Modality Mid Sussex

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. People were protected from abuse and avoidable harm. At our last assessment, we rated this key question as Inadequate. At this assessment, the rating has changed to Good.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learned to continually identify and embed good practice.

Staff we spoke with told us they knew how to identify and report incidents and were encouraged to do so. They were able to describe examples and talk about preventative action taken to prevent recurrence. We saw the practice had a centralised system for recording and monitoring significant events. Significant events were discussed at weekly clinical meetings, staff bulletins and in daily meetings for all staff. There were quarterly meetings for all staff to attend, where learning from significant events and complaints was discussed and shared.

In October 2024 the practice introduced an on-line triage system to help patients book appointments more quickly. We saw that the practice was continuing to learn lessons from the implementation and make improvements to the safety of the system. For example, in response to concerns raised by staff, referrals to paramedics were removed from the on-line pathway. Appointments with paramedics were now triaged by the duty GPs to ensure they were clinically appropriate.

The practice worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There were systems in place for processing information relating to new patients. The practice had care co-ordinators, social prescribers and regular multi-disciplinary meetings that supported patients moving across health and social care pathways. The practice shared any advanced directives with ambulance services, end of life care providers and urgent treatment centres. Patients told us they sometimes experienced delays to referrals and test results and that this caused delays in hospital treatment. The practice was aware of this and had implemented a system to improve the timeliness of these tasks. Staff monitored referrals daily and during our site visit we saw that there were no backlogs for urgent and routine referrals.

The practice worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. It held quarterly safeguarding meetings where new vulnerable patients were discussed and records updated.

The practice worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The practice detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

At our last inspection we found health and safety, and fire risk assessments had not been carried out sufficiently and appropriate actions taken. At this inspection contracts were in place to ensure health and safety, and fire risk assessments and audits had been undertaken and risks identified had been addressed. Health and safety and fire safety audits had been undertaken in September 2024 at each of the branch sites. Action plans were monitored, and we saw that risks identified had been addressed, for example the undertaking of electrical inspections and remedial electrical work. Fire extinguishers had been wall mounted where possible and work to ensure fire doors were compliant was ongoing. There was a business continuity plan in place which was monitored and reviewed.

At our last inspection we found the practice did not have sufficient staff to provide appointments and busy periods were not always managed effectively. At this inspection we found the practice had made improvements so it could ensure there were enough qualified, skilled and experienced staff. They received support and training and worked together to provide safe care that met people’s individual needs. Arrangements for clinical supervision needed to be strengthened for those working in advanced roles.

Since our last inspection, the practice had recruited additional GPs, paramedics and patient services assistants. It was actively recruiting for additional practice nurses. As a result, the number of patient appointments had increased and call waiting times had reduced. We found training was up to date, learning needs and development of staff was managed appropriately. However, feedback from some staff included that there was insufficient capacity to allow them to advance their clinical skills and that they still felt under pressure to meet patient needs especially during periods of sickness and annual leave. Some clinical staff told us they had insufficient time to attend clinical meetings, where information and learning was discussed and shared.Staff in advanced roles worked within their scope of competence and received daily supervision and advice on the management of cases. However, formal supervision sessions were infrequent and lacked the structure required to assist staff learning and development. Following inspection, the practice sent us an updated clinical supervision policy, which set out a more structured programme of supervision for all allied health professionals. Safe recruitment practices were followed, although gaps in employment history had not always been explored, in line with regulations.

At our last inspection we found the practice did not always act to ensure appropriate standards of cleanliness and hygiene were met. At this inspection we found the practice had made improvements which enabled them to effectively assess and manage the risk of infection.

At our last inspection we found the practice had not always acted on any issues identified in infection prevention and control audits. The staff identified as taking lead responsibility for assessing the risk of, and preventing, detecting, and controlling the spread of, infections at each site had not had additional training for this enhanced role. Additionally, there was no oversight of infection control across the 4 sites by the leadership team.

At this inspection we found the designated infection, prevention and control lead had received relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. For example, the replacement of flip top bins with foot pedal operated, lidded bins to prevent the contamination of hands during opening.

At our last inspection we found the practice did not have systems for the appropriate and safe use of medicines, including medicines optimisation. At this inspection we found the practice made sure that medicines and treatments were safe and met people’s needs, however the quality of medication reviews remained inconsistent.

At this inspection we found the practice had made improvements to the management of medicines. Our clinical searches identified there was now an effective process for reviewing patients’ health in relation to the use of medicines that required monitoring. The searches also showed that systems for recording and acting on safety alerts had improved. However, the quality and timeliness of reviews for patients on repeat medicines remained inconsistent. Our remote searches identified 374 patients as having had medication review in last 3 months. Two of the 5 records we reviewed in more detail lacked additional evidence to demonstrate what had been included in the medicine review. There was no record to show that necessary information had been discussed with the patient, for example, the associated risks of the prescribed medicines. We also identified 6673 patients showing as overdue for a medication review. Six of the 10 patients we reviewed in more detail identified they had not received a medicine review in the last 12 months. As well as being overdue there was no record in the previous reviews of what been assessed or actions taken. The practice told us they conducted monthly audits of the quality of medication reviews and acknowledged that compliance was still an area for improvement.

Medicines were now stored safely and securely with access restricted to authorised staff. We also found staff now had the appropriate authorisations to administer medicines. Staff managed prescription stationery appropriately and securely. Stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs were checked regularly and staff made sure they were stored at the appropriate temperature. There was medical oxygen and a defibrillator on site and systems to ensure these were regularly checked and fit for use. However, during our site visit to the branch surgery Crawley Down Health Centre we found that the oxygen cylinders were not being stored in line with safety recommendations. We raised this with the practice who addressed this immediately and confirmed after inspection that spare oxygen was now stored in a ventilated room, away from combustible materials. All relevant signage had been updated, and staff were all briefed on the new procedures.

The practice had taken steps to ensure appropriate antimicrobial use optimised patient outcomes and reduced the risk of adverse events and antimicrobial resistance. As part of an ongoing quality initiative, the practice conducted an annual antibiotic audit. The repeat audit showed a significant improvement in antimicrobial choice, with 96% of prescriptions now in line with national guidelines.

During our inspection we visited the dispensary at Crawley Down Health Centre. We found that the practice had made improvements to address concerns raised at our previous inspection. There was a GP responsible for providing effective leadership for the dispensary. There were clear standard operating procedures which covered all aspects of the dispensing process, which were regularly reviewed, and a system to monitor staff compliance. Dispensary staff who worked unsupervised had received appropriate training and regular checks of their competency. Where the electronic prescription service was not used, prescriptions were signed before medicines were dispensed and handed out to patents. There was a risk assessment or surgery policy for exceptions such as acute prescriptions. Medicines stock was appropriately managed and disposed of, and staff kept appropriate records. For medicines provided in monitored dosage systems, there were systems to ensure staff were aware of medicines that were not suitable for inclusion in such packs, and appropriate information was supplied to patients about their medicines. The delivery service had been risk assessed for safety, security, confidentiality and traceability. Dispensing incidents and near misses were recorded and reviewed regularly to identify themes and reduce the chance of reoccurrence. Information was provided to patients in accessible formats for example, large print labels, braille, information in a variety of languages. There was the facility for dispensers to speak confidentially to patients and protocols described the process for referral to clinicians.