The Care Quality Commission
  • Doctor
  • GP practice

WellBN

Overall: Good read more about inspection ratings

18-19 Western Road, Hove, East Sussex, BN3 1AE (01273) 772020

Provided and run by:
WellBN

All Inspections

2 May 2023 to 5 May 2023

During a routine inspection

We carried out an announced comprehensive inspection at WellBN from 2 May 2023 to 5 May 2023. Overall, the practice is rated as good.

Safe - good

Effective - good

Caring - good

Responsive - good

Well-led - good

We carried out an announced comprehensive follow up inspection from 4 May 2022 to 6 May 2022. At this inspection we found insufficient improvements had been made and we identified additional concerns. The provider was rated inadequate and placed in special measures. On 20 May 2022 we issued two warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). We carried out an inspection on 17 August 2022 and confirmed the provider was compliant with the warning notices.

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

Why we carried out this inspection

This inspection was carried out to confirm whether the provider continued to meet the legal requirements of regulations and to ensure enough improvements had been made.

The focus of our inspection included:

  • All key questions
  • Areas we said the provider should improve;
    • Review systems for recording disclosure and barring scheme checks, to ensure the date completed and the level of the check is included.
    • Review systems and processes to improve uptake of child immunisation and cervical screening.
    • Maintain records of completed and signed staff induction checklists
    • Review the frequency of basic life support training for all staff.
    • Continue to review the electronic triage system and appointment system, including monitoring call waiting times and missed calls.
    • Review arrangements to keep staff up to date with relevant practice information, including access to information about their Freedom to Speak Up Guardian.

How we carried out the inspection

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

Our inspection included:

  • Conducting staff interviews.
  • 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 site visit at the main practice and both branch sites.

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 provider had continued to make improvements since our last inspection. Risks to patients, staff and visitors were assessed, monitored and managed effectively.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Information to deliver safe care and treatment was available to staff.
  • They had clear processes to identify, understand, monitor and address current and future risks, including risks to patient safety.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice had reviewed and improved access and the telephone system. Improving access was a priority for them, and they used patient feedback to focus their actions.
  • Staff told us they were happy with the level of support and communication provided by their management team.
  • The practice encouraged staff development and gave staff the opportunities to further their career.
  • The practice had established an active patient participation group and patient views were acted on to improve services and culture.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
  • The provider was fully engaged and committed to completing and embedding improvement actions.

Whilst we found no breaches of regulations, the provider should:

  • Improve the systems for the identification of carers so that all carers are offered support.
  • Continue to improve patient access to appointments, the electronic triage systems, and telephone wait times.
  • Proactively offer a private room or area when patients appear distressed or are making a complaint.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

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 Health Care

17 August 2022

During an inspection looking at part of the service

We carried out an announced inspection at Brighton Health and Wellbeing Centre on the 17 August 2022 to assess compliance against two warning notices. Brighton Health and Wellbeing Centre is currently rated inadequate overall. This inspection was not rated and therefore the previous ratings remain unchanged.

We carried out an announced comprehensive follow up inspection of Brighton Health and Wellbeing Centre from 4 May 2022 to 6 May 2022. At this inspection we found insufficient improvements had been made and we identified additional concerns. The practice was rated inadequate and placed in special measures. On 20 May 2022 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 17 August 2022 to confirm whether the provider was compliant with the warning notices issued in May 2022. 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.

Our inspection included:

  • Conducting staff interviews.
  • 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 site visit at the main practice. We did not visit the branch surgery as part of this inspection.

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. Risks to patients, staff and visitors were assessed, monitored or managed in an effective manner. This included child and adult safeguarding processes, infection prevention and control, staffing including recruitment and supervision, and medicines management.
  • Information to deliver safe care and treatment was now available to staff. The provider had processes to monitor workloads and any potential delays for summarising, referrals, test results, scanning and correspondence.
  • The responsibilities, roles and systems of accountability to support good governance and management had been established. There had been improvements to procedures and processes.
  • The provider was fully engaged and committed to completing and embedding improvement actions. They now had clear processes to identify, understand, monitor and address current and future risks, including risks to patient safety.

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

3 May 2022 to 6 May 2022

During a routine inspection

We carried out an announced inspection at Brighton Health and Wellbeing Centre from 4 May 2022 to 6 May 2022. Overall, the practice is rated as Inadequate.

Safe - Inadequate

Effective – Requires improvement

Caring – Good (carried over from previous inspection)

Responsive – Good (carried over from previous inspection)

Well-led - Inadequate

Following our previous inspection on 8 October 2019, the practice was rated Good overall and for all key questions, but requires improvement for providing safe services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Brighton Health and Wellbeing Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This focused inspection was carried out to confirm whether the provider now met the legal requirements of regulations and to ensure enough improvements had been made. We also followed up on concerns that we had received since our last inspection.

