Scope of this report

Summary

The NHS Diabetic Eye Screening Programme aims to reduce the risk of sight loss among people with diabetes by the prompt identification and effective treatment of sight-threatening diabetic retinopathy, at the appropriate stage of the disease process.

The findings in this report relate to the quality assurance visit on 07 September 2022 to NEC Care provided centralised functions. Public Health Commissioning teams regionally commission individual linked services. Any commissioning findings are outside the scope of this report and will be followed up directly with the appropriate commissioning team.

Quality assurance purpose and approach

Quality assurance (QA) aims to achieve and maintain national standards, promote continuous improvement in diabetic eye (DES) screening and support with reducing health inequalities. This is to ensure all eligible people have access to a consistent high quality, effective, equitable and safe service wherever they live.

QA visits are carried out by the NHS England Screening Quality Assurance Service (SQAS).

The evidence for this report comes from the following sources:

• monitoring of routine data collected by NHS England
• evidence submitted by the provider
• information collected during pre-review visits to the centralised functions office on 10 August 2022
• information shared with the Midlands and East SQAS as part of the visit process.

The screening service

NEC Care are the centralised functions provider for 9 DES services across England. The NEC Care office is based in Worcester and provides centralised management of administration and failsafe, bookings for call/recall/referral, and letter distribution. Screening clinics, the screening test, slit lamp biomicroscopy and grading are managed by the individual linked DES programme managers and are not considered a centralised function in the scope of this report.

There is no single commissioning team with responsibility for the NEC Care functions. Each linked service is accountable to their regional commissioning team for incident reporting and management, programme boards, QA visits and oversight of recommendations. An important mechanism for fulfilling this accountability is through the interaction at respective programme boards.

NEC Care are commissioned to provide the diabetic retinal screening service for the Republic of Ireland which is outside the scope of this NHS England SQAS report.

Findings

This is the first QA visit to the NEC Care centralised functions office. Service delivery was observed to be professional, people centred and delivered by well organised cohesive teams who are enthusiastic and knowledgeable about diabetic eye screening.

Immediate concerns

The QA visit team identified no immediate concerns.  

High priority findings

The QA visit team identified no high priority findings.

The following were made as standard priority recommendations:

• provide a quarterly update from the centralised services team to linked services programme boards to share collective learning and service improvements
• review and update the standard operating procedures listed within appendix C
• develop a standard process for sharing actions and lessons learnt from audits
• separate the room used by the grading and failsafe team to facilitate a conducive working environment for both teams
• document the processes to identify and provide easy read materials for people who may find it useful in line with requirements of the Accessible Information Standard
• develop a SOP to include consistent and regular identification of eligible groups that may be considered vulnerable and/or underserved.

Examples of practice that can be shared

The QA visit team identified several areas of practice for sharing, including:

• weekly batch tracing for all individuals who are due a screening invitation within the next 21 days to ensure status and demographics are accurate
• implementation of a new phone system to allow monitoring of call statistics, a call back function and detailed analysis to inform future service developments
• people centred website with clear links to resources, online booking, translation tool, local information, maps of venues and feedback surveys
• strong ethos of training and continuous professional development for all staff members including:
• training for clinical leads that is recorded and can be shared with graders
• training for maternity services to promote the importance of eye screening in pregnancy
• planned training for the administration and call handler teams to help understand screening pathway standards and how their role influences the ability to meet these standards
• administration staff to undertake the British association of retinal screeners administration certificate
• phone calls made to all urgently referred individuals to tell them that they will be receiving an appointment to attend hospital eye service and explaining the importance of their attendance.

Recommendations

The following recommendations are for the provider to action unless otherwise stated.

Next steps

The NEC Care centralised services manager is responsible for developing an action plan to complete the recommendations contained within this report.

SQAS will work with the provider and the nominated commissioner(s) to monitor activity and progress of the recommendations for 12 months after the report is published. After this point SQAS will send a letter to the provider and commissioner(s) summarising progress made and will outline any further action(s) needed.

Appendix A: References

1. Screening pathway requirements specification Diabetic eye screening pathway requirements specification
2. Service specification no.22; NHS Diabetic Eye Screening Programme NHS Diabetic eye screening.pdf 

3. Accessible Information Standard equality-hub/patient-equalities-programme/equality-frameworks-and-information-standards/accessibleinfo/