Herstmonceux Integrative Health Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. People were protected from abuse and avoidable harm.

This is the first inspection for this service since its registration with CQC under a new provider in December 2022. This key question has been rated as requires improvement. This was because processes for monitoring patients’ health in relation to the prescribing of some medicines were not always effective. Numbers of suitably qualified, competent, skilled and experienced persons were not always sufficient. Staff did not always receive appropriate ongoing or periodic supervision in their role to make sure competence was maintained.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated then reported safety events appropriately. Lessons were learnt to continually identify and embed good practice.

Staff told us they knew how to identify and report incidents and were encouraged to do so. They were able to describe examples and talk about preventative action taken to prevent recurrence. We saw the practice had a centralised system for recording and monitoring significant events. The practice shared learning from incidents and complaints to specific staffing groups via email to ensure timely dissemination. There was evidence of learning and dissemination of information at weekly clinical meetings, however this was not always evident in meetings for other staff groups. The practice told us they would ensure learning was shared consistently at monthly team meetings. Learning from incidents and complaints resulted in changes that helped improve care for others.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The practice had a care co-ordinator, social prescribers and regular multi-disciplinary meetings that supported patients moving across health and social care pathways. Referrals and test results were managed in a timely way.

The practice worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. It held monthly safeguarding meetings where new vulnerable patients were discussed, and records updated.

There were gaps in systems to assess, monitor and manage risks to patient safety.

Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. However, feedback from staff indicated some reception staff had not had the training required to ensure they could safely and consistently direct patients to the most appropriate clinician. There was no formal training and staff told us they often just used their ‘common sense’. The practice told us that reception staff completed a thorough induction process when joining the practice to support them to ensure they could safety and consistently direct patients to the most appropriate clinician. However, we saw that the induction checklist for reception staff did not include guidance on how to identify and what actions to take if they encountered a deteriorating or seriously unwell patient.
The practice GP lead had also run an introductory session on 'The deteriorating patient' in October 2024, at the practice's protected learning time afternoon. This gave reception staff awareness of presentations such as chest pain, stroke, breathlessness and sepsis. However, it was unclear how many staff had attended this and what checks had been completed to assess understanding and competency. The practice intended to re-run this session to ensure that new colleagues also received this training.

There was limited evidence to show that the practice had its own policies and procedures for identifying and prioritising ‘same day’ care which meant people requiring urgent appointments may not always be identified and prioritised appropriately. The practice told us they were due to implement a digital triage system in August 2025 which would help ensure patients were prioritised according to clinical need.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work well together to provide safe care that met people’s individual needs.

At the time of the inspection there were insufficient permanent GPs in post which meant the practice was not always able to fulfil its own staffing model. The practice was aware of this and was actively recruiting an additional salaried GP. To fill the staffing gap, locum GPs were employed, which meant the practice was not always able to provide continuity of care where it was clinically appropriate to do so, for example for patients with complex mental health needs. Because there was no permanent on-site female GP, the service was not always able to offer the choice of seeing a female GP for face-to-face appointments. However, the practice employed a female locum GP and provided regular female GP led clinics. There was also the opportunity for a patient to speak remotely to a female GP if preferred.

Whilst the service had a remote duty GP who acted as clinical lead and managed on-the-day patient queries and telephone appointment requests, staff told us they were not available for urgent in-person clinical advice. This meant staff often sought physical or urgent advice and guidance from the single salaried GP in-between their fully booked clinical sessions which often led to interruptions and delays. Significant event records highlighted time constraints and staffing pressures that had contributed to errors and near misses.

Whilst training, appraisals and audits were taking place, there were no regular, structured supervision sessions for clinical staff with the clinical lead or other appropriate clinician. The practice was therefore unable to demonstrate sufficiently how they were assured of the competence of staff employed in clinical practice. Due to long term absence in the nurse leadership team, meetings for nursing staff had not been taking place, which meant reduced opportunities for supervision, communication and peer support for the practice nurses and health care assistants.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and were followed. We saw that an audit of infection control and prevention had been completed in May 2025, and actions taken to mitigate risks. For example, a poster had been displayed on entry to the building instructing patients with infectious illnesses such as respiratory symptoms or diarrhoea and vomiting to inform staff immediately on arrival.

The service did not always make sure that medicines and treatments were safe and met people’s needs.

Our clinical searches 5th June 2025 showed that the process for monitoring patients’ health in relation to the use of medicines was not always effective. For example, our searches indicated that out of 726 patients being prescribed medicines used to treat high blood pressure and heart conditions, 19 had not had the required monitoring. We reviewed the records of 5 patients in more detail and found that none had up to date blood tests prior to issuing their prescription. The practice told us they were aware of this and that they limited supply of medicines until blood tests were up to date. However, there was no evidence in the patient notes that this process had been followed.

We found non-steroidal anti-inflammatory and anti platelet medicines were not always prescribed safely to patients over the age of 70. Out of 206 patients prescribed these medicines, we identified 53 had not been prescribed the recommended medicines to reduce the risk of gastrointestinal irritation and bleeding. We reviewed 5 records in more detail and found all 5 patients were potentially at risk of this.

The practice told us they had a system for recording and disseminating safety alerts, however it was unable to demonstrate that all relevant alerts had been acted on. Our clinical searches showed that 2 patients out of 35, prescribed a medicine used to treat bladder problems, had not received necessary monitoring. In addition, there was no evidence to show they had been informed of the risks associated with taking the medicine.

The practice advised that all patients had been invited for monitoring at the time of inspection to address the gaps in patient monitoring.

Staff took steps to ensure antibiotics were prescribed appropriately. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobial medicines issued by the provider had reduced over time, indicating good antibiotic stewardship. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

Medicines were stored safely and securely with access restricted to authorised staff. We also found staff had the appropriate authorisations to administer medicines. Staff managed prescription stationery appropriately and securely. Stock levels and expiry dates for all medicines, including emergency medicines and vaccines were checked regularly and staff made sure they were stored at the appropriate temperature. There was medical oxygen and a defibrillator on site and there were systems to ensure these were regularly checked and fit for use.