The Care Quality Commission
  • Doctor
  • GP practice

Heathfield Surgery

Overall: Requires improvement read more about inspection ratings

96-98 High Street, Heathfield, East Sussex, TN21 8JD (01435) 864999

Provided and run by:
The Heathfield Surgery and The Firs Surgery

All Inspections

13 June - 16 June 2022

During an inspection looking at part of the service

We carried out an announced focused inspection at Heathfield Surgery on 16 June 2022. Overall, the practice is rated as Requires Improvement

Safe - Requires Improvement

Effective - Good

Caring – Not inspected rating carried over

Responsive - Not inspected rating carried over

Well-led - Requires Improvement

Following our previous inspection on 8 September 2021, the practice was rated Requires Improvement overall and in the key questions for safe and well led but good for effective.

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

Why we carried out this inspection

The practice had been previously rated as Requires Improvement in September 2021. This inspection was to follow up breaches of regulations 12, and 17 as identified in our previous inspection. The data and evidence we reviewed in relation to the caring and responsive key questions as part of this inspection did not suggest we needed to review the rating at this time. This inspection included aspects of the responsive key question in relation to access only.

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 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

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 Requires Improvement

We found that:

  • 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 adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic.
  • The practice was monitoring staff immunisations.
  • Staff recruitment files contained all of the required information.
  • Referrals were completed in the required time frames.
  • Staff training was up to date, which included safeguarding, basic life support, infection prevention and control, and sepsis.
  • Staff comments were mixed in regard to the culture of the practice.
  • Significant events, complaints and safety alerts were centrally recorded and shared with staff members for the wider learning. However, minutes taken could be strengthened.
  • Medicine reviews did not always contain any information. There was no evidence that some patients had received the required health monitoring. For example, for rheumatoid and inflammatory arthritis.
  • There was a high number of patients prescribed dependency forming medicines. Those we reviewed held no record of discussions on reducing prescriptions quantities.

We found breaches of regulations. 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.

The provider should:

  • Review and improve minutes taken for shared learning.
  • Review and continue to monitor cervical smear screening uptake to meet the Public Health England screening rate target.

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 September 2021

During an inspection looking at part of the service

We carried out an announced inspection at Heathfield Surgery on 8 September 2021. Overall, the practice is rated as Requires improvement.

Safe – Requires improvement

Effective – Good

Caring – Not inspected

Responsive – Not inspected

Well-led – Requires improvement

Following our previous inspection between 9 to 19 November 2020, the practice was rated as requires improvement overall and for providing well-led services. The practice was rated inadequate for providing safe services. The practice was rated good for providing caring and responsive services.

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

Why we carried out this inspection

This inspection was a focused inspection looking at the safe, effective and well led domains, with the previous ratings for caring and responsive carried forward.

We reviewed the breaches identified at the last inspection, carried out between 9 and 19 November 2020:

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

  • Although there had been improvement since our last inspection to address concerns raised, this inspection identified areas of medicines management that were not sufficient to keep patients safe.

We previously rated the practice as requires improvement for providing well-led services because:

  • Although there had been significant improvement to address concerns and leaders had demonstrated that they had a credible strategy to develop sustainable care.
  • We identified significant concerns around clinical governance.

We also reviewed the areas where the previous inspection identified that the provider should make an improvement:

  • Review and improve how the overview of staff vaccination status is recorded.
  • Complete the implementation of a system for recording near misses in the dispensary.
  • Review and strengthen the system for ensuring policies contain up to date information and are practice specific.

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 using telephone and 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
  • A staff questionnaire emailed to all staff.

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 Requires improvement overall.

We found that:

  • The practice had made improvements in how near misses in the dispensary were recorded and integrated into the practice significant events process.
  • The practice had made improvements in the specific areas identified at our November 2020 inspection.
  • 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.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • There were still areas of medicines management and clinical governance that could be improved.
  • Significant event reporting and recording was well established but learning was not always disseminated effectively to drive improvement.

We found two breaches of regulations. 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.

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

The provider should:

  • Review and improve how medication reviews are coded within the clinical system.

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

12 November 2020

During a routine inspection

We carried out an announced comprehensive inspection at Heathfield Surgery between the 9 and 19 November 2020. This was to follow up on breaches of regulation found at our previous inspection on 22 January 2020. The details of these can be found by selecting the ‘all reports’ link for Heathfield Surgery on our website at www.cqc.org.uk.

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 required to keep people safe and to hold providers to account where it is necessary for us to do so.

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 requires improvement overall and good for all population groups, with the exception of people with long term conditions which was rated requires improvement.

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

  • Although there had been improvement since our last inspection to address concerns raised, this inspection identified areas of medicines management that were not sufficient to keep patients safe.

We rated the practice as requires improvement for providing well-led services because:

  • There had been significant improvement 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 rated the practice as good for providing effective, caring and responsive services because:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Feedback received from patients regarding their care and treatment and access to the service was very positive.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.

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

The areas where the provider should make improvements are:

  • Review and improve how the overview of staff vaccination status is recorded.
  • Complete the implementation of a system for recording near misses in the dispensary.
  • Review and strengthen the system for ensuring policies contain up to date information and are practice specific.

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

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

22 January 2020

During an inspection looking at part of the service

We carried out an announced focused inspection at Heathfield Surgery on 22 January 2020 as part of our inspection programme.

The practice had previously been inspected in September 2016 where they were rated as good. We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

  • Safe
  • Effective
  • Well-led

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 for safe and well-led services. We rated them as good for effective services. We rated the practice as good for all of the population groups with the exception of working age people which was rated as requires improvement. This was due to cancer care reviews being below average and the cervical screening target not being met.

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

  • There were gaps in the systems, practices and processes to keep people safe and safeguarded from abuse.
  • The practice were unable to evidence pre-employment checks carried out on locums and risk assessments were not carried out on staff who did not have a DBS check in place at the time of recruitment.
  • Health and safety risk management processes were insufficient.
  • There was no system for monitoring the ongoing registration of clinical staff.
  • Infection control management processes were inconsistent.
  • Staff did not have the information to deliver safe care and treatment in relation to the monitoring of referrals, histology and cervical screening and there were insufficient failsafe systems for these processes.
  • Consent for minor surgery was not recorded in line with national guidance.
  • Learning was not always clearly identified to make improvements.
  • Non-clinical staff had not received sepsis training. There were gaps in mandatory training completion in relation to safeguarding and infection control.

  • Staff immunisations were not in line with Public Health England (PHE) guidance.
  • There was insufficient proper and safe management of medicines in relation to vaccine temperature monitoring and the recording of medicines used during minor surgery.

We rated the practice as inadequate for providing well-led services because:

  • The overall governance arrangements were ineffective.
  • The practice did not have clear and effective processes for identifying and managing risks and identified issues.
  • The practice did not always act on appropriate and accurate information.
  • There were inconsistent systems and processes for learning and continuous improvement.

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.
  • 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 that fit and proper persons are employed.

The provider should:

  • Improve staff vaccination records in line with Public Health England (PHE) guidance.
  • Improve cervical screening rates.
  • Meet the target for childhood immunisations.
  • Improve cancer care reviews in line with local and national averages.
  • Implement a process for new healthcare assistants to undertake the care certificate.
  • Review the role of the patient participation group with a view to improvement involvement and communication.

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

19 April 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 3 February 2015. Breaches of Regulatory requirements were found during that inspection within the safe domain. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the Regulatory responsibilities in relation to the following:

  • To ensure that patients were informed regarding medicine dose changes following blood test results in line with national guidance.
  • To review the management of the repeat prescribing system to ensure all staff are aware of the practice policy not to issue repeat prescriptions over the telephone.

We undertook this focused inspection on 19 April 2016 to check that the provider had followed their action plan and to confirm that they now met Regulatory requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathfield Surgery on our website at www.cqc.org.uk.

This report should be read in conjunction with the last report from November 2015. Our key findings across the areas we inspected were as follows:-

  • We saw that there was a robust system in place to inform patients of changes required in their medicines dose following blood tests.
  • We found the required changes had been made in the standard operating procedure documenting the Controlled Drug Accountable Officer (CDAO) and the contact details for this person.
  • Repeat prescriptions were now given to the practice via an online ordering system or repeat request slips. Telephone repeat prescription requests were undertaken by trained dispensary staff so as to reduce the risk of errors. Only patients who could not access other methods of repeat ordering were able to undertake telephone ordering.
  • We saw that a system was now in place that monitored medicines reviews to prevent prescriptions being issued after the review date unless a review had been undertaken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

3 February 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heathfield Surgery on 3 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It required improvement for providing safe services. It was also good for providing services for people with long-term conditions, families, children and young people, older people and people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia) and for working age people (including those recently retired and students).

The Heathfield Surgery provides services to people living in the Wealden area. At the time of our inspection there were approximately 12,260 patients registered at the practice with a team of seven GP partners. The practice was also supported by a salaried GP, nurses, healthcare assistants and a team of reception and administrative staff. Heathfield Surgery is able to dispense medicines to its patients and is a GP training practice. At the time of the inspection the practice was providing training and support to one registrar.

We visited the practice location at The Heathfield Surgery, 96-98 High Street, Heathfield, East Sussex,

TN21 8JD. Heathfield Surgery also operates a branch surgery at The Firs Surgery, Little London Road, Cross in Hand, TN21 0LT. We did not visit the branch surgery as part of our inspection.

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. There was a culture of openness and transparency within the practice and staff told us they felt supported. The practice was committed to providing high quality patient care and patients told us they felt the practice was caring and responsive to their needs.

Our key findings 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 and 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 and PPG had produced a comprehensive Young People’s Health Guide.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Review how patients are informed regarding medicine dose changes following blood test results and to follow national guidance.
  • Review the management of the repeat prescribing system to ensure all staff are aware of the practice policy not to issue repeat prescriptions over the telephone.

In addition the provider should:

  • Ensure that training records are updated when staff have completed training.
  • Ensure that there is a full practice meeting which includes all members of staff

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice