School House Surgery

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 assessed all quality statements and rated the practice as requires improvement for providing safe services. We identified concerns about safeguarding systems and processes, emergency medicines and equipment, medicines management, infection prevention and control, staff immunisation records and prescription security. However, we identified no concerns with the management of information, the practice had carried out health and safety monitoring activities, there were processes to learn from significant events and incidents, complaints were responded to and learned from, and staff had access to training and support.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found most people were positive about the experience of care and treatment they received at the practice within the last 12 months. People said staff were welcoming and helpful when they had questions or concerns.

Staff feedback was positive about significant events and staff felt they improved safety as well as encouraging a culture of learning and transparency. Staff and leaders understood how to raise significant events, incidents, concerns, or near misses. They provided examples of recent incidents, as well as the learning that took place to improve care. Staff told us they discussed learning from significant events, complaints, comments and feedback in meetings. We saw evidence of meetings that confirmed this. The practice management team told us they valued staff feedback, ideas and suggestions to improve which they obtained through meetings and individual conversations. Staff told us they felt encouraged to provide their suggestions and comments.

The practice had processes to identify, record and act on significant events. There were also systems to record, acknowledge and respond to patient complaints. When things went wrong, staff apologised and gave people support. Actions were identified to make improvements, and learning was shared. Significant events were also shared on a provider risk register that logged events across all of the practices managed by the provider, which meant they could identify trends and learning opportunities in a wider area.

We found most people were positive about the experience of care and treatment they received at the practice within the last 12 months. They were happy with the support they received from staff and commented the practice was responsive with correspondence and referrals.

We spoke with a range of staff during our assessment, including clinical and non-clinical staff, who told us they worked with each other and patients to ensure safe systems, pathways and transitions. Staff told us they had the clinical information they needed to deliver safe care and treatment.

We received feedback from partners including the commissioners of the service, NHS Sussex integrated care board (ICB) and Healthwatch. They did not make any comments relating to this quality statement.

We identified no concerns with the management of information, including correspondence, test results and referrals. Information was reviewed and actioned by practice staff in a timely manner. We saw there were effective processes for sharing information with staff and other agencies. There were systems for processing information relating to new patients, including the summarising of patient notes. Referrals to specialist services were documented and contained the required information. We found no delays relating to information management at the practice. There were appropriate systems in place to identify and manage activity should there be any backlogs.

We found most people were positive about the experience of care and treatment they received at the practice in the last 12 months. We did not receive any concerns or identify any specific feedback about safeguarding.

The leadership team explained they had recently reviewed and developed their safeguarding systems and processes. There was a safeguarding lead GP, and staff were aware of who to speak with if they had concerns about a patient. All staff knew how to raise concerns about a patient. The practice told us that discussions about safeguarding regularly took place, and we were provided with examples where the practice had followed up on patients due to concerns for their safety and welfare. However, not all staff were clear about the process to follow up on children and adults at risk who were not brought to their appointment. We were told by the practice management team that this process was being developed and not yet finalised. Following our assessment, the practice told us they took our concerns seriously. They were developing a standard operating procedure to ensure a clear process for staff to follow up on children who were not brought to their appointment.

We received feedback from partners including the commissioners of the service, NHS Sussex integrated care board (ICB) and Healthwatch. They did not make any comments relating to this quality statement.

We found safeguarding systems and processes had recently been reviewed and developed. The practice had reviewed their safeguarding registers to ensure they were up to date. There were regular meetings to discuss and monitor concerns about patients, with a log to ensure any identified actions were completed. We saw evidence to demonstrate this. All staff received a disclosure and barring scheme check before starting (a way for employers check a person’s criminal record, to help decide whether they suitable to work with children or vulnerable adults). As well as clinical staff, all receptionists were trained to act as a chaperone for patients. We saw staff had received appropriate training for this role. We saw records that showed clinical staff had completed appropriate safeguarding training. However, non-clinical staff had not yet received training to a level appropriate for their role. Processes to follow up children who were not brought to their appointment and adults at risk had not yet been fully implemented. The practice took immediate action in response to our concerns, including that they rolled out and prioritised training to all non-clinical staff.

