Modality Mid Sussex

We carried out an announced comprehensive at Modality Mid-Sussex on 18 and 25 May and 19 June 2023. Overall, the practice is rated as inadequate.

Safe - Inadequate.

Effective - Requires improvement.

Caring - Good.

Responsive – Inadequate.

Well-led – Inadequate.

Why we carried out this inspection.

We inspected the practice because it was newly registered following the merging of 4 practices and also in response to concerns. This inspection was comprehensive and covered the key questions are services safe, effective, caring, responsive and well-led.

How we carried out the inspection

This inspection 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.
• Five site visits.

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:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice had an active patient participation group and patient views were acted on to improve services and culture.
• The practice prioritised training and supported staff to obtain additional skills and qualifications.
• Staff felt supported by their managers who listened and acted on their views.

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

• Patients’ health was not always monitored in a way that ensured the safe prescribing of certain medicines.
• The practice was unable to demonstrate that effective reviews of patients’ medication were undertaken.
• Risks to patients, staff and visitors form infection control, health and safety and fire were not always assessed, monitored, or managed effectively.
• Safety alerts were not managed effectively to always keep patients safe.
• The practice did not have enough suitably qualified, competent, skilled, and experienced staff to provide the regulated activities.

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

• Not all patients with a long-term condition or a potential missed diagnosis had received appropriate monitoring and clinical review.
• Patients’ needs were not always assessed, and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance

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

• Patients were unable to access services in a timely way.

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

• The delivery of high-quality care was not assured by the leadership or governance in place.
• The practice could not demonstrate that comprehensive and effective systems were in place and regularly reviewed to identify and manage risk.
• The systems for assessing, monitoring and improving the quality and safety of the service were not always effective. Leaders lacked oversight of some processes and therefore failed to identify risks when those processes did not operate as intended.

We found three breaches of regulations. The provider must:

• 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 enough suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

In addition, the provider should:

• Implement arrangements to ensure privacy and confidentiality at the reception desk.
• Check the professional registration status of clinical staff on a regular basis.
• Authorise Patient Group Directions correctly.
• Keep records of the authorisation to administer medicines under Patient Specific Directions in individual patient notes.
• Include details of how to raise and report concerns about controlled drugs with the NHS England and Improvement Area Team Controlled Drugs Accountable Officer in the practice’s prescribing policy.
• Undertake a risk assessment to support the range and quantity of emergency medicines held at Crawley Down Health Centre and include a risk assessment for the storage of emergency medicines in the open plan reception and administration area.
• Implement a plan to improve patient satisfaction in response the National GP Patient Survey results.
• Lock doors to the treatment rooms and fridges for medicines, when unattended to prevent unauthorised access.

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 Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care