Ifield Medical Practice

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection in December 2021, the practice was rated requires improvement for providing safe services. This was because we found staff had not all received training and guidance to recognise patients who were acutely unwell (including sepsis), the location of the defibrillator was not clear to all staff, emergency medicines were not always available and in date, computer prescription paper and staff smartcards were not always secure, and a staff immunisation programme had not always been maintained for non-clinical staff. At this assessment between 28 February to 18 March 2024, we found the practice had addressed all our concerns. Risks to patients, staff and visitors were assessed, monitored and managed effectively. This included child and adult safeguarding processes, staffing including recruitment and supervision, medicines management, health and safety, and the management of information. Therefore, the practice is now rated good for providing safe services.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were systems and processes to identify, record and act on significant events. We saw the practice used their document management system to record incidents with relevant information, and to coordinate staff involvement. All incidents had clinical oversight and there was recording of actions completed. There were processes to cascade learning to all staff and all events were available for staff to view. We found the recording to link actions, such as meeting minutes, could be improved on the practice document system. The practice told us they would improve their systems to record this information. There were systems and processes to record, acknowledge and respond to complaints. We looked at 3 complaints and saw evidence they were fully investigated, with transparency and openness. Actions had been identified to make improvements, and learning was shared. We saw the practice carried out analysis of complaints to identify any patterns or trends, including regular audits. There were systems to receive and respond to medicine and safety alerts. We saw the practice maintained a log of all alerts, which included the completion of any identified actions and staff responsibilities. As part of our clinical searches, we looked for patients who may have been affected by safety alerts or medicines alerts published in the past. Our search identified a small number of patients affected by an alert that had not been followed up. There was no evidence of patient harm. Following our assessment, the practice demonstrated they took immediate action to further investigate and follow up on these patients. We also reviewed the whistleblowing policy which included a Freedom to Speak Up Guardian should staff want to raise concerns. We reviewed the Duty of Candour policy and this documented a clear process of how the provider would comply with the requirements of this process.

We found people were positive about their experience of care and treatment they received at the practice within the last 12 months. There were 11 records of feedback directly to CQC and 9 reviews published on the NHS website. Comments included that the practice was responsive and followed up on concerns, there had been improvements since the new practice manager had started in post, communication had improved, the information available online and on social media was helpful. There were also 127 Friends and Family Test responses for this practice within the most recent published records (December 2023). We saw that 91% of patients who responded were positive about their experience of the service they received.

Staff feedback was positive about significant events and they felt they improved safety as well as encouraging a culture of learning and transparency. Staff and leaders demonstrated their understanding about how to raise significant events, incidents, concerns, or near misses. They were able to provide examples of recent incidents, as well as the learning that took place to improve care. The practice told us they used patient views to improve services, including through the GP national patient survey, social media, their patient participation group, complaints and compliments. Staff and leaders told us they welcomed feedback and had recently improved the information available for patients to make a complaint or provide positive feedback. This included information on the website, a downloadable or physical leaflet, and a QR code on posters around the practice that took the patient directly to the feedback process using their mobile phone (a QR code is a type of barcode that can be read easily by a digital device and which stores information). Staff told us they discussed learning from significant events, complaints, comments and feedback with within department meetings. We saw evidence of meeting meetings to confirm this. The practice management team told us they valued staff feedback, ideas and suggestions to improve which they obtained through meetings and individual conversations. Staff told us they felt encouraged to provide their suggestions and comments.

We had no concerns with the management of information, including correspondence, test results and referrals. Information was reviewed and actioned by practice staff in a timely manner. Staff demonstrated that there were processes to share information with staff and other agencies to enable them to deliver safe care and treatment. We reviewed the practice policy on managing incoming pathology results and we saw the practice was working in accordance with the processes set out in their policy. Staff demonstrated there was a system for processing information relating to new patients, including the summarising of patient notes. Referrals to specialist services were documented and contained the required information. We found there were no delays relating to information management at the practice. However, there were appropriate systems in place to identify and manage activity should there be any backlogs.

We received feedback from the commissioners of the service, NHS Sussex integrated care board (ICB). They told us they had no concerns about the practice and had not received complaints or serious incidents. Following the last inspection in December 2021, they had worked with the practice to support their improvements in relation to the breaches. They told us the patient list had increased by 4% over the past 12 months, however due to the positive management changes this had not affected care or patient satisfaction results.

We found people were positive about their experience of care and treatment they received at the practice within the last 12 months. There were 11 records of feedback directly to CQC and 9 reviews published on the NHS website. Comments included that the practice staff were knowledgeable and followed up on actions or queries relating to their care. There were also 127 Friends and Family Test responses for this practice within the most recent published records (December 2023). We saw that 91% of patients who responded were positive about their experience of the service they received

We spoke with a range of staff during our assessment, including clinical and non clinical staff, who worked with patients and ensured safe systems, pathways and transitions. This included two GP partners, the practice manager, a healthcare assistant, the workflow administrator, a receptionist, and a secretary. They all demonstrated they maintained safe systems of care, in which safety was managed, monitored and assured. We saw examples of continuity of care, including when people moved between different services. Staff told us they had the information they needed to deliver safe care and treatment. Staff explained that although the workload was high, there were processes to identify any capacity issues and they felt this was always addressed. We were also told about new staff being recruited to manage demand.

We found people were positive about their experience of care and treatment they received at the practice within the last 12 months. There were 11 records of feedback directly to CQC and 9 reviews published on the NHS website. There were also 127 Friends and Family Test responses for this practice within the most recent published records (December 2023). We saw that 91% of patients who responded were positive about their experience of the service they received. We did not receive any concerns or identify any specific feedback about safeguarding.

There was a safeguarding lead GP, and staff were aware of who to speak with if they had concerns about a patient. There was also a dedicated safeguarding administrator. Staff we spoke with told us about training they had completed, and they demonstrated an understanding about safeguarding and how to raise concerns. The practice told us that discussions about safeguarding regularly took place, and we were provided with examples where the practice had followed up on patients due to concerns for their safety and welfare. We were told that safeguarding was a standing agenda item for discussion in their meetings and we saw minutes of meetings to demonstrate this. The practice had a number of staff who had been trained to act as a chaperone for patients. Staff demonstrated they had received appropriate training for this role.

The provider had developed safeguarding systems and processes. We saw the practice monitored and maintained oversight of training and this showed all staff had completed appropriate safeguarding training. Alerts were placed on the practice clinical system for patients at risk, and the practice had safeguarding registers that were used to monitor and action concerns about patients. There were clear systems to follow up on children who were not brought to their appointment, including an appointment at the practice, or at secondary care. We saw examples to demonstrate correspondence from other services was reviewed and actioned where safeguarding concerns were highlighted. Disclosure and Barring Service (DBS) checks were undertaken for all staff. There were processes to ensure clinical staff had current professional registration.

We received positive feedback from the commissioners of the service, NHS Sussex integrated care board (ICB). They told us they had no concerns about the practice and had not received complaints or serious incidents.

At our last inspection in December 2021, we found not all staff had received training and guidance to recognise patients who were acutely unwell (including sepsis), the location of the defibrillator was not clear to all staff, and staff smartcards were not always secure. At this assessment, we visited the practice and found there were appropriate emergency equipment and medicines held. The practice had ensured all staff could locate them and there was appropriate signage. We saw training records that demonstrated staff had received training to recognise signs of serious infection, including sepsis. This included online and face to face training as well as guidance/posters available around the practice. We found there were adequate systems to assess, monitor and manage risks to patient safety. For example, there were systems and processes to ensure enough staff to provide appointments and prevent staff from working excessive hours. We found the practice had effective rota systems to plan and manage staffing. This included processes to manage staff absences and busy periods. The practice also had policies to ensure patient data was securely stored and managed safely, this included staff smartcard use. Additionally, during our assessment, a CQC GP specialist advisor carried out remote searches of the practice's clinical system and reviewed patient records, to assess any risks for patients. We found individual care records were written and managed securely in line with current guidance and relevant legislation.

At our last inspection in December 2021, we found not all staff had received training and guidance to recognise patients who were acutely unwell (including sepsis), the location of the defibrillator was not clear to all staff, and staff smartcards were not always secure. During this assessment, we visited the practice and spoke with a range of staff. We found all staff we spoke with could demonstrate an understanding of signs of serious infection and knew the actions to take if a patient became unwell. They told us about online training completed, as well as a face to face training session which had been delivered by one of the GP partners. Staff were able to locate emergency medicines and equipment and we saw clear signage around the practice. Staff told us they completed information governance training and told us how they kept their smartcard secure. During our visit to the practice, we observed staff who confirmed this. Staff explained the appointment booking system and how they triaged patients to the right appointment, or identified those in need of urgent assistance. Clinical staff we spoke with demonstrated how they involved patients, by providing information about when to seek help and what to do if their condition deteriorated.

We found people were positive about their experience of care and treatment they received at the practice within the last 12 months. There were 11 records of feedback directly to CQC and 9 reviews published on the NHS website. Comments included that the clinicians provided helpful and thorough information about care and treatment during consultations, and patients told us they did not feel rushed in appointments. We also received feedback that patients found helpful information available on the practices' website or social media. The national GP patient survey showed that the practice results were in line with local and England averages relating to patient experience. There were also 127 Friends and Family Test responses for this practice within the most recent published records (December 2023). We saw that 91% of patients who responded were positive about their experience of the service they received.

The practice told us they ensured health and safety risk assessments were carried out and appropriate actions taken. The practice management team told us there was a strong emphasis on the safety and well-being of staff and patients. Staff we spoke with told us there were health and safety procedures and they had completed relevant health and safety training, including fire. They also described recent fire drills and knew what to do in an emergency or major incident.

We looked at the practice documentation relating to health and safety during our visit. We saw a range of activities had been completed. We carried out checks within a clinic room that confirmed the practice maintained appropriate equipment availability and safety, medicines storage, and waste management.

Health and safety, and fire risk assessments were carried out by the practice. Remedial actions were being monitored and completed. We saw the practice had a range of policies and protocols available to staff regarding safety arrangements. All documentation was recorded centrally on their document management system.

We found people were positive about their experience of care and treatment they received at the practice within the last 12 months. There were 11 records of feedback directly to CQC and 9 reviews published on the NHS website. Comments included that all staff were welcoming, friendly and helpful. We received feedback that clinical staff were kind, took the time to listen, and were responsive. There were comments about the new practice manager, stating there had been an improvement to communication since starting in post. Many referred to staff by name and expressed their gratitude for the care and treatment received. The national GP patient survey showed that the practice results were in line with local and England averages relating to patient experience. There were also 127 Friends and Family Test responses for this practice within the most recent published records (December 2023). We saw that 91% of patients who responded were positive about their experience of the service they received.

We looked at 4 staff files and found recruitment checks had been carried out in accordance with regulations and in line with the practice's own recruitment policy. There was a programme of learning and development for all staff and this included a range of mandatory training modules, as well as learning sessions within the primary care network of GP practices. We found completion of training was monitored. We found staff received regular support, supervision and appraisal appropriate to their role. These were used to develop and upskill their staff and to proactively identify any risk within the practice, including performance issues. There was clinical supervision of the staff in advanced clinical practice. The practice told us they were reviewing the format and content of the supervision, and improving their systems and processes to formally document these sessions.

Staff told us leaders and GPs were available throughout the day if they needed advice. Staff were positive about working at the practice and told us that everyone was friendly. We received feedback that they worked well together and all helped each other. They told us they felt supported, valued and listened to. We received numerous examples of staff being supported professionally and personally. Staff told us morale at the practice had recently improved and they appreciated that leaders were open and welcomed their thoughts or ideas. Although not all staff were aware of the Freedom to Speak Up Guardian, all staff told us they felt encouraged to raise concerns and knew how to do this. Staff were happy with the communication at the practice. Regular team meetings and discussions were held, including multidisciplinary team meetings, and staff group meetings.

We found people were positive about their experience of care and treatment they received at the practice within the last 12 months. There were 11 records of feedback directly to CQC and 9 reviews published on the NHS website. Comments included that the environment was pleasant and clean.

We found the maintained appropriate standards of cleanliness and hygiene. We observed the premises to be clean and tidy. They had a general cleaning schedule and daily task checklists. We found the arrangements for managing waste and clinical specimens kept people safe.

We spoke with the infection, prevention and control (IPC) lead, who was one of the GP partners. A practice nurse was the deputy IPC lead and the practice was arranging appropriate training for this role. They described appropriate systems to manage and monitor the prevention and control of infection. They kept up to date through national updates as well as through local engagement with local practices, for example a weekly meeting with their primary care network of GP practices. They had systems to ensure prompt identification of people who have or are at risk of developing an infection so they receive timely and appropriate treatment, and to reduce the risk of transmitting infection to other people. For example due to a recent outbreak of measles, the IPC lead had reached out to a local health protection team to request up to date guidance and toolkits to enable appropriate assessment and treatment for patients.

At our last inspection in December 2021, we found a staff immunisation programme had not always been maintained for non-clinical staff. At this assessment, the practice demonstrated that records of staff vaccination were being obtained and follow up actions were being completed. An infection prevention and control policy had been implemented and audits were carried out annually. There were processes to follow up on remedial actions identified by the audit. For example, as a result of the audit carried out in February 2024 they had replaced privacy screens. All staff had received appropriate training, including for handwashing techniques.

With the consent of the practice, a CQC GP Specialist Advisor (GP SpA) accessed the practice's systems to undertake remote searches. These searches indicated a small number of patients potentially at risk due to a lack of monitoring. A further investigation of patient records was undertaken to assess the potential risks. The CQC GP SpA sampled a select number of patient records, where any risks were potentially identified, to assess the risks for these individual patients. However, there was evidence within the records that the practice had identified any outstanding monitoring and had taken action to invite the patient in for a follow up appointment. There was no evidence of patient harm. We discussed our findings with the practice, and they demonstrated they took immediate action to further investigate and follow up on these patients. They also told us about planned improvements to the protocol to follow up when patients did not reply or did not attend following requests to attend for monitoring appointments. The medicines reviews included in our clinical searches contained information we would expect to see. Staff had the appropriate authorisations to administer medicines using Patient Specific Directions and Patient Group Directions. The CQC GP SpA reviewed 5 medicines reviews, and all of these had information we would expect to see, for example the patients’ entire medicines list was documented, and the reviewer had checked all monitoring was up to date.

We spoke with a range of staff during our assessment, including clinical and non clinical staff. This included two GP partners, the practice manager, a practice nurse, a healthcare assistant, the workflow administrator, a receptionist, and a secretary. All staff told us about the practice systems to ensure the appropriate and safe use of medicines, including medicines optimisation. All staff we spoke with told us they were passionate about providing consistent high-quality person-centred care to patients. They told us they felt supported in their role, and there was a GP available at all times if they needed advice or were concerned about a patient.

At our last inspection in December 2021, we found emergency medicines were not always available and in date, and computer prescription paper was not always held securely. At this assessment, we visited the practice and found the practice had appropriate emergency medicines and equipment. There were risk assessments in place to determine the range of medicines held, and a system was in place to monitor stock levels and expiry dates. We also saw blank prescriptions were kept securely, and their use monitored in line with national guidance. We saw evidence that staff had the appropriate authorisations to administer medicines using Patient Group Directions or Patient Specific Directions. We found medicines, including those requiring refrigeration, were appropriately stored, monitored and transported in line with national guidance to ensure they remained safe and effective.

We found people were positive about their experience of care and treatment they received at the practice within the last 12 months. There were 11 records of feedback directly to CQC and 9 reviews published on the NHS website. Comments we received included that patients had confidence and trust in the practice, GPs and staff were thorough and responsive, and praise for health care assistants and nurses for their care. There were also 127 Friends and Family Test responses for this practice within the most recent published records (December 2023). We saw that 91% of patients who responded were positive about their experience of the service they received.

There were no concerns around the monitoring and prescribing of medicines, including for patients with long term conditions. There were governance structures in place to ensure regular review and oversight of medicines management. For example, the practice was having regular oversight meetings and clinical meetings to discuss and cascade information, national prescribing guidelines and relevant guidance. We found there was a programme of clinical audit and second cycle audits. These demonstrated improvements to the quality of care. This included audits of prescribing and medicines management audits.