Our inspection focused on:

  • The key questions; safe, effective and well-led.
  • Breaches of regulation 12 safe care and treatment, which were identified at our previous inspection on 8 October 2019.
  • Areas we said the practice should improve.
  • Themes of concerns received.

During this inspection we also considered the management of access to appointments.

We carried forward ratings for caring and responsive from previous inspections, as the information we held did not indicate any change to ratings.

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 which 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 in person, and 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
  • A short site visit
  • Conducting a staff survey

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 have rated this practice as Inadequate overall.

We found that:

  • The practice did not always provide care in a way that kept patients safe and protected them from avoidable harm.
  • Risks to patients, staff and visitors were not always assessed, monitored or managed in an effective manner. This included child and adult safeguarding processes, infection prevention and control, staffing including recruitment and supervision, and medicines management.
  • Information to deliver safe care and treatment was not always available to staff.
  • Uptake of cervical screening and child immunisation were below the minimum target.
  • Governance systems and processes were not established and operating effectively.
  • The responsibilities, roles and systems of accountability to support good governance and management were not always clear or effective.
  • Opportunities for patients to be actively involved in shaping and improving services provided by the practice were limited.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • Patients had access to additional wellbeing services and treatments.
  • The practice held weekly specialist clinics for refugees, trans patients, and a menopause clinic for those receiving hormone replacement therapy (HRT).
  • Staff commented they felt supported and encouraged to reach their potential. They said it was a rewarding workplace and they were part of a diverse and inclusive team.

We found breaches of regulations. The provider must:

  • 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).

Additionally, the provider should:

  • Review systems for recording disclosure and barring scheme checks, to ensure the date completed and the level of the check is included.
  • Review systems and processes to improve uptake of child immunisation and cervical screening.
  • Maintain records of completed and signed staff induction checklists
  • Review the frequency of basic life support training for all staff.
  • Continue to review the electronic triage system and appointment system, including monitoring call waiting times and missed calls.
  • Review arrangements to keep staff up to date with relevant practice information, including access to information about their Freedom to Speak Up Guardian.

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 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

8 Oct 2019

During an inspection looking at part of the service

We carried out an inspection of Brighton Health and Wellbeing Centre on 8 October 2019 following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions: safe, effective and well-led services.

Due to the assurance received from our review of information we carried forward the ratings for the following key questions: caring and responsive.

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.

Overall this practice is rated as good.

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

  • Appropriate recruitment checks were not always completed.
  • Infection prevention and control was not always well managed. This included a lack of evidence to demonstrate regular audits, a staff vaccination programme and evidence of completed cleaning.
  • The practice could not demonstrate there was an effective system for the production of Patient Specific Directions.
  • The systems in place to monitor the storage of refrigerated medicines and vaccines were not implemented effectively.

At this inspection our key findings were:

  • We observed staff interacting positively with patients, who were treated with kindness and respect. Feedback from patients who used the service was consistently positive.
  • The service had systems to record, investigate and monitor significant events and safety alerts. When incidents did happen, the practice learned from them and improved their processes.
  • The service ensured that care and treatment was delivered according to evidence- based research or guidelines.
  • Staff maintained the necessary skills and competence for their role and to support the needs of patients.
  • The dedicated practice pharmacy team evidenced an effective monitoring and review process for patients prescribed high risk medicines.
  • The culture of the service encouraged candour, openness and honesty.
  • Staff were proud to work at the practice and told us they felt well supported, both professionally and personally.
  • Patients had access to additional services and could self-refer or drop in to groups, such as a Saturday singing group and healing arts group.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Review the level of training provided to staff for child and adult safeguarding.
  • Review and strengthen the guidance and training provided to staff on sepsis and serious infection.
  • Strengthen the recorded details on patient group directions to include the organization name.
  • Continue to monitor and take action to improve performance for areas that are not in line with targets, including for patients with diabetes, smoking or alcohol status for those with a mental health condition, and the uptake of childhood immunization and cervical screening.

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 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brighton Health and Wellbeing centre on 27 September 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • 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.
  • 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 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. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice developed a well-being programme in response to local demand in which complementary and alternative medicine practitioners and Healing Arts therapists worked beside GPs in the building to offer a wide range of therapeutic options complementary to and additional to standard medical practice. The practice had formed a charity which helped patients on low incomes and benefits to access these therapies. The development of the programme had led to the practice winning a national innovation award.

The areas where the provider should make improvement are:

To keep higher than average exception reporting rates for the quality and outcomes framework under review and ensure action is taken to reduce rates where clinically appropriate.

To continue to monitor closely and encourage the uptake of childhood vaccines and of cervical screening.

Ensure that references are checked for all locums.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice