Background to this inspection
Updated
15 June 2021
School House Surgery, also known as Allied Medical Practice, is based in a residential area of Brighton. It is part of the Brighton and Hove City Clinical Commissioning Group (CCG). The practice holds a contract to provide general medical services and at the time of our inspection there were approximately 5,600 patients on the practice list. School House Surgery is part of a wider network of GP practices, which includes five other local practices.
The service is provided from the following locations:
School House Surgery, Hertford Road, Brighton, BN1 7GF.
There is a branch surgery operating at:
Church Surgery, Saunders Park Rise, Brighton, BN2 4ES.
Information published by Public Health England reports that the practice is in an area which is in the third most deprived centile nationally. The practice has a higher than average proportion of patients who are unemployed. The practice has a slightly higher than average number of children under 18 when compared with the local average, although this is less than the national average. The practice has a higher proportion of patients diagnosed with a mental health condition, including a significantly higher than average proportion of patients diagnosed with dementia.
The practice is run by two GP partners (male) and a practice manager who is the registered manager. The GPs are supported by regular long-term locum GPs (male and female). There is one practice nurse (female) and one healthcare assistant (female). There is a small team of clerical and reception staff. There is also a pharmacist, employed by the primary care network.
The practice is open between 8.30am and 6pm Monday, Tuesday and Thursday and from 8.30am to 5pm on a Friday. The practice is closed on a Wednesday afternoon and arrangements are in place with a neighbouring practice to provide access to patients with urgent needs.
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.
Due to the enhanced infection prevention and control measures put in place since the pandemic and in line with the national guidance, most GP appointments were telephone consultations. If the GP needs to see a patient face-to-face then the patient is offered a choice of either the main GP location or the branch surgery.
For further details about the practice and its opening times please see the practice website: www.alliedmedicalpractice.org.uk.
Updated
15 June 2021
We carried out an announced comprehensive inspection at School House Surgery between 24 November and 3 December 2020 as part of our inspection programme.
CQC previously inspected the service in September 2019 and the practice was rated inadequate and placed into special measures. Two warning notices were issued against Regulation 12 Safe care and treatment, and Regulation 17 Good governance. We inspected the service in February 2020 to follow up on those concerns and found sufficient improvements had been made. The details of these can be found by selecting the ‘all reports’ link for School House Surgery on our website at www.cqc.org.uk.
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.
At this inspection our key findings were:
- The practice had continued to make improvements since our last inspections. The processes to identify, understand, monitor and address current or future risks had been revised and improved.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
- Staff maintained the necessary skills and competence for their role and to support the needs of patients.
- There was a clear leadership structure and staff told us they felt valued and supported to reach their potential.
- The practice had taken steps towards improving patient engagement. This included patient surveys, improving online access, and they had set up a patient participation group.
We rated the practice as inadequate for providing safe services because:
- The systems and processes to safeguard children and adults from abuse were not all established and operating effectively.
- There were concerns around the monitoring and prescribing of patients’ medicines, including those that are high risk.
- Medicines were not always stored and monitored appropriately.
- The systems and processes for recording and acting on significant events were not yet embedded at the practice.
We rated the practice as requires improvement for providing effective services because:
- We found that annual health reviews had not always been completed, to ensure patients health and medicines needs were being met.
- Some performance data was below local and England averages.
We rated the practice as inadequate for providing well-led services because:
- We saw the practice had made improvements since our last inspection to address concerns.
- Leaders had demonstrated that they had a credible strategy to develop sustainable care.
- However, at this inspection we identified significant concerns around clinical governance.
- We could not be assured that the practice had systems to regularly review quality and audit data to review performance relating to medicines management.
- We found there were some systems and processes that were not implemented effectively or were not yet well embedded.
We rated the practice as good for providing caring and responsive services.
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:
- Strengthen the programme of clinical audit and quality improvement activity, including to routinely review the effectiveness and appropriateness of the care provided.
- Continue to monitor and take action to improve performance for areas that are not in line with targets, including the prescribing of hypnotics, and the uptake of childhood immunisation and cervical screening.
We are mindful of the impact of COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions as required to keep people safe and to hold providers to account where it is necessary for us to do so.
This service was placed in special measures in November 2019. Although a number of concerns have been addressed and improvements have been made by the practice, there remains a rating of inadequate overall. Therefore, the practice is to remain in special measures for a further six months to ensure that they continue to make improvements. The practice will continue to receive support from NHS England. The service will be kept under review and another inspection will be conducted within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any population group, key question or overall, we will take 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 varying the terms of their registration within six months if they do not improve.
Special measures will give people who use the practice the reassurance that the care they get should improve.
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