The Care Quality Commission
  • Doctor
  • GP practice

Buxted Medical Centre

Overall: Good read more about inspection ratings

Framfield Road, Buxted, Uckfield, East Sussex, TN22 5FD (01825) 732333

Provided and run by:
Buxted Medical Centre

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Buxted Medical Centre 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 Buxted Medical Centre, you can give feedback on this service.

13 September 2022

During a routine inspection

We carried out an announced comprehensive inspection at Buxted Medical Centre between 8 September and 14 September. The onsite visit was on the 13 September. Overall, the practice is rated as Good.

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

Following our previous inspection in March 2020, the practice was placed in special measures after being rated inadequate overall and for the key questions safe and well led. Effective was rated as requires improvement and responsive and caring was rated as good. The practice was re-inspected in November 2020, to follow up on warning notices issued and there was no change in ratings. The practice received a further comprehensive inspection in August 2021 and was rated as inadequate in safe and well led, and therefore remained in special measures. The other key questions were rated as good. In December 2021, an inspection was carried out to follow up on warning notices issued. The practice had shown improvement but was not rated at that inspection.

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

Why we carried out this inspection

The practice had been previously placed in special measures in March 2020. The practice remained in special measures after being inspected in August 2021 and was issued warning notices for regulation 12 safe care and treatment and regulation 17 good governance.

How we carried out the inspection/review

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

This included:

  • Conducting staff interviews using video conferencing.
  • 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 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 found that:

  • Leaders were aware of the improvements needed and had worked as a team to improve processes to ensure they were working as intended. There was an understanding of what the challenges were and the practice had put actions in place to address them.
  • The practice was using innovative technologies to ensure that the recording of fridge temperatures was assessible to all staff members involved in the task. The new way of working ensured that processes were consistent across all three sites.
  • The practice required all staff members to provide evidence of their immunisation status. Where necessary the practice had conducted a full risk assessment to ensure safe working for the individual staff member and patients.
  • Our remote searches of patient records showed that patients were now being effectively and safely managed.
  • A variety of audits and risk assessments had been conducted, including infection control. Any concerns or required actions had been completed or were in progress.
  • We noted an open culture in which all safety concerns raised, including significant events and complaints, were highly valued as being integral to learning and improvement. Shared learning was communicated widely to support improvement.
  • Managers and partners were now actively monitoring and reviewing activity within the practice to understand risks and ensure a clear, accurate and current picture of safety.
  • The practice now provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients now 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.
  • 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.

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

  • Continue to take action in relation to recording staff immunisation.
  • Continue to improve cervical screening uptake.
  • Continue to review and improve patient access

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

This service was placed in special measures in March 2020. The practice has made significant improvements and is now rated good overall and for all domains. I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service. The service will be kept under review and will be inspected within 12 months to ensure improvements are sustained.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

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

8 December 2021

During an inspection looking at part of the service

We carried out a comprehensive inspection of Buxted Medical Centre in August 2021 and found breaches of regulations. We took enforcement action and issued warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After our inspection in August 2021 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

We carried out an announced focussed follow-up inspection on 8 December 2021 to confirm that Buxted Medical Centre now met the legal requirements in relation to those breaches of regulations and to ensure sufficient improvement had been made. This report covers findings in relation to those requirements. We also focused on the management of access to appointments. The practice was not rated as a consequence of this inspection.

The full comprehensive report on the August 2021 inspection can be found by selecting the ‘all reports’ link for Buxted Medical Centre on our website at www.cqc.org.uk.

Why we carried out this review

We carried out an announced focussed follow-up inspection on 8 December 2021 to assess the provider’s compliance to meet the legal requirements against the warning notices issued in relation to the breaches in regulations that we identified in our previous inspection in August 2021. This report covers findings in relation to the warning notices and our findings from reviewing access to appointments.

How we carried out the review

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 reviews 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.

The practice was not rated as a result of this inspection:

At this inspection we found the practice had made the following improvements:

  • The staff immunisation policy and matrix had been updated. Where required, staff had an updated risk assessment and action plan.
  • The remote searches of the clinical system carried out by a CQC GP specialist advisor indicate that systems had been reviewed and updated to improve patient care.
  • Policies and protocols were being updated and reviewed to ensure they held accurate information and were personalised appropriately to the practice. Policies we reviewed had been updated and included who had reviewed or approved the policy and the version number.
  • The recommended changes from the last Infection Prevention Control audit had been actioned. For example, the couch with torn fabric had been replaced and the staff member who was the lead for infection control had their infection control responsibilities added to their job description.
  • We found no evidence of reusable instruments for the purpose of coil insertion and removal at any of the sites.
  • Emergency equipment available to staff to manage medical emergencies were standardised across all three sites
  • There were standardised documented daily cleaning schedules for external cleaners to follow across all three sites.
  • Fridge monitoring was standardised across the three sites. However, staff monitoring fridge temperatures did not fully understand the consequences of fridge temperatures being out of range or not being monitored for a length of time. Staff were not always aware of the procedure to follow if the recording of a fridge temperature had been missed or was out of range. Leaders in the practice were not aware that the system for fridge monitoring was not working effectively.
  • Health care assistant supervision contract documents had been re-written and signed and dated by both parties involved. However, the document did not include details of the discussions that had taken place to establish how the supervisor and supervisee would work together.

During this inspection we also reviewed information in relation to patients accessing appointments. We found:

  • People were able to access appointments in a timely way
  • The practice offered a range of appointment types
  • Patients with the most urgent needs had their treatment prioritised
  • There were systems in place to support people who face communication barriers to access treatment
  • There were systems in place to monitor access to appointments and make improvements

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 September 2021

During a routine inspection

We carried out an announced inspection at Buxted Medical Centre on 25 August 2021 Overall, the practice is rated as Inadequate.

The key questions are rated as

Safe - Inadequate

Effective - Good

Caring - Good

Responsive - Good

Well-led - Inadequate

Following our previous inspection in December 2020 the practice was rated Inadequate overall and for Safe and Well led key questions. Effective was rated as requires improvement and Caring and Responsive were rated as good.

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

Why we carried out this inspection

The practice had been previously placed in special measures in March 2020. The practice was subsequently re-inspected in December 2020 to ensure that warning notices issued at the previous inspection had been complied with and to ensure that the practice had made significant improvements. We found that although some improvements had been made, the practice remained inadequate for the safe and well led key questions and requires improvement for the effective key question. Therefore, the practice remained in special measures and further warning notices were issued. We were provided with action plans detailing how the practice planned to make the required improvements throughout this process. This inspection was to follow up the warning notices issued and to check the improvements made to date.

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 Inadequate overall and good for all population groups.

We rated safe and well led as Inadequate due to the insufficient improvements made from the previous three inspections.

We rated the practice Inadequate for providing safe care because:

We found the practice had responded to some of the issues raised at the previous inspection. For example, the monitoring of fridge temperatures and processes to support the management of controlled drugs. However, we found new breaches of regulation and repeated breaches at this inspection. For example, we found insufficient monitoring of some patients who were prescribed medicines, a lack of monitoring of staff immunisations and concerns raised from infection control audits and electrical installation condition reports were not always actioned.

We rated the practice Inadequate for providing a well-led service because:

Although we found the provider had made some improvements, there were still breaches of regulation found. We saw examples of ineffective governance systems. The practice did not always act on appropriate and accurate information. Processes for identifying and managing risk were not always clear or working as intended. The systems and processes in place did not always assess, monitor or mitigate risks found. Leaders had insufficient oversight in order to identify when processes were not working as intended.

We rated the practice good for providing effective, caring and responsive services because:

The practice had made improvements to the quality of care and outcomes for patients through clinical audits. Systems were in place to ensure all staff had completed their required training.

Patients received 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 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 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).

The areas where the provider should make improvements are:

  • Review the required training for delivery drivers to include infection prevention and control and or use of PPE

This service will remain in a period of extended 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.

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

2 December 2020

During a routine inspection

Buxted Medical Centre was placed into Special Measures in March 2020. We carried out this announced comprehensive inspection to follow up on breaches of regulation and to ensure sufficient improvements had been made. In the light of the COVID-19 pandemic, we undertook some of the inspection processes remotely and spent more focused time on site. We conducted remote staff interviews between 30 November and 8 December and an on-site visit on 2 December 2020.

The practice had previously been inspected in February 2015 and rated as good overall but with requires improvement in safe. A subsequent focused inspection was conducted in July 2016 where safe was rated as good. A further focused inspection was carried out in March 2018 in response to information received by the Care Quality Commission regarding patients’ test results and correspondence. At this time the practice was rated as requires improvement in safe. A further inspection in October 2018 found that breaches had been addressed and the practice was rated as good in safe. We carried out an inspection of this service in March 2020 following our annual review of the information available to us, including information provided by the practice. At this inspection the practice was placed into Special Measures and rated as Inadequate overall, Inadequate in Safe, Well led and Requires Improvement in Effective. Caring and Responsive were not inspected during this inspection. Warning notices were issued due to the concerns found.

All of the practices’ previous reports can be found by selecting the ‘all reports’ link for Buxted Medical Centre on our website 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.

This inspection looked at the following key questions:

  • Is it Safe
  • Is it Effective
  • Is it Caring
  • Is it Responsive
  • Is it Well led

We based our judgement of the quality of care at this service on a combination of:

  • What we found when we carried out a remote review of patient records on 24 November 2020 by a GP specialist adviser.
  • A visit to the location on the 2 December 2020.
  • Telephone/video conferencing interviews with the practice staff, including the practice managers, partner GPs, salaried GP, advanced nurse practitioners, nurses, health care assistants and administration and reception staff.
  • Information requested from the provider, patients, the public and other organisations.
  • Information from our ongoing monitoring of data about services.

We have rated this practice as inadequate overall, with safe and well led being inadequate, effective being requires improvement and caring and responsive being good. All of the population groups have been rated as requires improvement as the concerns found in the effective domain affect all of the population groups.

We rated the practice Inadequate for providing safe care because:

We found the practice had responded to some of the issues raised at the previous inspection regarding Patient Specific Directions, recruitment, risk assessments, and the management of significant events and safety alerts, and had started to make some improvements in these areas. However, further work was required to fully implement, embed and then review some of these systems. We also found new breaches of regulation. For example, the monitoring of fridge temperatures, monitoring patients who were prescribed high risk medicines, failing to follow up abnormal test results appropriately, not prescribing in line with current MHRA guidance, staff immunisation status and not working to the providers own policy for processes involving controlled drugs.

We rated the practice requires improvement for providing effective care.

Although we found the practice had made some improvements, such as having a programme for quality improvement through audits, the systems in place to ensure training was completed required further improvements to ensure all staff completed their required training.

We rated the practice Inadequate for providing a well-led service.

Although we found the provider had made improvements by reviewing and initiating new policies, procedures and systems, these needed to be reviewed to ensure they were working as intended and embedded to further ensure the quality of the service going forward and ensure any changes could be sustained.

We rated the practice good for providing caring and responsive.

Patients received 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 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 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 their duties.

(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 training is recorded.
  • Review and improve policies. For example, staff immunisation policy and clinical supervision policy.

This service will remain in a period of extended 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.

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

10 March 2020

During an inspection looking at part of the service

We carried out an announced focused inspection at Buxted Medical Practice on 10 March 2020 as part of our inspection programme.

The practice had previously been inspected in February 2015 when they were rated as good overall and requires improvement in safe. A subsequent focused inspection was conducted in July 2016 where they were rated as good. A further focused inspection was carried out in March 2018 in response to information received by the Care Quality Commission regarding patients’ test results and correspondence. At this time the practice was rated as requires improvement in safe. A further inspection in October 2018 found that breaches had been addressed and the practice was rated as good in safe.

We carried out an inspection of this service 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 looked at the following key questions:

Is the service safe?

Is the service effective?

Is the service well-led?

Because of the assurance received from our review of information we carried forward the ratings for the following questions:

Is the service caring? Good

Is the service responsive? Good

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 requires improvement for effective services. We rated the practice as requires improvement for all of the population groups because of the issues identified within the effective domain.

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

  • Patient specific directions not properly authorised.
  • Batch numbers for medicines used in minor surgery were not recorded in patient records.
  • The practice was an outlier for antibiotic prescribing and there was no clear plan to address this.
  • There was no process in place for monitoring of the non-medical prescribers’ prescribing practice.
  • The practice did not have Atropine (for emergencies relating to coil insertions) and there was no risk assessment for this. However, following inspection we were informed that Atropine was stored separately from the other emergency medicines and routinely monitored. The practice did not provide us with evidence of this.
  • There were no risk assessments for the storage and use of medical gases, including nitrous oxide which was not stored securely. Not all staff were aware of where the emergency oxygen was stored.
  • Actions relating to the fire risk assessment had not been recorded.
  • There was no formal risk assessment for emergency medicines.
  • Actions and learning from significant events were not clearly identified or completed.
  • Actions relating to safety alerts were not clearly recorded and it was not clear how alert guidance was incorporated into practice.

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.

We rated the practice as requires improvement for effective services because:

  • There was a significant proportion of staff who had not completed training required by the provider.
  • The practice did not have a clear plan for quality improvement activity.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

  • Continue to improve cervical screening rates.
  • Consider developing a programme of clinical audit and service evaluation.
  • Review how batch numbers for medicines used in minor surgery are recorded.
  • Improve antibiotic prescribing practices.

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.

We are mindful of the impact of the 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.

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

31 October 2018

During an inspection looking at part of the service

The areas where the provider should make improvements are:

  • Keep under review, improve and audit the workflow criteria protocol for correspondence.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information

07 March 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Buxted Medical Centre on 10 February 2015. The overall rating for the practice was good but was rated as requires improvement in the safe domain. Following this we undertook a desktop review in 1 July 2016 to confirm that the provider now met all the regulatory requirements. On this occasion the practice was found to be good overall and in all domains. The full comprehensive report on the February 2015 inspection and the July 2016 desktop review can be found by selecting the ‘all reports’ link for Buxted Medical Centre on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 7 March 2018 in response to information we had received in respect of procedures relating to the timely review and response of clinicians to test results and to correspondence received by the practice. The information alleged that a large backlog of both test results and letters had built up in the past. We carried out an unannounced focused inspection to ensure that systems currently in place to deal with test results and correspondence were working in a way that kept patients safe and were being employed in a timely manner. This report covers our findings in relation to those questions.

Our key findings were as follows:

  • Test results and correspondence received electronically were managed appropriately and within expected time frames that kept patients safe.

  • There were systems in place which allowed designated staff to identify urgent paper correspondence and forward it to a clinician for action. However we identified an instance when this had failed to work correctly.

  • There was a backlog of approximately 25 working days of paper correspondence waiting to be scanned in to the electronic notes.

  • Clinicians did not always have all the most recent information available to them at the time of a consultation.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Additionally the provider should:

  • Consider reviewing their workflow systems and protocols to assess which correspondence requires review by a clinician and the time frames in which that should occur.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

1 July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 10 February 2015. Breaches of regulatory requirements were found during that inspection within the safe domain. Following our comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the Regulatory responsibilities in relation to the following:

  • To ensure staff that undertake chaperone duties, or who have unsupervised contact with patients, are checked by the disclosure and barring service (DBS) and that the practice had a recruitment policy that reflected this need.
  • To ensure that the practice had undertaken an appropriate risk assessment in regards to legionella (legionella is a germ found in the environment which can contaminate water systems in buildings) and that the practice had a policy for this risk assessment.

We undertook this desktop review on 1 July 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 Buxted Medical Practice on our website at www.cqc.org.uk.

This report should be read in conjunction with the last report published in May 2015. Our key findings across the area we reviewed were as follows:-

  • We saw that there was a robust recruitment policy in place in place to ensure that all applicants were checked by the disclosure and barring service (DBS).
  • We noted that there had been a risk assessment for legionella undertaken in July 2015 and that the practice had a policy in place to manage this risk.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

10 February 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Buxted Medical Centre on the 10 February 2015. The practice has an overall rating of good.

We visited the practice location at Buxted Medical Centre, Framfield Road, Buxted, Uckfield, East Sussex, TN22 5FD. Buxted Medical Centre also operates a branch surgery at East Hoathly Medical Centre, Juziers Drive, East Hoathly, BN8 6AE. We did not visit the branch surgery as part of our inspection.

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, older people, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Buxted Medical Centre provides primary medical services. At the time of our inspection there were approximately 10,200 patients registered at the practice with a team of five GP partners. The practice was also supported by an advanced nurse practitioner, a lead practice nurse plus four practice nurses, three healthcare assistants, a paramedic, a team of receptionists and administrative staff and a practice manager. The practice is involved in the education and training of doctors and is also able to dispense medicines to it patients.

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 across all the areas we inspected 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, with the exception of those relating to recruitment checks.
  • 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.
  • 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 was a training practice and there was a culture of continuous development
  • The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
  • The practice recognised the needs of its older population and had systems in place to support patients through care plans, hospital avoidance schemes and providing extra support for those patients with dementia.

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

Importantly, the provider must:

  • Ensure that all recruitment checks are carried out and recorded as part of the staff recruitment process, including criminal record checks via the Disclosure and Barring Service (DBS) for staff who have chaperone duties, and that the recruitment policy reflects accurately the procedures necessary.
  • Ensure the practice carries out a risk assessment for legionella and has a corresponding policy.

In addition the provider should:

  • Ensure that patient information is clearly displayed for requesting chaperones
  • Ensure that patient information is clearly displayed in relation to the complaints system and contains information of other organisations that can support a complainant.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice