We carried out an announced focused inspection at Benfield Valley Healthcare Hub on 20 March 2019 as part of our inspection programme.

At the last inspection in March 2018 we rated the practice as requires improvement for providing safe services because:

• The practice did not have reliable systems and processes to make sure refrigerated medicines were stored safely.

We also found areas where the provider should make improvements:

• Review training and guidance given to all staff to identify children and adults at risk on the practice computer system.
• Review the premises and facilities provided at both sites and ensure all reasonable adjustments are made, including that all patients can raise an alarm if they require assistance.

At this inspection, we found that the provider had satisfactorily addressed all of these areas.

We based our judgement of the quality of care at this service is 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.

Overall the practice continues to be rated as good and is now good in the safe domain.

Details of our findings

At this inspection we found:

• The practice had reviewed and updated their policies and procedures to ensure that refrigerated medicines would be appropriately monitored. Actions were taken if temperatures went out of the recommended range, or if checks had not been completed and recorded.
• Staff had been fully updated and they had received additional guidance. This included an updated reception staff handbook to include information on the computer alerts used to identify children or adults at risk.
• There were processes to identify, understand, monitor and address current and future risks including risks to patient safety. The practice fully recorded and investigated significant events. Actions were taken to improve safety and lessons were learned
• The practice had updated their premises, including an emergency assistance alarm, baby changing facilities, and replacement of flooring.

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

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

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Benfield Valley Healthcare Hub and the branch surgery Burwash Medical Centre on 21 March 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions, as the practice had been registered under a new provider in April 2017. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had systems to manage risk, including risk assessments, so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. Although systems were in place to manage and store medicines, including vaccines, medical gases, and emergency medicines and equipment to minimise risks, some of these systems were not reliably implemented.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.

• The practice understood the needs of its population and tailored services in response to those needs. For example, extended opening hours, advanced booking of appointments, telephone consultations, text message blood results and a redesigned contraceptive service.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.

We saw one area of outstanding practice:

The practice had redesigned their contraceptive service to ensure it met the needs of their patients. Following a review and consultation with patients to ask how they wanted to access contraception, the practice found that patients wanted fewer appointments. In response, they made changes to their processes and provided 12 month prescriptions (where appropriate) with an option to have annual reviews by telephone consultation. The practice used a data collection and analysis programme that showed that prescriptions produced by the practice had decreased; therefore this presented a reduction in workload for administrative and clinical staff.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Review training and guidance given to all staff to identify children and adults at risk on the practice computer system.

• Review the premises and facilities provided at both sites and ensure all reasonable adjustments are made, including that all patients can raise an alarm if they require assistance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice