The impact of an investigation
Optometrist Dick Manns shares his experience of being under investigation by NHS England with OT
Shocked, shaken, sick. These are the words that are used by optometrist Dick Manns to describe his feelings when he opened a letter to find that he was the subject of an investigation by NHS England.
The letter, received on 15 June 2016, informed Mr Manns that he was suspended from the Ophthalmic Performers List with immediate effect. “Opening the letter and reading it, I couldn’t believe that it was happening to me. I felt physically sick,” he told OT.
Mr Manns learned the news on arriving at work for a locum shift in a practice that he had previously owned. “I had a full clinic booked in for the day and after opening and reading the letter I had to go and inform my boss that I couldn’t work,” he explained.
Opening the letter and reading it, I couldn’t believe that it was happening to me. I felt physically sick
The letter stated that Mr Manns was suspended following an NHS England Performers List Decision Panel meeting the previous day that had reviewed a report regarding the optometrist’s clinical practice and record keeping. It added that he was suspended “until a comprehensive assessment of clinical competence” could be carried out.
Recalling those initial moments, the whole day went by in a blur Mr Manns said.
Returning home from practice, Mr Manns’ wife, Ana, described him as “white with shock” after learning the news. “He was a shell of himself,” she told OT.
After re-reading and processing the information, Mr Manns, who has been a career-long member of the AOP, picked up the phone to seek advice and support from the Association.
Mr Manns’ experience with NHS England began in 2015 when he was in the process of selling the group of five practices that he had owned for a number of years.
Mr Manns had decided to sell the business as he began to “wind down” a career that had spanned more than 35 years. Once a buyer was secured and the deal that was negotiated was being processed, Mr Manns informed NHS England of the sale.
That year he was contacted by NHS England’s contracts team to inform him that it wished to perform a record card audit on his practices. The audit took place in September 2015.
During the audit, the optometric adviser raised concerns relating to records in practice below the required standards and clinical practice issues.
I want NHS England to be held accountable and for a fair and consistent process to be put in place
Mr Manns was asked to address the areas of concern and the Performance Advisory Group requested a follow-up audit to confirm this.
Mr Manns explained to OT that he strives to be the best practitioner he can be and is therefore happy to improve his performance and processes when and where necessary. “I qualified in 1977 and of course the profession and record keeping requirements have changed substantially since then,” he said.
However, on this occasion Mr Manns felt that the claims were unjustified and he was compelled to disagree with them. “I didn’t agree with some of the recommendations as they were not required by law and felt that it would be dangerous to agree to something that was not necessarily required of others,” he explained.
In March 2016, out of the blue Mr Manns was asked to undertake a second audit, which was performed in May, by which time he had sold his practices and was working as a locum within the group. The purpose of the second audit was to confirm if the concerns previously raised had been addressed.
During this process, in Mr Manns’ opinion, the advice on how he could do better was unclear and at times confusing, and communication was also poor. “I was happy to improve in some areas, but I felt like the goal posts were being constantly moved and it was hard to understand where they had been moved to and what was required of me,” he said.
A month after the second audit had been performed, Mr Manns received the letter of suspension through the post.
On the advice of the AOP, the optometrist decided to appeal the suspension and was supported in the case by barrister Sam Thomas and the AOP’s head of clinical and regulatory, optometrist Henry Leonard.
It was a great relief and I remember hugging Sam and Henry. Their support, and the support of the AOP, was invaluable
During the appeal hearing in July 2016, the points of concern raised during both the September 2015 and May 2016 audits on Mr Manns’ records were discussed. The AOP successfully argued that the record keeping audit produced by NHS England’s optometric adviser was so inaccurate as to be misleading and ultimately four of the five allegations were found not to be proven and the suspension was lifted. Mr Manns was cleared of all clinical practice allegations against him. The allegation upheld related to record keeping standards.
However, at the hearing Mr Manns agreed to work with his local performance team in order to improve his record keeping.
“I was stunned when the appeal was closed so quickly,” he said. “It was a great relief and I remember hugging Sam and Henry. Their support, and the support of the AOP, was invaluable.”
Following the investigation, NHS England undertook a review of the optometric adviser’s audit which had led to the suspension and confirmed that the results of the review were different from the original audit and, in general, supported the comments and scoring that Mr Leonard presented at the hearing on behalf of the AOP.
At an informal meeting in October 2016, NHS England confirmed that Mr Manns had been marked to an unfair gold standard and that many aspects of the record keeping that were flagged as red would have been identified as amber or green if they had of been measured against the correct standard, which is that of a reasonably competent practitioner.
When discussing the case with OT, Mr Manns said that he has chosen to speak out about his experience because: “I want NHS England to be held accountable for its actions and for a fair and consistent process to be put in place.”
After the case was closed, Mr Manns returned to work and received £5000 in loss of earnings. He said that compensation or not, no sum could make up for the effect that the experience has had on him mentally and physically.
Mr Manns said that it was his wife who gave him the confidence he needed to step back into the testing room and he is not sure how he would have withstood the experience without her.
I considered quitting every day during my suspension and even after I was cleared. What has kept me in practice is my passion for the profession. I have been working in a profession that I love for over 35 years and I really didn’t want it to all end like that
A number of years after the case against Mr Manns was closed, the optometrist is still visibly shaken by the experience and recalling it to OT triggers many emotions.
He admits that the pressure he found himself under during the period of suspension was “very big.” “It made me feel like throwing away my ophthalmoscope. And if it had happened to me when I was a newly-qualified optometrist or earlier on in my career, I may have left the profession altogether,” he shared.
“I considered quitting every day during my suspension and even after I was cleared. What has kept me in practice is my passion for the profession. I have been working in a profession that I love for over 35 years and I really didn’t want it to all end like that,” he added.
Even today, Mr Manns said the investigation is something that is always in the back of his mind with every patient who walks through his clinic door. “I am always wondering if it will happen to me again,” he said.
Despite this, Mr Manns acknowledged that “it is of course right for checks and balances to be in place” and for “optometrists to be held accountable.” However, he emphasises: “The processes used by NHS England must be clear, consistent and fair for everyone.”
When asked what he would like NHS England to learn from his experience, the optometrist said: “They must understand the cost and consequences of the inconsistency of their actions to someone mentally, physically and financially. I will never forget this experience.”