Avisford Medical Group

Updated 26 April 2022

Avisford Medical Group is in Yapton, West Sussex at:

Yew Tree Surgery

North End Road

Yapton

West Sussex

BN18 0DU

And:

Middleton Medical Centre

Elmer Road

Middleton-On-Sea

West Sussex

PO22 7SR

The local clinical commissioning group (CCG) is NHS West Sussex. The provider is registered with CQC to deliver the following regulated activities:

• diagnostic and screening procedures,

• maternity and midwifery services

• treatment of disease, disorder or injury

• surgical procedures

• family planning

The practice offers services from both a main practice and a branch surgery. Patients can access services at either surgery.

Information published by Public Health England shows that deprivation within the practice population group is in the seventh highest decile (seven of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is 97.3% White, 1.3% Asian, 0.9% Mixed and 0.4% Black.

As well as a team of two GP partners and five salaried GPs (two male and five female), the practice also employs three advanced nurse practitioners, two practice nurses, four health care assistants and a paramedic practitioner. A practice manager is employed and there is a team of receptionists and administrative clerks.

More information in relation to the practice can be found on their website:

www.avisford.nhs.uk

Updated 26 April 2022

We carried out an announced review at Avisford Medical Group on 29 March 2022. Overall, the practice is rated as Good.

Safe - not inspected

Effective - not inspected

Caring - not inspected

Responsive - not inspected

Well-led - Good

Following our previous inspection on 7 July 2021, the practice was rated as Good overall and for all key questions except for Well-led, which was rated as Requires Improvement.

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

Why we carried out this review

This review was a follow-up to our previous review, undertaken without a site visit. It focused on the well-led key question and the breaches of regulation 17 (good governance) and regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

How we carried out the review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections and reviews differently.

This review was carried out remotely with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing
• Requesting evidence from the provider

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 Good overall and is now rated as Good for providing well-led services

At this review we found that:

• The practice maintained an accurate and complete chronological log of significant events. Systems had been developed that enabled the practice to monitor action and identify trends.
• Records of significant events showed that more thorough investigations had been conducted and that root causes had been identified.
• The practice implemented a system for assuring that all safety alerts were received and where relevant were acted on. It maintained clear records to demonstrate this.
• The practice maintained an accurate log of complaints including discussions at meetings.
• Records showed that the practice followed and monitored its own complaints policy in relation to process and timescales for response.

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