The Care Quality Commission
  • Doctor
  • Independent doctor

Hightree Clinic

Overall: Good read more about inspection ratings

High Tree House, Eastbourne Road, Uckfield, East Sussex, TN22 5QL (01825) 712712

Provided and run by:
Hightree Medical Limited

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Hightree Clinic on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Hightree Clinic, you can give feedback on this service.

5 October 2022

During an inspection looking at part of the service

This service is rated as Good overall. (Previous inspection September 2019 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good (carried over)

Are services caring? – Good (carried over)

Are services responsive? – Good (carried over)

Are services well-led? – Good (carried over)

We carried out an announced focused inspection at Hightree Clinic, because breaches of regulations were found at our previous inspection.

Following our previous inspection in September 2019, the service was rated Good overall. However, they were rated as requires improvement for providing safe services. They were rated good for all remaining key questions. We issued a requirement notice for regulation 12 (safe care and treatment), and regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC, which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Hightree Clinic is an independent doctor service. They provide consultation, treatment and prescribing services for conventional and complementary medicine, with an aim to improve and/or sustain patients’ overall quality of life. The clinic offers consultation and treatment only to patients over the age of 18.

Hightree Clinic provides a range of complementary therapies, for example medical acupuncture, osteopathy and nutritional therapy, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

The lead GP is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • The provider demonstrated they had taken action to address the areas we said they must improve on at our last inspection, and areas they should improve.
  • The service had systems to safeguard children and vulnerable adults from abuse. All staff had received safeguarding training to an appropriate level for their role.
  • Systems and processes for infection prevention and control had been implemented; including processes to mitigate the risk of legionella and to ensure staff immunisation was maintained in line with national guidance.
  • There was a system for receiving, recording and acting on safety alerts.
  • Information about care and treatment was available in an immediately accessible way.
  • There was a training programme in place that ensured staff received appropriate learning and development opportunities.
  • The service was actively involved in quality improvement activity.

Although we found no breaches of regulation, we told the provider they should make improvements:

  • Improve the training matrix to record the level training completed, where available.
  • Conduct a risk assessment for staff whose immunisation history is not available, to determine the level of risk to the staff member and patients, and any mitigating actions.
  • Continue to improve clinical record keeping; including electronic and paper records, and accurate recording of chaperones offered or used.
  • Complete training on how to interact appropriately with people with a learning disability and autistic people.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

25 Sep 2019

During a routine inspection

We carried out an announced comprehensive Hightree Clinic on 25 September 2019. This was the provider’s first rated inspection, and to follow up on breaches of regulations

CQC inspected the service on 9 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This was the provider’s first comprehensive inspection. We found the service was not providing safe, effective, responsive or well-led care in accordance with the relevant regulations. We issued two warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance), requiring the provider to achieve compliance with the regulations set out in those warning notices. We also issued two requirement notices for Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 19 (Fees) of the CQC (Registration) Regulations 2009.

We then undertook a focussed inspection on 23 January 2019. At this inspection, we found the requirements of the two warning notices had not all been met. We issued two further warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

We then undertook a focussed inspection on 30 April 2019 to follow up on the actions taken in response to the warning notices. Although improvements had been made, not all issues were resolved and we issued two requirement notices for Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

We followed up on the requirement notices issued following inspection on 9 October 2018 and 30 April 2019 at this inspection. We found the issues concerning Regulation 19 (Fees) of the CQC (Registration) Regulations 2009 had been resolved. We found that although significant improvement had been made, not all issues concerning Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) had been resolved.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC, which relate to particular types of regulated activities and services and these are set out in and of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Hightree Clinic is an independent doctor service. They provide consultation, treatment and prescribing services for conventional and complementary medicine, with an aim to improve and/or sustain patients’ overall quality of life. The clinic offers consultation and treatment only to patients over the age of 18.

Hightree Clinic provides a range of complementary therapies, for example medical acupuncture and osteopathy, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

The lead GP is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received 14 completed comment cards. Feedback from clients was consistently positive. We received comments that the staff were friendly, kind and knowledgeable. They commented that the service received from the lead GP was caring, professional and thorough.

Overall this service is rated as good.

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

  • Systems and processes for infection prevention and control were not all effective, including processes to mitigate the risk of legionella and to maintain staff immunisation.
  • Patient records we reviewed showed that information about care and treatment was not always available in an immediately accessible way.
  • The clinic was not receiving all safety alerts.

Our key findings were :

  • The clinic organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The provider was fully aware of the issues and challenges that affected the service. They had realistic action plans to make sure all necessary improvements were made.
  • Feedback from clients who used the service was consistently positive.
  • The service was proactive in seeking patient and staff feedback to identify and resolve concerns.
  • There was a clear leadership structure and staff felt supported by management.
  • The culture of the service encouraged candour, openness and honesty.
  • Staff worked well together as a team. All staff demonstrated their determination and willingness to improve systems and processes at the clinic.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We have told the provider to take action. You can see full details of the action and regulations not being met in the Requirement Notices section at the end of this report.

The areas where the provider should make improvements are:

  • Review and improve the organisation and structure of personnel files.
  • Continue to review and strengthen training received relating to child and adult safeguarding, and basic life support.
  • Strengthen and continue clinical quality improvement activity.
  • Strengthen staff training by determining and implementing mandatory requirements for the clinic.


Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

30 April 2019

During an inspection looking at part of the service

We carried out an announced comprehensive inspection of Hightree Clinic on 9 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This was the providers first comprehensive inspection. We found the service was not providing safe, effective, responsive or well-led care in accordance with the relevant regulations. We issued two warning notices requiring the provider to achieve compliance with the regulations set out in those warning notices. Warning notices were issued against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). We also issued two requirement notices for Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 19 (Fees) of the CQC (Registration) Regulations 2009. We then undertook a focussed inspection on 23 January 2019. At this inspection, we found the requirements of the two warning notices had not all been met. We issued two further warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

This inspection was a focused inspection carried out on 30 April 2019 to confirm whether the provider was compliant with the warning notices issued, following the inspection on 23 January 2019. This report only covers our findings in relation to the requirements set out in the warning notices.

Our findings were:

At this inspection, although significant improvements had been made, we found the requirements of the two warning notices had not all been met.

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services responsive?

We found that this service was not providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC, which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Hightree Clinic is an independent doctor service. They provide consultation, treatment and prescribing services for conventional and complementary medicine, with an aim to improve and/or sustain patients’ overall quality of life. The clinic offers consultation and treatment only to patients over the age of 18.

Hightree Clinic provides a range of complementary therapies, for example medical acupuncture and osteopathy, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

The lead GP is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • The clinic had made significant improvements since our last inspection, although not all requirements had been met. The provider was fully aware of the remaining issues and had realistic action plans to make sure all improvements were made.
  • The provider had improved the systems and processes for the recording of patient details, consultation and treatment. These changes were new and not yet embedded. Therefore, we found some gaps in recording in both hard copy and electronic files. The provider was taking appropriate steps to improve record keeping.
  • There were processes for managing risks and performance, however these were not always complete or fully implemented. This included; the systems for infection, prevention and control; procedures to minimise the risk of legionella; the recording and oversight of safety alerts.
  • There was some evidence of quality improvement. However, we found a lack of clinical audit to monitor quality and to drive improvements.
  • Some of the processes to identify, understand, monitor and address current and future risks including risks to patient safety had improved. This included the recording and oversight of significant events and complaints.
  • The provider had continued to review and update their policies and procedures. We found not all policies were in place, and some were undated. This was a significant piece of work that was ongoing.
  • The provider had strengthened the workforce by employing a nurse and a data management administrator. Staff were clear on their roles and responsibilities at the clinic.
  • Staff we spoke with told us it was an open and friendly culture. They felt communication and organisation at the clinic had improved and they felt positive about the improvements.

We identified regulations that were not being met and the provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We have told the provider to take action (you can see full details of the action and regulations not being met in the Requirement Notices section at the end of this report).

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

23 January 2019

During an inspection looking at part of the service

We carried out an announced comprehensive inspection of Hightree Clinic on 9 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This was the providers first comprehensive inspection. We found the service was not providing safe, effective, responsive or well-led care in accordance with the relevant regulations. We issued two warning notices requiring the provider to achieve compliance with the regulations set out in those warning notices. A warning notice was issued against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). We also issued two requirement notices for Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 19 (Fees) of the CQC (Registration) Regulations 2009.

This inspection was a focused inspection carried out on 23 January 2019 to confirm whether the provider was compliant with the warning notices issued, following the inspection on 9 October 2018. This report only covers our findings in relation to the requirements set out in the warning notices.

Our findings were:

At this inspection we found that although improvements had been made, the requirements of the two warning notices had not all been met.

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services responsive?

We found that this service was not providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC, which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Hightree Clinic is an independent doctor service. They provide consultation, treatment and prescribing services for conventional and complementary medicine, with an aim to improve and/or sustain patients’ overall quality of life. The clinic offers consultation and treatment only to patients over the age of 18.

Hightree Clinic provides a range of complementary therapies, for example medical acupuncture and osteopathy, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

The lead GP is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • The service had reviewed and improved some systems and processes at the clinic, but not all requirements had been completed. They had developed an action plan to make sure the concerns identified at our last inspection would be addressed. We saw all actions were planned for completion by March 2019.
  • The processes to identify, understand, monitor and address current and future risks including risks to patient safety were not always complete or clearly set out. This included the recording and oversight of safety alerts, significant events and complaints, the systems for monitoring patients’ health and the management of patient records.
  • Although the recording of patients’ information, consultations and treatment had been improved, the standard of the files we reviewed was inconsistent and they did not always contain information we would expect to see.
  • We saw that the provider had started a process to review and update their policies and procedures to ensure they contained relevant and up to date information. This was not yet complete.
  • A variety of risk assessments had been completed in relation to safety issues, including for fire and health and safety. However, an action plan was not in place to ensure required improvements were completed.
  • Staff told us the morale had improved at the clinic and they felt more supported. They were aware that improvements were still required and they felt encouraged to be involved in the process.

We identified regulations that were not being met and the provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We have told the provider to take action (you can see full details of the action and regulations not being met in the Enforcement Actions section at the end of this report).

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice

9 October 2018

During a routine inspection

We carried out an announced comprehensive inspection on 9 October 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was not providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC, which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Hightree Clinic is an independent doctor service. They provide consultation, treatment and prescribing services for conventional and complementary medicine, with an aim to improve and/or sustain patients’ overall quality of life. The clinic offers consultation and treatment only to patients over the age of 18.

Hightree Clinic provides a range of complementary therapies, for example medical acupuncture and osteopathy, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

The lead GP is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received 12 completed Care Quality Commission comment cards. Feedback from patients was consistently positive. We received comments that the staff were friendly, kind and put them at ease. They commented that the service received was supportive, caring, informative and efficient. Many patients described how they had used the service on several occasions.

Our key findings were:

  • The registered manager recognised that the current systems and processes at the clinic needed updating or improvement. They had identified gaps in compliance with regulation and throughout the inspection we recognised some improvements were planned or underway.
  • We found that the processes to identify, understand, monitor and address current and future risks including risks to patient safety were not yet well implemented. For example, the recording and oversight of safety alerts, significant events and complaints.
  • We found that patients’ medical records were not always clear, comprehensive and legible. We noted that not all records contained information we would expect to see about the consultation and treatment plan. We could not be assured that they always prescribed, administered and supplied medicines to patients in line with legal requirements.
  • Risks to patients, staff and visitors to the clinic were not always assessed or well managed. This included; the systems to manage infection prevention and control (IPC), the completion of recruitment checks, and comprehensive risk assessments being carried out in relation to safety issues.
  • There was limited evidence of quality improvement activity to review the effectiveness and appropriateness of the care provided. We did not see any clinical audits to monitor the quality of prescribing for instance.
  • The facilities and premises were appropriate for the services delivered.
  • Feedback from patients was consistently positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • We found that policies and procedures were not all specific to the clinic, regularly reviewed or contained up to date information.
  • There was a clear leadership structure and staff felt supported. The clinic proactively sought feedback from staff and patients.

We identified regulations that were not being met and the provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
  • Ensure service users, or a person acting on the service user’s behalf, are provided with written information about any fees, contracts and terms and conditions, relating to the cost of their care or treatment.

You can see full details of the regulations not being met at the end of this report.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice