3 Microscope Floor Stand


Microscope held in Grimsby suggested

intervention carried out by company/

Jun-17

Jun-17MDA/

2017/014

All Heartstart Mrx Defibrillators ? Possible Failure To Deliver A Shock, Cardioversion, Pacing Or Monitoring


Nil Stock, action complete

Jun-17

May-17MDA/

2017/013

All Lifepak 1000 Automatic External Defibrillators (Aeds) - Risk Of Device Shutting Down Unexpectedly During

Patient Treatment And Possible Failure To Deliver Therapy



May-17

May-17PL15872/

0010

Drug Alert 2 (Action Within 48 Hours); Fdc International Ltd; Sodium

Cromoglicate 2% W/V 13.5 Ml Eye Drops; Pl 15872/0010; Update

To Instruction For Returns

Check if drug is in use in Newmedica


May-17

Apr-17Company Adsvisoty

Notice

Voluntary Field Safety Notice - Alcon - Recall of Select

Lots of AMO Healon OVDs

Check all stocks held by Newmedica and

Stock check complete - analysis of delivery notes reports zero affected product

received.

May-17

23

3.2 – Quality

3.2.1 – Patient Feedback

The NHS Friends and Family Test (FFT) was created to

help service providers and commissioners understand

whether their patients are happy with the service

provided, or where improvements are needed. It is a

quick and anonymous way for patients to give their

views after receiving care or treatment.

The FFT asks patients the following question:

How likely are you to recommend our service to

friends and family if they needed similar care

or treatment?

Patients can choose from six different responses:

• Extremely Likely.

• Likely.

• Neither Likely or Unlikely.

• Unlikely.

• Extremely Unlikely.

• Don’t know.

During 2017/18 Newmedica received 13,039 responses

across our services. 97% of the responses stated

“Extremely Likely” or “Likely” to recommend the

Newmedica service.

Response rates and positive recommendation

percentages are closely monitored throughout the

year and tracked against internal targets to monitor

performance within each service.

Newmedica Patient Satisfaction Survey

In addition to the FFT patients are asked to grade six

aspects of the Newmedica service along a three point

scale (Excellent, Satisfactory or Poor):

• Customer service provided prior to appointment.

• Signage for the Service and the waiting area.

• Your appointment.

• Location and setting.

• Staff.

• Overall Experience.

Response rates and positive recommendation

percentages are closely monitored throughout the

year. Responses are tracked against internal targets

to monitor performance within each service.

During 2017/18 Newmedica received 13,262

responses across our services, with the following

distribution below:

Friends & Family Test

RecommendNot

RecommendResponses

Total 97% 1% 13,039

Q1 Q2 Q3 Q4 Q5 Q6 Q7

All Services

Likely to Recommend

Service prior to Appt

Signage & waiting Area

Your Appointment

Location & Setting

StaffOverall

ExperienceResponses

Total 97% 99% 98% 99% 98% 100% 99% 13262

24

3.2.2 – Compliments

Traditional ways of complimenting members of staff,

by letter or card, have been replaced in recent years

by patients expressing their gratitude through social

media. A majority of our compliments are through the

friends and family test (see section 2.3.4) and via NHS

choices. Patients who leave a compliment are sent

a response which is shared with the department or

individual concerned and often reflects the care and

professionalism of staff. Some examples are:

• “After arriving for my post op appointment, I must

write to you praising the team that performed my

cataract operation. I cannot speak highly enough

of the Doctors, nurses and the rest of the team.

They were fantastic, would you please pass on

my very grateful thanks for a very highly

successful operation.”

• “Just a quick letter, but an important one, a week

ago, I came in to have my cataract done in my

right eye. I would like to thank the optician and

their team the improvement in just a week is

truly great.”

• “At my visit today, I found all the specialists I

met polite and professional. My appointment

started on time and the Consultants were very

happy to explain what would happen during the

consultation and very happy to fully discuss what

they were doing. The whole appointment took

about an hour during which time they were testing

and conversing with me, with only a short wait

of about 15 minutes for drops to work. Although

my appointment was ‘non-urgent’, from the time

I phoned for the appointment to my visit was less

than 2 weeks and would have been sooner if I

could have re-arranged my diary. In all, very happy

with the service; medical care at its best.”

• “The speed at which the whole treatment took

was exceptional. When I visited Specsavers I was

expecting many months of waiting on the NHS

for cataract treatment, however the time was

about 3 weeks.”

• The staff were friendly and helpful which helped

to keep an aura calm and confidence. The whole

process was well managed with little time waiting

for various elements of the treatment.”

• “I enjoyed the fact that I attended on a Saturday

as it was nowhere as busy as weekday clinics. My

consultation with all 3 staff was second to none.

Well done.”

• “Staff very friendly and make you feel very

welcomed. Great service. I’ve already told many

people about this service.”

• “The appointment was arranged for my

convenience. Both members of staff were very

pleasant and explained everything in an easy way

for a non-medical person to understand. A far

more personal service than attending a hospital.”

• “The best service and attention I’ve ever had in

any clinic or hospital. Many thanks to all the staff.”

3.2.3 – Use of Translation Services

It is recognised that a proportion of the population

requiring Newmedica’s services may not have English

as a first language. Newmedica is dedicated to

ensuring that all patients receive the support and

information they need to be able to communicate

effectively and make informed decisions about the

care they receive. All Newmedica services have links

with local interpreters and translation services as well

as access to language line to support patients and

enable effective communication to take place.

25

3.2.4 – Waiting Times & Cancelled Operations

Newmedica believes in excellent access to its services

for NHS patients. As such we aim to exceed the 18

week Referral To Treatment which is guaranteed

under the NHS Constitution. While we are not able

to control waiting times in sub-contracted services

that we operate for our partners, performance in

Newmedica’s new referral services has shown that

94% patients attend their first appointment within

8 weeks of referral.

3.2.5 – Cancelled Operations

We have had no incidence of patients having their

operations cancelled for nonclinical reasons more

than once. In the unusual event of any patient

cancelled due to nonclinical reasons the patients are

rebooked within 28 days.

3.2.6 – NHS England Framework for Nursing, Midwifery and Care Staff

We acknowledge we must ensure that we are

delivering quality of care as well as quality of

treatment. Newmedica are a single speciality

outpatient and day case elective provider of care and

within this service we deliver we are committed to

delivering safe, effective and compassionate care.

Delivery of exemplary care for our patients and

looking after the wellbeing of our workforce are

paramount to our ethos. We acknowledge we are

all responsible for the care we deliver every day

and are committed to ensuring all our people work

to the values and behaviours of the 6Cs: Care,

Compassion, Competence, Communication, Courage

and Commitment and have these at the heart of all

they do.

The values as laid out in the NHSE 6C’s strategy

and ‘Leading Change, Adding Value’ complement

Newmedica’s vision statement:

’Our Vision – to deliver an exceptional, accessible

and cost effective service, to NHS and private

patients, working in conjunction with all optometrists

and GP’s, by establishing a national network of

ophthalmology partnerships.’

Our workforce strategy has been refocussed to

include the health and wellbeing of staff which we

measure through our annual staff survey and a health

and wellbeing survey in the last quarter of 2018. This

will enable us to support our people in managing

their own health and wellbeing with the aim that this

will in turn enhance patient care.

3.2.6 – Making Every Contact Count

Maintaining good eye health is essential for everyone,

including blind and partially sighted people.

Ophthalmology is the speciality with the second

highest cause of attendance at hospitals.

Eye health deteriorates with age. Poor eye health

can often lead to depression or other mental health

issues, particularly when a patient is already suffering

from loneliness or isolation, as can be the case for

elderly people. Poor eye health can also be a factor in

a number of other public health issues, such as falls

amongst the frail elderly. However, some important

causes of vision impairment, such as glaucoma, are

treatable if detected early and prevention of sight

loss can have a significant impact on people’s

quality of life.

The Royal College of Ophthalmologists estimates

that at least 20 patients per month suffer severe

but preventable sight loss due to delays to hospital

appointments. The College recently outlined this

challenge in their Three Step Plan: ‘The hospital eye

service is overwhelmed and patients are losing sight

because of delayed treatment due to postponed

or delayed hospital eye service appointments and

emphasising the need to take action to reduce the

risk of patients coming to harm.

26

Newmedica has therefore tailored its approach

to Making Every Contact Count by focusing on

the benefits that can be provided to patients

through encouraging good eye care and providing

transformation care with the aim to prevent visual

loss by:

• Working with community opticians to provide

education and training in encouraging appropriate

referral to specialist ophthalmology centres.

• Making access to services easy for patients,

providing care in bespoke single speciality services

with low waiting times for elective care and

appointment timescales which meet best practice

for those with chronic eye conditions.

• We work with local opticians to provide

community-based care, working in collaboration

to provide care close to home by the local optical

network with the support of the Newmedica

consultants.

• We work closely with sight loss services, providing

signposting for patients and their carers who may

benefit from third sector support, these services

are usually available on site.

3.2.7 – Adoption of the Royal College of Ophthalmologists Quality Standard for people with sight loss and dementia in ophthalmology (Dec 2015)

‘Looking Out For Sight’ is a sight loss awareness

program developed by Wiltshire Sight, funded by

The Pocklington Trust and accredited by the RNIB

to be delivered nationally through local sight loss

charities to businesses and healthcare providers as

part of mandatory training programs. Newmedica

and Specsavers’ national learning and development

teams are discussing integrating the program into

our induction processes. In the interim; staff at

Newmedica Gloucestershire, Swindon and Bristol

services have attended sight loss training with

Wiltshire Sight.

Newmedica supports the England Vision Strategy and

one of our Operations Directors is a Trustee of both

Wiltshire Sight & Vision South West.

3.2.8 – Integrating Eyecare Services – Working with Community Optometrists

During 2017/18 Newmedica have worked with

colleagues in the Local Optical Committee Support

Unit and several pilot local optical committees to

develop a community assessment and management

pathways. We have adopted best practice and are

rolling out a community post-operative follow up

service. Our pilot has been running within Specsavers

stores successfully delivering over 100 post-operative

appointments in the last 6 months.

3.2.9 – Feedback to referrers on referral quality, feedback capture and improvements

To help reduce inappropriate referrals and to

support and improve patient pathways Newmedica

regularly feedback any comments regarding referral

information. The feedback provided helps ensure

referrals contain the right information to ensure

patients receive the right treatment and care.

Newmedica services have participated in the

recent survey produced by the Professional Record

Standards Body (PRSB). The PRSB were seeking

feedback from providers to support their project in

developing standards for clinical referral letters to

improve the quality of information sent by GPs.

27

3.3 – Workforce

3.3.1 – Staff Engagement

Our annual engagement survey looks at three key

measures of a sustainable engagement.

The key measures are as follows:

• Engagement (hearts and minds).

• Enablement (resources, tools to do the job well).

• Energise (work-life balance, energy needed to

perform well throughout day).

Since the survey, engagement sessions have taken

place enabling us to listen to our staff feedback

and their ideas on how we can support and

improve on sustainable engagement. An ‘Insight

Action Plan’ has been developed as a result of the

feedback and the two areas we will be focusing on

for 2018/19 will be around respect and recognition

related to communication and improvement in line

management practice.

Questions Response

I would recommend Newmedica /my site as a good place to work 73%

I am willing to go above and beyond what is normally expected to help

Newmedica/ my site succeed88%

I fully support the vision and values for which Newmedica stands 85%

I feel proud to work here 79%

Research has shown that employee engagement

for sustainability can enable change towards

sustainability, predicts organisational success,

financial performance and employee outcomes such

as retention and attraction.

The results of Newmedica’s survey indicated that 76%

of our employees are sustainably engaged.

The survey also received favourable responses when

employees were asked the following questions:

3.3.2 – Smoke Free Sites

All Newmedica services are delivered on smoke free

premises.

29

4. Priorities for 2018/19

Newmedica have five key improvement priorities for

2018/19. These will be monitored quarterly during

2018/19 and reported to the board of Directors:

• Dementia Strategy.

• Audit Programme.

• Patient and Carer Engagement.

• Implementation of Local Safety Standards for

Invasive Procedures.

• Improving Staff Engagement.

4.1.1 – Priority One - Dementia Strategy

There are currently 850,000 people living with

dementia in the UK, of which 45,000 are under

the age of 65. These numbers are set to rise to

a staggering 1 million by 2025. The majority of

Newmedica’s patients are aged 65 years and older.

It is therefore vitally important for Newmedica to

consider the role we can play supporting our patients

affected by dementia.

Objective

• Help staff understand dementia through specialist

training, how it impacts Newmedica and the

practical steps staff can take to support patients.

• Ensure our working environment is dementia

friendly improving the patient experience when

visiting our services.

We aim to

• Become a dementia friendly organisation with a

working environment and processes that prevent

avoidable harm to patients with dementia.

• Develop our network of Dementia Friends in all

our services.

• Deliver person centred care that supports the

dementia patient and their carer.

• Develop a skilled and effective workforce able

and unafraid to champion compassionate person-

centred care.

Monitoring achievement

• Report on the completion of Dementia Friends

training by March 2019 - an initiative run by

the Alzheimer’s Society. In doing so individuals

become recognised as Dementia Friends and

receive a badge to wear on their uniforms

indicating increased level of patient

dementia awareness.

30

4.1.2 – Priority Two - Audit programme

Following an internal review and feedback from our

CQC inspections it was apparent that Newmedica’s

audit systems were inconsistent. We agreed to make

some improvements to automate the collection of

our audits. Our current system is manual and very

labour intensive which makes collation and

reporting challenging.

A review of our audit plan has taken place during

2017 and Newmedica’s revised audit plan has been

launched as of January 2018. This has included a

major investment in an IT solution to support the

audit process.

Objective

• Implementation of an electronic solution (RADAR)

to allow ease of collation and reporting.

• Ensure all services are carrying out the required

audits for their service.

• Use the audit data to measure quality and support

with quality improvement programmes.

We aim to

• Roll out the IT system in September 2018.

• Have a consistent audit approach and systems

across all services so that the business is easier to

manage, compare statistical data and implement

improvement programmes.


• Newmedica Governance team will report by March

2019 on the standardisation of audit approach

across the organisation.

• Audit data will be collected monthly by the

Newmedica Governance team to ensure all

services are compliant with audit completion.

• Action plans will be created from the results of

audits delivering improvements to the quality of

patient healthcare.

4.1.3 – Priority Three - Patient and Carer engagement

Ensuring our patients and their carers are engaged

with the opportunity to express their views, which will

provide valuable insight into how our patients want to

experience delivery of services. Patient centric care

needs input from the people who are most affected –

the patient and their carers.

We have already established Patient Participation

Groups in two of our services (Nuneaton, in January

2018 and East Suffolk in February 2018), both

of which were successful. A carer survey will be

introduced to gain insight into the carers experience

of the patient’s pathway.

Objective

• Establish a Patient Participation Group for all

directly commissioned services.

• Understand how patients want care delivered

to them.

• Understand how we might better support carers in

our services.

We aim to

• Share across the organisation patient feedback via

newsletters, internal communications or formal

quality improvement programmes.

• Improve Newmedica’s decision making about

how to deliver patient healthcare throughout

all services.


• Quarterly review and feedback into the Board of

Directors by the Governance team.

• End of year report summarising the outcomes of

patient engagement forums and carers survey.

31

4.1.4 – Priority Four - Implementation of Local Safety Standards for Invasive Procedures (LocSSIPs)

Our aim is to provide safe, reliable and compassionate

care to our patients and one of the ways in which we

can strive to achieve this is through implementation

of LocSSIPs for outpatient interventions.

LocSSIPS are modified safety standards created from

National Safety Standards for Invasive Procedures

(NatSSIPs) which were developed by NHS England to

support national and local learning from the analysis

of never events, serious incidents and near misses

in order to provide safer care to patients.

Objective

• Produce standardised local standards to prevent

patient safety incidents.

We aim to

• Reduce patient safety incidents.

• Improve delivery of safe care during invasive

procedures.

• Improve education and training.


• Development of robust and auditable checklists –

which will be audited as part of Newmedicas audit

programme.

• Action plans will be created from the results of

audits delivering improvements to the quality

of patient healthcare.

• On-going capture and analysis of patient

safety incidents.

4.1.5 – Priority Five – Improving Staff Engagement

A Newmedica engagement survey is conducted

annually with our employees allowing measurement

of staff engagement year on year. Response to

the 2017/18 survey showed 76% of employees are

sustainably engaged.

Objective

• Improve our engagement survey score from 76%

to 78% for 2018/19.

• Collect more timely feedback.

We aim to

• Fulfil the actions from our ongoing insight action

plan, created from the feedback collected through

the 2017/18 engagement survey and in other forums,

including the operational management group on a

quarterly basis to improve employee engagement.

• Conduct a Wellbeing Survey on an annual basis.

• Change the provider of our engagement survey

to allow flexibility and results in real time.

• Continue our monthly employee newsletter

that includes organisational updates to all staff,

reviewing content on an ongoing basis.

• Focus on the development of our managers to

enable them to have the skills and knowledge to

manage their teams.

• Review our clinical training strategy and content, to

ensure it is able to adapt to changes in the scope of

our services.


• Monthly monitoring of staff retention.

• Repeat employee engagement survey for 2018/19.

• Collect feedback on the usefulness of the monthly

stand ups and refine approach.

32

4.2 – Other Focus Areas for 2018/19

4.2.1 – On Line Quality and Compliance System

Newmedica’s current quality reporting system

is heavily reliant on manual processes. In order

to improve our reporting systems and to ensure

oversight of quality as our services expand

Newmedica are implementing a cloud-based

governance reporting and workflow solution to allow

the migration from highly manual processes into a

scalable system environment which affords enhanced

control and reporting capabilities. The new system

will be built and fully embedded across the services

by September 2018. The system will:

• Provide a robust reporting solution

for Newmedica.

• Provide a reporting and workflow solution that

will allow effective and structured reporting,

along with prescribed, timebound workflow

management processes, improving our compliance

with our internal and external standards.

• Significantly improve the organisations ability to

analyse data, identify trends, and report internally

and externally.

• Have a secure data storage solution.

4.2.2 – Our agreed National CQUIN’s for 2018/19:

• A 5% point improvement from our baseline staff

survey results undertaken in 2017/18. This will be

an improvement on the questions asked about

health and well-being, musculoskeletal issues

and wellbeing.

• Achieving an uptake of flu vaccinations by

frontline clinical staff of 75%.

• We have specific local CQUIN’s that are agreed on

a specific contract basis.

4.2.3 – Integrating Eyecare Services – Working with Community Optometrists

Following the success of our pilot to develop

community assessment and management pathways

we are now working on a launch of a national

framework and governance process and expect

our first community post-operative service to go

live in 2018/19. The service will be rolled out

across all community optometry practices within

a targeted region.

33

5. Newmedica in the media

High Patient Satisfaction in West Suffolk Glaucoma Service

Press release 6 February 2018.

Patients in west Suffolk are benefitting from a

glaucoma service provided by West Suffolk NHS

Foundation Trust in partnership with West Suffolk

Clinical Commissioning Group.

Set up two years ago, patients who have a simple puff

test to see if they’re at risk of developing glaucoma

when they visit the opticians, are then referred to the

community glaucoma service, run in partnership with

Newmedica, for additional tests if they are required.

The Newmedica team works closely with hospital

consultants to review around 100 to 120 patient

test results every week in a ‘virtual glaucoma clinic’

allowing for faster diagnosis and treatment.

Previously patients would have been offered an

appointment with a hospital consultant for both a

follow-up test and a review, which took around double

the time per patient compared to the service delivered

alongside Newmedica.

Consultants are now free to spend more time

with patients who require direct face-to-face

consultant review.

Mr Inderraj Hanspal, consultant ophthalmologist and

clinical lead at West Suffolk NHS Foundation Trust, said:

“Previously, to keep up with demand, we were running

nine doctors’ clinics a week as well as additional clinics

at weekends. We had to employ locum doctors to help

manage demand but can now help the same amount

of patients with only five doctors’ clinics a week and

no additional glaucoma clinics at weekends. This not

only saves vital NHS resources, but means the time I

was spending doing tests can now be with my high-

risk patients with more complicated conditions and

progressive glaucoma.”

Glaucoma is the name given to a group of eye

conditions that cause permanent sight loss by

damaging the optic nerve. Most types of glaucoma

have no symptoms in the early stages, so a regular eye

test is the only way to know if you have the condition.

Although there is currently no treatment to restore

sight loss caused by glaucoma, treatments such as eye

drops, laser and surgery can help prevent sight loss

from happening in the first place.

Hanspal continued: “We are offering a much better

service to our patients’ because new referrals can be

tested out in the community. This is saving around 80%

of our patients’ time, with only around 20% of these

new patients needing to meet a consultant in hospital.”

Emma Wilden, service manager for the Suffolk

community glaucoma service at Newmedica, said: “We

are very pleased to be working with Mr Hanspal and

the team at West Suffolk Hospital. Working closely with

clinicians across the community means we can deliver

the best possible eye care for patients.

“In December 2017, 97% of patients seen at the clinic

would recommend the service to their friends and

families. This shows the high level of patient care and

satisfaction that this collaborative service provides.”

Dr Christopher Browning, chairman, NHS West Suffolk

Clinical Commissioning Group, said: “This community

glaucoma service is certainly benefiting patients, who

are receiving good care as well as having the peace

of mind that their eyes are being checked in a clinical

setting. It is certainly pleasing that those patients are

reporting such high levels of satisfaction.

“This is another example of how delivering more

services in the community can deliver positive results

for patients and give hospital consultants more time to

deal with the most serious cases.

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