People were positive about the advice and support given by staff. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

All staff we spoke with understood the signs of serious infection and knew the actions to take if a patient became unwell. Staff were able to locate emergency medicines and equipment, and we saw clear signage around the practice. Staff told us they completed information governance training and told us how they kept their smartcard secure. During our visit to the practice, observations of staff confirmed this. Staff explained the appointment booking system and how they triaged patients to the right appointment or identified those in need of urgent assistance. Clinical staff we spoke with demonstrated how they involved patients, by providing information about when to seek help and what to do if their condition deteriorated.

Staff were trained to manage emergencies and to recognise signs of serious infection, including sepsis. This included online and face to face training as well as guidance/posters available around the practice. There were some systems and processes to ensure there were enough staff to provide appointments and prevent staff from working excessive hours. We found the practice had rota systems to plan and manage staffing, however the practice recognised there was a lack of nurses. The practice had policies to ensure patient data was securely stored and managed safely, this included staff smartcard use. We found individual care records were written and managed securely in line with current guidance and relevant legislation.

The practice told us they ensured health and safety risk assessments were carried out and appropriate actions taken. Staff told us there were fire procedures and they had completed relevant health and safety training. They also described recent fire drills and knew what to do in an emergency or major incident. While there was one fire marshal, staff were unsure who would fulfil this role if this person was not at the practice. Following our assessment, the practice told us they took immediate action in response to our concerns. They told us 4 additional fire marshals had been trained to ensure marshal presence at both practice sites. They also planned to train further non-clinical staff.

During our visit, we did not find all the emergency equipment would expect to see. There were no stethoscopes for use in an emergency and we found they were of limited general availability at both sites. There was also no nebuliser (a machine used to help control breathing problems, including asthma). However, there was medical oxygen and a defibrillator on site and systems to ensure these were regularly checked and fit for use. The remaining equipment, facilities and technology we saw during our site visit were well maintained. Following our assessment, the practice told us they took immediate action in response to our concerns and the missing equipment was now in place at both practice sites.

Health and safety, and fire risk assessments were carried out by the practice. Remedial actions were being monitored and completed. The practice had a range of policies and protocols regarding safety arrangements. All documentation was recorded centrally on their document management system. However, the practice did not provide evidence to demonstrate they had identified and mitigated the risks associated with missing equipment, namely stethoscopes and nebulisers.

We received positive feedback about staff at the practice, including that they were knowledgeable, helpful and professional. Negative comments related to continuity of care and access to appointments.

Staff told us they had access to support and received regular appraisals. We heard that leaders and GPs were available throughout the day if they needed advice. They told us they felt there were enough administrative staff and GPs, but there was a lack of female GPs and of nurses. Staff feedback reflected a concern that this limited their capacity to see patients. However, they were aware this was being addressed. For example, the use of agency nurses and recruitment of permanent staff. Leaders told us about their plans to improve and manage the availability of nursing appointments, including that they were increasing the number of clinics with additional staff. They had also recruited a female advanced nurse practitioner to support patients who required access to a female clinician.

We looked at 5 staff files and found recruitment checks had been carried out in accordance with regulations. However, we found the recording of checks could be improved, to include a documented explanation of any gaps in employment. There was a programme of learning and development for all staff, and this included a range of mandatory training modules. We found completion of training was monitored by a department at provider level, however this process was not working as expected. Not all staff had completed or were up to date with training identified as mandatory. For example, we saw not all staff had completed or were up to date with basic life support training. We were told clinical supervision took place for staff employed in advanced clinical practice, however this process had not been formalised. The practice had recognised this as an area for improvement and processes to consistently document clinical supervisions were being finalised and improved. A new GP clinical director had been appointed who would have oversight of clinical supervision and quality control. Following our assessment, the practice told us they took action in response to our findings. They told us they now record gaps in employment, have introduced clinical supervision sessions for all staff employed in advanced clinical practice, and line managers now have access to training compliance data for their teams at practice level.

We found most people were positive about the experience of care and treatment they received at the practice within the last 12 months. We did not receive any concerns or identify any specific feedback about infection prevention and control.

We spoke with the interim lead for infection prevention and control (IPC). They had recently taken over the role and had begun to make a number of changes and improvements. They described issues they planned to resolve such as adapting the IPC policy specifically for GP practice use, developing communication with the cleaners, and improving the recording and access to staff immunisation records. Some staff told us they felt there was a lack of clarity for roles and responsibilities, including for aspects of IPC and maintaining staff records.

We found the maintained appropriate standards of cleanliness and hygiene. We observed the premises to be clean and tidy. We found most of the arrangements for managing waste and clinical specimens kept people safe. However, we noted a lack of sharp boxes in all clinical rooms. This had been identified by the practice’s infection prevention and control audit but not yet remedied.

There were some systems and processes to ensure effective infection prevention and control (IPC), however some of these were not operating as expected. We saw there was an IPC policy for all staff employed by the provider, however it had not been adapted for use at this practice. It lacked specific detail including named individuals and clarity about roles and responsibilities including ordering and waste management. An IPC audit had been completed and remedial actions had been identified. However, at the time of assessment, not all actions had been completed. For example, a lack of cleaning schedules and documentation for cleaning, including for clinical rooms. Staff immunisation records were recorded centrally by the provider organisation. However, records did not include all recommended immunisations in line with national guidance and the provider policy, for example tetanus and polio. Following our assessment, the practice told us they acted in response to our findings. This included ensuring staff immunisation records were complete, progressing remedial actions identified through the IPC audit, and clarifying staff roles and responsibilities.

We found most people were positive about the experience of care and treatment they received at the practice. However, there were some negative comments from people about a lack of follow up relating to their long-term health conditions, and issues with prescriptions.

Staff told us they involved patients in decisions about their medicines during reviews and assessments. Staff we spoke with during our assessment had knowledge of current and relevant best practice and professional guidance.

During our visit, we did not find all the emergency medicines we would expect to see. We found both sites did not have access to medicines to treat seizures, asthma and breathing disorders, and croup in children. At the branch site, staff did not have access to medicines for the early treatment of heart attacks. We found the ambient room temperature was not being monitored where medicines were stored, including those for use in an emergency, to ensure they remained effective and safe to use. For example, the temperature in the nurse’s room was over the recommended maximum of 25c. There was no thermometer in the administrative office where emergency medicines were stored, for which high temperatures had been reported by staff. Staff had the appropriate authorisations to administer medicines using Patient Specific Directions. Patient Group Directions (PGDs) were in use, however we saw health professionals had not always been named and authorised before they used it to provide care. Vaccines requiring refrigeration were stored, monitored and transported in line with national guidance. We found that fridge temperatures were monitored and appropriate actions taken to respond to potential cold chain breaches. Paper records demonstrated that temperatures had not been consistently recorded at the main site in April and May prior to our assessment. However, prior to our assessment the practice had recognised the need to improve and was now using a document management system to record temperature monitoring information. Processes to securely store and monitor blank prescription stationary were not consistently followed. We identified blank prescription paper that had been removed from storage, without being logged, and could not be accounted for. Following our assessment, the practice told us they acted in response to all of our concerns, including relating to the emergency medicines, ensuring correct completion of PGDs and improving blank prescription security procedures.

During our assessment we conducted remote clinical searches, which allowed us to review patients’ medical records to understand the practice processes and ensure people were receiving safe and effective care. Our searches indicated a low number of patients potentially at risk due to outstanding monitoring, including for medicines that control blood pressure. However, there was evidence within the records that the practice had identified this and had taken action to invite the patient in for a follow up appointment. We shared our findings with the practice, and leaders demonstrated they took immediate action to further investigate and follow up on these patients. We received a full response from the practice regarding all of the patients we were concerned about. We also found there were systems to receive and respond to medicine and safety alerts. The practice had a log of all alerts, and this recorded appropriate information about any actions taken. We saw examples within our search that demonstrated patients affected by alerts had been followed up.

Staff had taken steps to ensure appropriate antimicrobial use to optimise patient outcomes and reduce the risk of adverse events and antimicrobial resistance. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antibiotics issued by the practice was in line with local and national averages. We also looked at the practice performance relating to dependency forming medicines, which was higher than the local and England averages. The practice was aware of the result and told us this was an ongoing area of focus. Leaders provided evidence of an audit conducted in March 2024 that reviewed patients prescribed a type of medicine called hypnotics. As a result, they reduced the prescribing of 9 patients, reviewed prescribing policies, removed hypnotics as a repeat prescription, and set up a 3-monthly search to ensure no further repeats were added. They worked closely with the primary care network pharmacist and continued to work with patients on a one-to-one basis, over extended appointment times, to support them with reducing their dose. They told us the practice had made a commitment that they would not initiate any more patients on these types of medicines and to improve outcomes for their community.