The Care Quality Commission
  • Doctor
  • GP practice

Saxmundham Health

Overall: Good read more about inspection ratings

Lambsale Meadow, Saxmundham, Suffolk, IP17 1DY (01728) 602022

Provided and run by:
Saxmundham Health

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Saxmundham Health on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Saxmundham Health, you can give feedback on this service.

5 April 2022

During an inspection looking at part of the service

We carried out an announced desk based review of Saxmundham Health on 5 April 2022 Overall, the practice is rated as Good

Set out the ratings for each key question

Safe - Good

Effective -Not inspected

Caring - Not inspected

Responsive - Not inspected

Well-led - Not inspected

Following our previous inspection on 18 October 2019 the practice was rated good overall and for effective, caring, responsive and well-led key questions but requires improvement for providing safe services:

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Saxmundham Health on our website at www.cqc.org.uk

Why we carried out this /review

This desk-based review was to follow up on the breach of regulation and areas where the provider ‘should’ improve which were identified at our previous inspection. We found the required improvements had been made and the practice is now rated as good for providing safe services.

How we carried out the review

Throughout the COVID-19 pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our reviews differently.

This review was carried out in a way which enabled us to review the information without a site visit. This was with consent from the provider and in line with all data protection and information governance requirements.

This included

  • Conducting staff interviews using video conferencing
  • Requesting evidence from the provider

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Good for providing safe services

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • The practice had addressed the concerns identified in the previous report.
  • Recruitment checks were carried out in accordance with the regulations.
  • There were formal and recorded competency checks for staff to ensure they were competent to undertake their duties. This included a review of consultations, group supervision and case discussions. Additional recording in medical records was used to document where nursing or other staff had undertaken joint consultations or had sought advice from GPs.

In addition, in our previous report we identified the provider should:

  • Review the process for recording and the distribution of prescription forms to ensure an effective audit trail. We saw systems and processes to ensure prescription forms were kept safe had been improved and sustained.
  • Continue to work to reduce the likelihood of reoccurrence of significant events particularly in relation to the dispensary. At this inspection the practice provided clear evidence of events being recorded, actions identified and taken, and learning shared.
  • Continue work to ensure the summarising of patient records is timely and effective. The practice had taken steps to reduce any significant backlog of patient’s medical records summarises. They had employed additional staff to enable this to happen.
  • Take action to improve the uptake of all childhood immunisations. During this inspection we found despite the COVID-19 pandemic the practice had improved their performance. According to the public health data 1 April 2020 to March 2021, two out of five domains were above the 90% target rate. The other three were slightly below the 90% target rate. The practice team had completed a comprehensive review which they planned to do annually. A review had been undertaken on 1 and 22 June 2021 and covered all aspects including responsibilities of the GPs and nurses, overall management and clinical responsibility.
  • Continue work to improve the review of patients diagnosed with cancer. The practice employed a nurse consultant who undertook reviews of patients with a diagnosis of cancer, they had completed 98% of all reviews. The practice had despite the COVID -19 pandemic also improved their performance for patients attending their appointments for the national cervical cancer screening programme.

Area of outstanding practice;

At our last inspection we told the provider they should continue work to monitor quality outcomes for people with long term conditions and those experiencing poor mental health, including dementia.

At this inspection we found the provider had improved and regularly reviewed the care of these vulnerable patients. This included additional meetings to review data, which led to improved recall systems, care in patients own homes, information for patients on their website, and coding of medical records.

Following the identification of reduced resources in the community to support patients experiencing poor mental health or dementia they employed additional staff such as a nurse specialising in mental health who had been employed for six sessions per week. This equated to approximately 50 appointments per week giving extra support for patients who were experiencing poor mental health or those who required review of their medicines such as anti-depressants. The practice told us, despite the COVID-19 restriction they had undertaken 75% of complete annual reviews for patients with dementia and their carers, with many taking place in the patient’s own home where they were less anxious and more comfortable. The practice had worked with other organisations such as ‘Dementia together’ and carried out an audit of their premises to ensure they were doing all they could to accommodate patients who could become more confused with different surroundings. The practice had also developed a pilot project with the Green Light Trust who help patients with poor mental health, low moods, or addictions to change their lifestyles by communing with nature rather than medication. Some of the practice nursing team were undertaking an academic study to show the positive outcomes of this work. The practice had worked with their PPG to help reduce social isolation and have activities such as a regular film club organised.

The practice told us they recognised that in particular during the COVID-19 pandemic patients found it harder to maintain healthy lifestyles. The lead GP formed a group called SHIFT (Saxmundham Health Intermittent Fasting Team) and has educated and supported patients to make changes. As a result of this work they have recorded positive outcomes for patients with some losing a significant amount of weight and having reduced or no longer needing medication to help their diabetes.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

23/09/2019

During a routine inspection

We previously carried out an announced comprehensive inspection at the practice on 20 February 2019. The practice was rated as requires improvement overall, inadequate for providing safe services and requires improvement for providing well led services. The practice was rated as good for providing effective, caring and responsive services. As a result of the findings on the day of the inspection, the practice was issued with a warning notice on 13 March 2019 for Regulation 12 (safe care and treatment).

We carried out an announced comprehensive inspection at Saxmundham Health on 23 September 2019. This inspection was to follow up on the warning notice and breaches of regulation identified at the previous inspection.

The practice is rated as good overall, with requires improvement for providing safe services, and requires improvement for the population group families, children and young people.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall. At this inspection we found:

  • Improvements had been made in relation to the dispensing process and safety in the dispensary, acting on safety alerts, summarising of patients records, infection control and the completion of mandatory training. Identified actions from fire and health and safety risk assessments, and significant events were monitored to completion. The Hepatitis B status of clinical staff was known.
  • A system had been established to keep clinicians up to date with evidence based practice.
  • Unverified 2018/19 QOF data showed an improvement to the achievement and exception rates for people with long term conditions and people experiencing poor mental health (including people with dementia).
  • Staff dealt with patients with kindness, compassion and respect and involved them in decisions about their care and treatment. Staff were all aware of the arrangements to ensure confidentiality at the reception and dispensary desk.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • Improvements had been made to governance processes and there was an embedded process for identified actions from risk assessments, audits and significant events to be monitored to completion. Systems for responding to and managing complaints and monitoring the completion of mandatory training had been embedded. Staff reported they felt supported and were able to raise concerns.

We rated the practice as requires improvement for providing safe services because:

  • There was no formal oversight and assurance of the competency and work of clinical staff with extended roles. We found an example of unsafe care which had not been identified through competency checks or reviews of consultations.
  • Safer recruitment procedures were not always followed. This did not follow the practice’s policy.

We rated the practice as good for providing effective services, with requires improvement for the population group families, children and young people because:

  • Childhood immunisation uptake rates were below the World Health Organisation (WHO) target of 95% and achievement had declined from 2017/18 to 2018/19. The practice advised they had reduced appointment capacity for a three month period during 2018 to 2019, which may have impacted on the reduced achievement. The practice run monthly reports to identify patients who have not attended for their immunisation and these children were followed up by the nursing team. Following the inspection, the practice advised they had texted information, with a link to an NHS film to non-attenders and a follow up text would be sent for those who did not respond.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

  • Continue work to ensure the summarising of patient records is timely and effective.
  • Review the process for recording the distribution of prescription stationery to ensure an effective audit trail.
  • Continue work to reduce the likelihood of reoccurrence of significant events, particularly in relation to the dispensary.
  • Continue work to improve the review of patients diagnosed with cancer.
  • Continue to monitor QOF outcomes for people with long term conditions and those experiencing poor mental health, including those with dementia.
  • Take action to improve the uptake for all childhood immunisations.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BS BM BMedSci MRCGP
Chief Inspector of General Practice

20/02/2019

During a routine inspection

The practice is rated as requires improvement overall. The practice was previously inspected in December 2016 and rated as good.

The key questions at this inspection are rated as:

Are services safe? –Inadequate

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Saxmundham Health on 20 February 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall, and good for all population groups, with the exception of people with long-term conditions, which we rated as requires improvement. At this inspection we found:

  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence-based guidelines; this was undertaken on an individual clinician basis, as the practice did not have a system or process to share this.
  • Staff involved and treated patients with compassion, kindness and dignity and patients were involved in their care and decisions about their treatment.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.

We rated the practice as inadequate for providing safe services because:

  • The practice issued medicines against unsigned prescriptions and did not have a safe process in place for ensuring the final dispensed prescription was correct. Following the inspection, the practice introduced a process for ensuring prescriptions were signed before they were dispensed to patients and for double checking that dispensed medicines were correct. These processes needed to be embedded.
  • There were 263 patient records which had not been summarised. Following the inspection, the practice advised there was an eight-month backlog. The practice was aware of the backlog and had employed an additional temporary member of staff, who had since left. The summariser role also included the role of financial assistant and occasional scanning, so summarising was undertaken on an ad hoc basis. The practice planned to review administration job descriptions and hours to allow dedicated workforce hours to summarising and to recruit if necessary and viable.
  • Information about safety was not always comprehensive or timely. The identified actions from the fire and health and safety risk assessments, infection control audit and significant events were not monitored to completion. Although some actions had been completed, these were not always documented.
  • The actions identified for significant events were not always effective in reducing the likelihood of reoccurrence, particularly in relation to the dispensary.
  • The Hepatitis B status of some clinical staff was not known and a risk assessment had not been undertaken for their role.
  • There were no documented cleaning schedules or records of cleaning undertaken by practice staff.
  • Training deemed mandatory by the practice had not been completed by all staff. This included safeguarding children, infection control, advanced life support, immunisation and fire safety training.
  • The practice did not always review or act on patient safety alerts. We looked at three safety alerts, two from November 2018 and one from January 2018. There was no evidence of review in the patient records. Following the inspection, the practice submitted a new policy for receiving, reviewing and actioning alerts. They advised they would review patients who had been identified during the inspection as not having been reviewed following a safety alert.

We rated the practice as requires improvement for providing well led services because:

  • The governance processes for monitoring the completion of identified actions from the fire and health and safety risk assessments, infection control audit and significant events were not always effective. The practice was aware of this and were in the process of establishing and embedding new systems.
  • The practice had established a new system for responding to and managing complaints, and monitoring the completion of training deemed mandatory by the practice, which needed to be embedded.
  • Staff did not all feel supported or able to raise concerns without fear of retribution and responses to identified incidents did not always emphasise safety and the well-being of staff.

We rated the population group, people with long-term conditions as requires improvement because:

  • The exception reporting for some of the Quality and Outcomes Framework (QOF) long term condition indicators were higher than the Clinical Commissioning Group (CCG) and England averages. Although the practice excepted patients in line with QOF requirements, a significant number of patients were not receiving the interventions and there was no action plan in place to address this.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Establish a system to keep clinicians up to date with evidence based practice.
  • Continue work to improve the review of patients diagnosed with cancer.
  • Arrange for appropriate staff to sign the standard operating procedures in the dispensary and monitor that staff are following them.
  • Review the arrangements and work undertaken, particularly at the dispensary desk, to maintain patient confidentiality.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

19 December 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 30 March 2016. We set a requirement in relation to safe care and treatment. The practice sent in an action plan informing us about what they would do to meet legal requirements in relation to the following:

  • The appropriate storage and recording of controlled drugs.
  • The system for ensuring changes to prescriptions recommended by secondary care were checked and authorised by a GP.
  • Improving the prescribing protocol to ensure GPs had good oversight of prescribing to patients, including dates for medicines reviews. For example, those patients using salbutamol or thyroxine.

We undertook a follow up inspection visit on 19 December 2016 to make a judgement about whether the actions had addressed the requirements.

  • Improvements had been made in relation to the storage and recording of controlled drugs.
  • Procedures were followed appropriately when patient’s medicines were changed following discharge from hospital or outpatient appointments.
  • The practice had set out plans to monitor and assure the quality of its dispensing service.
  • The practice’s repeat prescribing policy had been appropriately reviewed.
  • The practice needs to continue to ensure GPs have good oversight of prescribing to patients, ensuring reviews for patients on medication are undertaken timely.
  • The practice had reviewed and amended their protocol around recruitment checks.
  • A review of the legionella assessment findings was carried out internally and remedial work had been carried out shortly after the inspection in March 2016.
  • A medication review system flowchart was introduced for all staff involved in the process of medication reviews. The practice had also implemented a policy to support staff in the process of exception reporting for the QOF (Quality and Outcomes Framework, a voluntary incentive scheme for GP practices in the UK. The scheme financially rewards practices for managing some of the most common long-term conditions e.g. diabetes and implementing preventative measures. The results are published annually.).

The area where the provider should make improvement is:

  • Continue to strengthen the systems for ensuring GPs have good oversight of prescribing to patients, ensuring reviews for patients on medication are undertaken in a timely way
  • Continue to review QOF exception reporting levels and to try and reduce this to improve the health and wellbeing of patients

The overall rating for the practice is good. You can read our previous report by selecting the ‘all reports' link for on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

30 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Saxmundham Health on 30 March 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance but improvement was needed for the prescribing protocol and associated procedures.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make an improvement is:

  • Controlled drugs held within the practice other than in the controlled drugs’ safe, for example in GP bags, were not properly registered in line with the same regulations. The practice must ensure in follows legislation for controlled drug storage at all times.

  • Prescriptions were reviewed and signed by GPs before they were given to the patient, however, following discharge from hospital and outpatient appointments dispensers made changes to patient’s medicines which were not checked by GPs to ensure safety. The practice must ensure this takes place in all instances.

  • Improve the prescribing protocol to ensure GPs have good oversight of prescribing to patients, including review dates for patients on medication. For example, for those patients using salbutamol or thyroxin we noticed a number of reviews were overdue.

The areas where the provider should make improvements are:

  • Ensure that staff who access and use patient sensitive data have received a Disclosure and Barring Service (DBS) check or have a written risk assessment completed.
  • Whilst an external legionella risk assessment had been undertaken, required actions that were raised had not been addressed despite the assessment taking place in May 2015.
  • Improve patient recall systems, consistently code patient groups and produce accurate performance data.

We saw one area of outstanding practice:

  • The practice was very proactive in trialling and delivering innovative projects that aimed to improve patients’ care, knowledge and experiences. The local CCG confirmed this was the case and considered the practice’s approach to innovation to be very positive. Not all proposed projects had come to fruition or had been successful but several had been and were (or had been) active in the practice’s area. Amongst others there were for example, “Advice Letter Listing (ALL)”, "Instantcare" and "i-Van".

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice