Dr. Palit & Partners Also known as The Old School Surgery Seaford, incorporating Alfriston & East Dean Surgeries

We carried out an announced comprehensive inspection at Dr Palit and Partners (also known as Old School Surgery) on 6 February 2020, because breaches of regulation were found at our previous inspection. At our last inspection in February 2019 we rated the practice as requires improvement overall. The full comprehensive report for the last inspection can be found by selecting the ‘all reports’ link for Dr Palit and Partners on our website at .

After the inspection in February 2019 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

At the last inspection we rated the practice as requires improvement for providing safe services because:

• Records of identification checks were not found in all staff recruitment files.
• Risk assessments had not always been undertaken in a timely way. Action identified to mitigate risks was not always carried out.
• There was no system in place to follow up patients who did not attended for blood tests, including urgent ones.
• The provider had not carried out appropriate monitoring of patients on high risk medicines. The system for re-authorising repeat prescriptions was not sufficient.
• There was a system in place for monitoring safety alerts, however there was evidence of an alert not being actioned.

At the last inspection we rated the practice as requires improvement for providing effective services because:

• There was no system in place to monitor patient attendance following urgent cancer referral appointments for suspected cancer.
• Mandatory training was out of date in a number of areas for some clinical and non-clinical staff.

At the last inspection we rated the practice as requires improvement for providing well-led services because:

• The way the practice was led and managed did not promote the management of risk.
• Staff reported that they did not feel their concerns and views were always listened to or acted on.

At this inspection 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 the practice is now rated good. All populations groups are also now rated good.

Details of our findings

At this inspection we found:

• We saw and heard staff interacting positively with patients, who were treated with kindness and respect.
• Feedback from patients who used the service was consistently positive about the care and support they received from the practice staff.
• The practice 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 practice delivered care and treatment according to evidence- based research or guidelines.
• Staff worked well together as a team. They were positive about working at the practice and felt supported by the management team.
• Patients received effective care and treatment that met their needs.
• Staff were developed and supported to ensure services were of high quality.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care. Staff told us that the culture and morale at the practice had improved significantly.

The areas where the provider should make improvements are:

• Review and strengthen risk assessment for the use of an external defibrillator at East Dean Surgery.

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

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

We carried out an announced comprehensive inspection at Dr Palit and Partners on 13 February 2019 as part of our inspection programme. We undertook a second inspection day on the 22 February 2019 to gather additional medicines management evidence.

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 for providing safe, effective and well-led services and overall. We have rated this practice as good for providing caring and responsive services. The areas identified in effective affected all population groups so we rated all population groups as requires improvement in effective and overall. 

We found that:

• The practice did not provide care in a way that kept patients safe and protected them from avoidable harm. Risks were not always managed in relation to recruitment, fire safety and the management of the water system within the practice.
• There were safe systems in place for the management of medicines within the dispensary, although there was poor management and monitoring of patients on high risk medicines. However, the practice had developed an action plan to improve monitoring immediately after the first day of our inspection.
• There was a system in place to manage safety alerts, although we saw evidence of one 2016 safety alert that had not been actioned. However, the practice took action to address this immediately following our inspection.
• There was no clear system of safety netting patients referred for two week wait appointments where a cancer diagnosis was a possibility and no system to follow up patients who did not attend for a blood test. However, the practice reviewed and changed the systems immediately following our initial inspection to ensure that patients not attending appointments within the two weeks and those not attending for blood tests would be identified.
• There were gaps in staff completion of mandatory training.
• 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.
• Complaints were managed and responded to appropriately. There was evidence of learning from both complaints and significant events.
• The way the practice was led and managed did not promote the management of risk and staff reported that they did not feel their concerns were always listened to or acted on.

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

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