All inspections: Saltdean and Rottingdean Medical Practice

We carried out an announced comprehensive at Saltdean and Rottingdean Medical Practice from 8 November to 11 November 2022. Overall, the practice is rated as requires improvement.

Safe - requires improvement

Effective - requires improvement

Caring – good

Responsive - good

Well-led – requires improvement

Following our previous inspection on 6 June 2019, the practice was rated requires improvement overall. They were rated as requires improvement for all key questions, except for caring, which was rated as good. We issued a requirement notice for regulation 12 (safe care and treatment), regulation 17 (good governance) and regulation 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Saltdean and Rottingdean Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection.

The focus of our inspection included:

All key questions
Areas we said the provider should improve; to improve patient satisfaction, to improve diabetes management, and to include details of how to contact the ombudsman in responses to complaints.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This included:

Conducting staff interviews in person and using video conferencing.
Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
Reviewing patient records to identify issues and clarify actions taken by the provider.
Requesting evidence from the provider.
A staff survey.
A short site visit.

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 found that:

The practice was addressing challenges that had arisen from their recent merger with another local practice, which increased their patient list size by approximately 3000 patients.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
Patients could access care and treatment in a timely way.
There was a programme of learning and development for staff.
Staff told us they were happy with the level of support provided by their management team and each other.
There were some concerns around the management of medicines and review of patients with long-term conditions.
The practice did not always have effective processes for managing risks, issues and performance.
The practice did not always have clear systems, practices and processes that were consistently followed.

We found breaches of regulations. The provider must:

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

Additionally, the provider should:

Ensure staff files contain complete information about recruitment checks undertaken.
Establish a formalised programme of audit and review of the workflow optimisation system.
Continue to embed improvements to prescription form security.
Ensure expired medical equipment is promptly disposed of.
Continue plans to complete training on how to support people with a learning disability and autistic people.
Continue to improve clinical supervision to include prescribing activity of non-medical prescribers.
Continue to improve the recording of complaints and strengthen the identification of trends.
Consider methods to improve communication within the practice and opportunities for feedback.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

We carried out an announced comprehensive inspection at Saltdean and Rottingdean Medical Practice on 28 March 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 requires improvement for all population groups.

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

The practice did not have appropriate systems in place for the safe management of all high-risk medicines.
There was no risk assessment as to which emergency medicines were kept in the practice and there was no medicine for use in case of seizures.
The practice did not have appropriate systems in place for the recording of action in relation to safety alerts received.
The practice did not always learn and make improvements when things went wrong.

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

The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

However:

Patients received effective care and treatment that met their needs.
Clinical audits were carried out and there was evidence of change and improvements.

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

Verbal complaints were not recorded; therefore the practice did not always learn and make improvements from these.

However:

The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

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

Systems were not in place to monitor the overall governance arrangements of the practice.

However:

Leaders were visible and approachable.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing caring services because:

Staff dealt with patients with kindness and respect and involved them in decisions about their care.

The areas where the provider must make improvement is:

Ensure that care and treatment is provided in a safe way.
Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the provider should:

Continue to work to improve areas of patient satisfaction such as in relation to patients feeling listened to and treated with care and concern.
Continue to work to improve diabetes indicators.
Include details of how to contact the ombudsman in complaints communication with patients.

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

Letter from the Chief Inspector of General Practice

The practice was rated good overall and is now rated good for providing safe and well led services.

We carried out an announced comprehensive inspection of this practice on 19 April 2016. A breach of legal requirements was found during that inspection within the safe and well led domains. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements. We conducted a focused inspection on 8 December 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

During our previous inspection on 19 April 2016 we found the following areas where the practice must improve:

Ensure that all significant events are consistently captured, recorded and shared in order to maximise learning opportunities and to ensure the practice maintains an accurate overview.
Develop an on-going audit programme that demonstrates continuous improvements to patient care in a range of clinical areas. Ensure there are at least two cycles of a clinical audit.
Put plans in place to address lower than average levels of patient satisfaction as identified in the national GP survey. Undertake regular surveys of patient views and act on the results in order to ensure continuous improvement.

Our previous report also highlighted the following areas where the practice should improve:

Ensure that all staff who undertake chaperone duties are trained.
Develop a business plan that sets out the future direction for the practice.
Consider extending the practice’s opening hours in order to meet the needs of patients who cannot attend during working hours.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During the inspection on 8 December 2016 we found:

The practice had a system in place to ensure that significant events were captured and recorded consistently in one place. We saw that significant events were regularly discussed and that the learning was shared at team meetings.
The practice now had a formal programme of on-going clinical audit and that two cycles of one clinical audit had been completed since our last inspection.
The practice had undertaken a survey of 130 patients and was in the process of analysing the results. This along with the results of the national GP survey was due to be discussed at a GP meeting in January 2017 where an action plan would be developed.

We also found in relation to the areas where the practice should improve:

All staff who undertook chaperone duties had received appropriate training for the role
The practice had not yet developed a formal business plan that set out its future direction.

The partners had considered extending the practice’s opening hours, however they still felt that they were not in a position to extend their current working hours any further

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Saltdean and Rottingdean Medical Practice on 19 April 2016. Overall the practice is rated as requires improvement.

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

There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, not all significant events had been consistently captured and recorded.
Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
There was limited evidence to show that clinical audits had been undertaken and that quality improvement had been demonstrated.
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. Improvements were made to the quality of care as a result of complaints and concerns.
Patients said they found it easy to make an appointment with a named GP and 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.
There was limited evidence to show that the practice proactively sought feedback from patients, which it acted on.
The provider was aware of and complied with the requirements of the duty of candour.

The areas where the must make improvements are:

Ensure that all significant events are consistently captured, recorded and shared in order to maximise learning opportunities and to ensure the practice maintains an accurate overview.
Develop an ongoing audit programme that demonstrates continuous improvements to patient care in a range of clinical areas. Ensure there are at least two cycles of a clinical audit.
Put plans in place to address lower than average levels of patient satisfaction as identified in the national GP survey. Undertake regular surveys of patient views and act on the results in order to ensure continuous improvement.

The areas where the provider should make improvements are:

Ensure that all staff who undertake chaperone duties are trained.
Develop a business plan that sets out the future direction for the practice.
Consider extending the practice’s opening hours in order to meet the needs of patients who cannot attend during working hours.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Saltdean and Rottingdean Medical Practice

All Inspections

9 to 11 November 2022

During a routine inspection

28 March 2019

During a routine inspection

8 December 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

19 April 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)