Optical Express - Newcastle (St Nicholas) Clinic has been established in its current city centre location since 2013 having previously traded from another location in the city centre for more than 10 years. The clinic is located on the ground floor of a multi-occupied office building. The clinic shares the location with an Optical Express optician which provide a general optical service including contact lenses, eye health screening and examinations as well as pre and post-operative intra-operative lens and laser vision correction assessments.

Patients are self-referring and self-funded. The clinic provides laser correction procedures under topical anaesthetic using Class 4 and Class 3b lasers and intra-ocular surgery to adults under local anaesthetic and conscious sedation. Ophthalmologists carry out the treatments. The clinic undertakes laser vision correction procedures approximately three times a month and intra-ocular lens procedures approximately four days a month.

All patients self-refer themselves to the clinic and they make enquiries via the website, by telephone via the Optical Express central customer services centre; they may be existing optical practice patients or in person in the clinic. Following an initial consultation with an optical practice optometrist (at any branch), they patient must then book an appointment with a surgeon. As the surgery is not operational every day, the clinic has five resident team members who form part of a regional surgery team covering the North of England. Treatment days are staffed by the resident team members and supported by others within the regional team.

The clinic provides the following regulated activities:

• Diagnostic and screening

• Surgical procedures

• Treatment of disease, disorder and injury

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 12 December 2017, along with an unannounced visit to the clinic on 15 December 2017.

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

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

Services we do not rate

We regulate refractive eye surgery services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• All areas of the unit were clean and tidy. The clinic provided a safe environment for patients, visitors and staff to move around freely.

• Medicines were safely stored in locked cupboards or fridges where appropriate.

• Staff stored intravenous sedation (Midazolam) in the controlled drugs cupboard. The stock was checked in accordance with the local policy and we found checks completed each day the clinic was open. The clinic manager completed bi-monthly controlled drugs compliance audits.

• There was collaborative team working observed at the Newcastle clinic involving surgeons, optometrists, nursing and administrative staff.

• We observed professional and caring interactions between staff and patients.

• Patients informed us that they were never pressurised to undergo laser eye surgery.

• The clinic made reasonable adjustments for vulnerable patients and those living with a disability.

• The clinic environment was spacious for ease of access for wheelchair users. There was access to disabled toilets and child changing facilities.

• Patients had access to a very informative website which provided company information, eye health information, guidance on procedures offered and patient testimony.

However, we also found the following issues that the service provider needs to improve:

• We looked at five staff files and found that one file had no evidence of employee references and another file had no evidence of appraisal.

• The consent policy did not reflect Royal college of Ophthalmologists 2017 guidance for a seven day cooling off period between the initial consent meeting with the surgeon and the final consent by the surgeon.

• The provider did not have any patient information leaflets for patients where English was not their first language. The provider was looking at ways to improve this.

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

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)