Background to this inspection
Updated
17 October 2019
Warrior Square Surgery is based in Hastings. The practice moved back to their current location at Marlborough House in March 2018, having relocated to a different location following a fire at Marlborough House in 2013. The practice holds a contract to provide general medical services and at the time of our inspection there were approximately 7,800 patients on the practice list. The practice has a slightly higher than average number of children from birth to four years. The practice is located in an area that is considered to be in the most deprived centile nationally. The practice has a higher than average proportion of patients who are unemployed and a higher proportion of patients with a learning disability. The practice has a higher proportion of patients diagnosed with depression.
The practice is run by two GP partners and an executive non-clinical partner. The practice is part of the Hastings and Rother Healthcare Partnership, a group of practices that is in development to become a formal partnership. The GPs are supported by two part time salaried GPs (male) and two regular locum GPs (female). They are supported by a paramedic practitioner (male), a pharmacist (female), two advanced nurse practitioners (female) and three practice nurses (female) and two healthcare assistants (female). A practice manager and deputy practice manager are in post along with a small team of clerical and reception staff. Additional management functions are provided from the Hastings and Rother Healthcare Partnership in terms of business management and financial management.
The practice is open between 8.30am and 6.00pm Monday to Friday, telephones are open from 8.00am each morning. Extended hours appointments are offered on a Monday and Tuesday evening until 8.00pm and on Saturday mornings. Telephone appointments are also available on a Sunday morning. The practice is the hub for a local extended access service. When the practice is closed patients are advised to call NHS 111 where they will be given advice or directed to the most appropriate service for their medical needs.
For further details about the practice please see the practice website: www.warriorsquaresurgery.co.uk
The practice is registered with CQC to provide the following regulated activities; diagnostic and screening procedures, treatment of disease, disorder or injury, family planning services, maternity and midwifery services and surgical procedures.
The service is provided from the following location:
Marlborough House 19-21, Warrior Square, St Leonards-on-sea, TN37 6BG.
Updated
17 October 2019
We carried out an announced comprehensive inspection at Warrior Square Surgery on 29 July 2019 as part of our inspection programme. This was to follow up on breaches of regulations and as part of our schedule of inspection where services placed in special measures will be inspected again within six months. At this inspection we followed up on breaches of regulations identified at a previous inspection on 7 November 2018.
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 inadequate overall.
We rated the practice as inadequate for providing effective services because:
- There was limited monitoring and improvement to patient outcomes, particularly in relation to asthma and mental health indicators.
- Actions to ensure improvements as a result of clinical audits were inconsistent and not always clear.
- Cancer screening was lower than average, including in relation to cervical screening.
- Childhood immunisation uptake remained below target.
We rated the practice as inadequate for providing responsive services because:
- People were not able to access care and treatment in a timely way.
- The system for dealing with complaints did not always take account of the needs of patients.
We rated the practice as inadequate for providing well-led services because:
- Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
- While the practice had a clear vision, that vision was not supported by a credible strategy with sufficient focus on quality improvement.
- The overall governance arrangements were ineffective.
- The practice did not have clear and effective processes for managing risks, issues and performance.
- Patient views were not always acted on to improve services.
- There was evidence of some systems and processes for learning, continuous improvement and innovation, however there were a number of areas where improvements had not been sufficient.
These areas affected all population groups, so we rated all population groups as inadequate.
We rated the practice as requires improvement for providing safe services because:
- The practice did not have comprehensive environmental risk assessments and safety checks in place.
- There was insufficient review and oversight of non-medical prescribing.
- Not all incidents were reported or recorded.
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 improvements are:
- Ensure that care and treatment is provided in a safe way.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Take action to improve the identification of carers.
- Improve the recording of patient’s smoking status.
This service was placed in special measures in February 2019. Insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall. Therefore, we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration’.
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