The Care Quality Commission
  • Doctor
  • GP practice

Saxonbrook Medical

Overall: Good read more about inspection ratings

Maidenbower Square, Maidenbower, Crawley, West Sussex, RH10 7QH (01293) 450400

Provided and run by:
Saxonbrook Medical

All Inspections

23 March 2022

During an inspection looking at part of the service

We carried out an announced follow up inspection at Saxonbrook Medical on 23 March 2022, because a breach of regulation was found at our previous inspection.

Following our previous inspection on 8 October and 24 October 2019, the practice 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 19 (fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Why we carried out this inspection

This inspection was a focused inspection to confirm whether the provider now met the legal requirements of regulations and to ensure enough improvements had been made.

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
  • Requesting evidence from the provider to review remotely and on site
  • 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 Good for providing safe services, and the provider continues to be rated as Good overall.

We found that:

  • 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 new management team were engaged and committed to improvements.
  • The provider had an effective process to ensure Disclosure and Barring Service (DBS) checks or risk assessments were completed, as appropriate.
  • The practice had conducted regular in-house fire risk assessments and any remedial actions requiring completion were monitored and documented.
  • All staff, including receptionists, had received training and updated information relating to sepsis and serious illness.
  • The provider had taken action to improve the uptake of cervical screening. They were confident that future performance data would reflect these actions.
  • There was a training programme in place that ensured staff received appropriate learning and development opportunities. Staff received ongoing support from their management team, although formal appraisals had been delayed due to the pandemic.
  • The provider had taken action to address aspects of underperformance in relation to the GP national patient survey. This was reflected in the indicators, that were now all in line with the England and clinical commissioning group averages.
  • The patient participation group (PPG) engagement had increased. We received feedback from the chair of the PPG who told us they felt positive about the future of the PPG and the relationship with the practice.

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

  • Continue to monitor and take action to improve uptake rates for cervical screening.
  • Continue to deliver a programme of staff appraisals.

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 October 2019 to 24 October 2019

During a routine inspection

We carried out an announced comprehensive inspection at Saxonbrook Medical on 8 October 2019 and 24 October 2019 as part of our inspection programme.

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.

We rated the practice as requires improvement for providing safe services because the provider had not always ensured clinical staff had the appropriate disclosure and barring service checks (DBS) in place before starting work in the practice and there was no risk assessment for these staff.

We rated all population groups as good.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm. However, they did not always ensure staff recruitment kept patients safe.
  • 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 organised and delivered services to meet patients’ needs.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • There was a clear leadership structure and staff felt supported by management.
  • Staff worked well together as a team and all felt supported to carry out their roles. There was a strong team ethos and culture of working together. Staff received access to training and support to develop their skills.
  • The practice had utilised the roles of paramedic practitioners and physicians associates to provide care and treatment to patients.

The areas where the provider must make improvements are:

  • Ensure recruitment procedures were operated effectively.

(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 guidance for reception staff on dealing with acutely unwell patients, including patients who are suspected of sepsis.
  • Ensure that all aspects of underperformance in the national GP patient survey are addressed, including areas such as access to appointments and overall experience of the service.
  • Continue to work to support and develop the patient participation group.
  • Continue to monitor and take action to improve target rates for cervical screening.
  • Review and update the practice fire risk assessment documenting any actions since the last risk assessment took place.
  • Keep appraisal and training records under review to demonstrate staff receive appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

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

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

8 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Saxonbrook Medical on 15 March 2016. The practice was rated as requires improvement for safe, effective, responsive and well-led services and overall. They were rated as good in caring. On 8 November 2016 we undertook a further comprehensive inspection. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. Improvements had been made to the reporting and recording of significant events and there was evidence of discussion and learning with staff.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety. Improvements had been made with the development of a range of risk assessments and the way in which risks were managed was evident. Health and safety, legionella, electrical testing and equipment calibration had been addressed through this process.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect although results for patients feeling involved in their care and decisions about their treatment were lower than the national average.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. The process for managing complaints had improved with evidence of patient apologies and the identification of trends.
  • Patients and staff we spoke with said improvements had been made in accessing appointments with the newly developed call and triage system. National survey results demonstration that satisfaction was below average in this area, however on the day of inspection patients told us there had been recent significant improvements with this.
  • 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. Staff told us that communication had improved and they felt involved in the development of the practice.
  • The provider was aware of the requirements of the duty of candour.
  • Clinical audits were undertaken and we saw evidence that some of these were full cycle. The practice had made improvements in this area and had held audit meetings with the multi-disciplinary team to develop a programme and involve a range of clinical staff.
  • Patient outcomes were mixed, with some areas of performance below average, such as in relation to asthma and chronic obstructive pulmonary disease. Exception reporting was higher than average in some areas. However, these issues were adversely affected by changes within the practice including relocation, an influx of patients registering with the practice from a local walk in centre and a high proportion of patients from hard to reach groups. The practice were working to make improvements and there were demonstrable improvements in diabetes performance since the previous inspection. Unpublished data showed an increase of sixteen percentage points in the number of patients receiving a foot examination.
  • Mental health performance was below average; however the practice had developed a dedicated mental health and wellbeing service which had recently won national awards.
  • The practice had made improvements in mandatory training attendance for staff with the development of a range of training available including online and some in-house sessions to ensure that training was timely. However, records relating to induction were not always evident or complete.

We saw one area of outstanding practice:

  • A mental health wellbeing service had been developed within the practice. This provided patients with support with a number of issues including anxiety, depression, eating and mood disorders. The service also provided support around the long term management of chronic conditions such as schizophrenia. Data showed that the service had reduced the number of referrals into secondary care mental health services. The service had been the recent recipient of the Nursing Times ‘Nursing in Mental Health’ category and the clinical lead for the practice had been awarded the Nurse of the Year for the development of the service.

The areas where the provide should make improvements are:

  • Ensure that induction records are complete for new staff.

  • Ensure that improvements are made to the way in which the practice identifies carers.

  • Ensure that all aspects of underperformance in the national GP patient survey are addressed, including areas such as patients not feeling involved in the planning of their care.

  • Continue to work to improve patient outcomes (QOF) within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

15 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Saxonbrook Medical Centre on Tuesday 15 March 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • The practice had recently been through a number of changes including a move of premises, increase of list size due to a local practice closure, a management re-structure and a number of new staff.
  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However the practice could not demonstrate that all incidents and complaints were recorded, that reviews and investigations were thorough or that learning was shared effectively with staff.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Risks to patients were not all assessed and well managed.
  • Data showed patient outcomes were mixed compared to the local and national averages. Although some audits had been carried out, we found a lack of evidence to support that audits were driving improvement in performance to improve patient outcomes.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Information about services and how to complain was available and easy to understand, but we found recording processes of investigations and responses could be improved.
  • Patients said urgent appointments were usually available the same day requested. However the telephone and non-urgent appointment systems were not working well, so patients reported that they did not receive timely care when they needed it.
  • The practice was mostly well equipped with good facilities to treat patients and meet their needs.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • There were a number of up to date practice specific policies and procedures to govern activity.
  • The practice had proactively sought feedback from patients and had an active patient participation group.

We saw one area of outstanding practice:

  • The practice ran an innovative “Wellbeing clinic” which they set up to provide care and treatment to patients suffering anxiety, depression, eating problems, mood disorders and long term management of chronic conditions such as schizophrenia. The practice had conducted a survey of patients who had used the clinic, which showed that 84% would recommend the clinic to friends or family.

The areas where the provider must make improvement are:

  • Ensure that there are robust processes for reporting, recording, acting on and monitoring significant events, incidents and complaints. Ensure that lessons learnt from complaints and significant events are communicated to the appropriate staff to support improvement at all levels.
  • Ensure that all staff complete relevant and appropriate training; including for adult and child safeguarding, the Mental Capacity Act (MCA) 2005, infection control and information governance.
  • Improve policies and procedures to ensure the security and tracking of blank prescriptions at all times.
  • Ensure that all Patient Specific Directions are recorded and completed correctly, in line with legislation.
  • Ensure that all building risk assessments and recommended actions are completed, monitored and acted on in a timely manner; including for health and safety, Legionella and electrical safety.
  • Ensure arrangements are in place to regularly check and calibrate all equipment to satisfy the practice it is fit for use.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced staff are deployed in order to meet patients’ care and treatment needs, particularly during periods of absence.
  • Continue to ensure that all staff who act as chaperones receive a Disclosure and Barring Service check (DBS check) or that an adequate risk assessment is completed. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • Carry out an on-going audit programme to show that continuous improvements have been made to patient care in a range of clinical areas as a result of clinical audit.
  • Ensure that patient care plans are recorded, accessible and monitored.
  • Continue to review, assess and improve access to and availability of appointments.

The areas where the provider should make improvement are:

  • Review the arrangements for the disposal of clinical waste in all treatments rooms, to ensure waste is disposed of safely and securely in order to minimise the risks to staff, patients and visitors to the practice.
  • Review the arrangements to share information with health visitors when children repeatedly do not attend immunisations, to ensure their safety and welfare is being considered.
  • Consider the training needs of all staff and whether protected time could be allocated for mandatory or appropriate certified training courses.
  • Display information that translation services are available to patients who do not have English as a first language, and ensure all staff are aware of these services.
  • Continue to improve support for carers and proactively identify patients who are carers.
  • Ensure all staff are aware of facilities and equipment provided to assist patients with a hearing impairment.
  • Provide arrangements for all staff to attend formal meetings, and improve information sharing from management meetings with staff at all levels.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice