The Care Quality Commission
  • Doctor
  • GP practice

Archived: School House Surgery Also known as Allied Medical Practice

Overall: Inadequate read more about inspection ratings

Hertford Road, Brighton, East Sussex, BN1 7GF (01273) 551031

Provided and run by:
School House Surgery

All Inspections

4 May and 5 May

During an inspection looking at part of the service

We carried out an announced focused inspection at School House Surgery on the 4 and 5 May to assess compliance against two warning notices. School House Surgery is currently rated inadequate overall. This inspection was not rated, therefore the previous ratings remain unchanged.

CQC placed this service into special measures in November 2019. We carried out an announced comprehensive follow up inspection of School House Surgery between 24 November and 3 December 2020. Although a number of concerns had been addressed and improvements had been made by the practice, the practice was rated inadequate and remained in special measures. In January 2021, we issued two warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

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

Why we carried out this inspection

This focused inspection was carried out on the 4 and 5 May to confirm whether the provider was compliant with the warning notices issued in January 2021. This report only covers our findings in relation to the warning notices.

How we carried out the inspection

Throughout the 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 inspections differently.

This inspection was carried out in a way that enabled us to spend a minimum amount of time on site. 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.
  • Completing clinical searches on the practice’s patient records system and discussing. findings with the provider.
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider, which was reviewed remotely.
  • 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.

At this inspection we found that improvements had been made and the provider was compliant with the two warning notices.

We found that:

  • The provider had made significant improvements since our last inspection. This included the systems and processes for reporting and recording significant events, safeguarding, and failed attendances for appointments.
  • We saw that a new emergency assistance alarm had been installed within the disabled toilet, and the lighting had been improved with the installation of automatic lights.
  • The processes and procedures to ensure the proper and safe storage of medicines had been improved. This included emergency medicines and medicines requiring refrigeration.
  • Blank prescriptions were kept securely and there were systems to monitor their use, including when distributed throughout the practice.
  • The provider had addressed our concerns relating to the monitoring and prescribing of medicines. We saw there had been improvements to procedures and processes.
  • We saw evidence that the completion of medicine reviews and health assessments had improved. We noted that the recording of these could be improved further, relating to the clinical system.
  • The provider did not always have effective processes to identify, understand, monitor and address current and future risks, including risks to patient safety. This included the oversight and supervision of staff undertaking clinical work, and automated coding of medication reviews.

We found the following breach of regulations. The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Additionally, the provider should:

  • Continue to review and improve health assessments, including the method of recording within the clinical system.
  • Strengthen the recording and coding of medication reviews to enable ongoing actions to be identified and followed up.

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

24 November to 3 December 2020

During a routine inspection

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

6 February 2020

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at School House Surgery on 17 and 23 September 2019 as part of our inspection programme. The overall rating for the practice was inadequate. The full comprehensive report on the September 2019 inspection can be found by selecting the ‘all reports’ link for School House Surgery on our website at .

This inspection was an announced focused inspection carried out on 6 February 2020 to confirm that the practice was compliant with warning notices issued following the November 2019 inspection. Warning notices had been issued against regulation 12 (safe care and treatment) and regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report covers our findings in relation to the requirements against these regulations.

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.

The ratings remain unchanged from the September 2019 inspection, as the purpose of the February 2020 inspection was to review compliance against the warning notices issued.

We found the provider had made sufficient improvements in all areas of the issued warning notices, for example:

  • The management of medicines, including ensuring the availability of necessary emergency medicines.
  • The storage and security of medicines and substances hazardous to health.
  • The availability of emergency equipment at both surgeries.
  • Safeguarding processes.
  • Fire safety.
  • Infection prevention and control.
  • Health and safety risk assessments and the general management of risk.
  • Reporting and recording significant events.
  • Learning and continuous improvement.
  • Records relating to the management of the regulated activities, including practice policies and meeting records.

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

17 and 23 September 2019

During a routine inspection

We carried out an announced comprehensive inspection at School House Surgery on 17 September 2019 due to the length of time since the last inspection and information that patient numbers had increased since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions: Safe, effective and well-led. Because of the assurance received from our review of information we carried forward the ratings for the following key questions: Caring and responsive. A second inspection visit was carried out on 23 September 2019.

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 and requires improvement for all population groups.

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

  • The practice did not have comprehensive environmental risk assessments and safety checks in place.
  • Not all incidents were reported or recorded.
  • The practice did not have comprehensive safeguarding systems in place.
  • There was a lack of equipment for dealing with medical emergencies.
  • Medicines were not managed effectively.
  • Cleanliness and infection control processes were poor.

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

  • There was evidence of some monitoring and improvement to patient outcomes. However, long term condition and mental health indicators were significantly below average. Cervical screening performance was below average. Diabetes performance was tending towards negative.
  • Clinical meetings where patients on the palliative care register were discussed were held infrequently.

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.
  • The overall governance arrangements were ineffective.
  • The practice did not have clear and effective processes for managing risks, issues and performance.
  • The practice had limited mechanisms in place to involve the public, staff and external partners to sustain high quality and sustainable care.
  • There was evidence of some systems and processes for learning, continuous improvement and innovation, however learning from when things went wrong was not given sufficient priority.

The areas where the provider must make improvements are:

  • Provide safe care and treatment.
  • 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:

  • Continue to work to improve the uptake of cervical screening.
  • Continue to work to improve QOF performance.
  • Nurses to undertake level three safeguarding training.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of 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 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 a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service 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

27 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at School House Surgery on 27 July 2015. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • 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 practice was involved in working closely with the clinical commissioning group and other practices in the area about the development of services and how best to meet the needs of the local population.

There was one area of practice where the provider should make improvements:

  • Ensure the continuation of the patient participation group and establish the group on a firm footing.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

27 May 2014

During a routine inspection

School House Surgery is a small practice set in a residential street. The practice is located at Hertford Road, Brighton, BN1 7GF. The practice provides a range of services for patients, which include clinics to manage long term conditions, family planning and child health. The practice has a branch called Church Surgery, we did not visit this premises during this inspection.

We spoke with the lead GP, the practice manager who is also the registered manager and seven patients who use the service. We also received feedback from 19 patients in response to our comment cards left at the practice. On the day of our inspection neither of the two nurses who work at the practice were available due to training and holiday commitments. However, we spoke to them on the telephone following the inspection.

Patients we spoke with gave positive feedback about the practice and staff. We reviewed the results of the last patient survey. This told us that patients were satisfied with the service they received. The practice manager told us they had developed an action plan for areas that required further improvement. We noted that this was also available on the practice website.

The practice was actively involved with the clinical commissioning group (CCG). A clinical commissioning group is an NHS organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services. As commissioners of local health services, a CCG is responsible for planning the right services to meet the needs of local people, and ensuring that they are provided. The practice manager was part of the CCG local management group. The practice engaged with patients through a virtual patient participation group (PPG) influencing and shaping services to meet patient needs. The patient participation group (PPG) is a group of active volunteer patients that work in partnership with practice staff and GPs.

Systems were in place to safeguard children and vulnerable adults. Patients were safeguarded by a structured recruitment and vetting practice however some records related to this area needed to be more robust.

The GP partners and practice manager were supportive and staff found them very approachable. There were risk management measures in place.