This practice is rated as Good overall. (Previous rating April 2017 – Good)

The key questions at this inspection are rated as:

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced focused inspection at Ardingly Court Surgery on 12 July 2018 in response to concerns relating to access to appointments, dealing with complaints and customer service.

At this inspection we found:

• Feedback from patients was positive about the way staff treat people.
• The practice took complaints and concerns seriously and responded to them appropriately to improve the quality of care.
• There were processes for providing all staff with the development they needed. This included recent staff training on dealing with difficult situations and customer service.
• The practice had recently gone through a period of change when the two sites from which it operated divided into two separate practices. The electronic patient system had not successfully allocated patients to the separate practices which generated a substantial increase in workload while the issue was resolved.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

The practice is rated good overall and good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 19 January 2016. The overall rating for the practice was good. However, a breach of legal requirements was found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements. We conducted a focused inspection on 25 April 2017 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

During our previous inspection on 19 January 2016 we found the following areas where the practice must improve:

• The provider had failed to adequately identify the risks associated with prescription forms being stored in printers in unlocked rooms in the practice.

• The provider had failed to ensure recruitment procedures were operated effectively by not ensuring that proof of identity included a recent photograph.

Our previous report also highlighted the following areas where the practice should improve:

• Continue to take action to improve patient experience around accessing services.

• Work to ensure the patient participation group (PPG) is actively participative in the development of services.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During the inspection on 25 April 2017 we found:

• The provider had effective arrangements in place for the safe security and tracking of prescriptions.

• The provider had effective recruitment procedures in place and there was photographic proof of identity on file for all employees.

We also found the following in relation to the areas where the practice should improve:

• The practice had a comprehensive action plan to increase patients’ access to the practice by phone and to appointments. There were additional phone lines and staff available to take calls at busy times. Improvements had been made to procedures for making appointments.

• The PPG was now actively engaged with the practice. For example, the PPG had encouraged the practice to become more involved in the wellbeing of local people and had arranged for one of the practice nurses to give a talk on sexual health to a local young persons’ support group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ardingly Court Surgery on 19 January 2016. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were generally assessed and well managed although the practice did not consistently record checks of photographic identification as part of their recruitment processes and prescription forms were stored in printers in unlocked rooms.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients did not always find it easy to make an appointment with a named GP although the majority told us they were happy with their care. Urgent appointments were available the same day.
• 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.
• The practice had a virtual PPG (patient participation group) although participation was limited to supporting the practice with their patient survey.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• Feedback from patients included issues relating to telephone access and waiting times for appointments. The practice had engaged with the Clinical Commissioning Group and NHS England following an increase in new patients due to a local practice closure. They had also taken action to address concerns by increasing awareness of online services.

The areas where the provider must make improvements are:

• Review the risk assessment relating to prescriptions forms stored in printers to ensure action taken fully mitigates the risk and that forms are stored securely.

• Ensure that recruitment records evidence that checks of identification are recorded to include evidence of photographic identification.

The areas where the provider should make improvements are:

• Continue to take action to improve patient experience around accessing services.

• Work to ensure the PPG is actively participative in the development of services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Ardingly Court Surgery is located in purpose built premises near the Brighton sea front. It provides primary medical services to approximately 6000 registered patients. The practice has a higher proportion of patients in the working age group compared to the clinical commissioning group (CCG) and national average and lower in the below 20 year age group. The practice serves a population which is more deprived than the national average. The practice is a member of the local Brighton and Hove CCG.

This was the first inspection since registration. The announced inspection at Ardingly Court Surgery took place on 4 June 2014.

We spoke with seven patients and 11 staff during the inspection.

Our key findings were:

• The practice delivered care in a safe and clean environment. Systems were in place to report and learn from incidents.
• The practice had not carried out Disclosure and Barring Service (DBS) checks in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities). Staff recruitment checks were not all in place in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities).
• The practice provided effective care; it achieved 100% in all of the domains in the Quality and Outcomes Framework 2013/14. The QOF is part of the General Medical Services (GMS) contract for general practices. It is a voluntary incentive scheme which rewards practices for how well they care for patients.
• Patients were very positive about the care they received. Staff were caring and compassionate and treated patients with dignity and respect.
• Some patients expressed dissatisfaction with obtaining appointments.
• Care was provided in a supportive team environment.

Older people

The practice worked closely with a local nursing home to ensure patients received consistent care from a named GP.

People with long-term conditions

Patients with long term conditions were well supported to manage their health, care and treatment. The practice proactively monitored the prevalence of long term conditions across the practice population. Ardingly Court Surgery worked closely with the Brighton and Hove Integrated Care Service to improve pathways of care for people with long term conditions.

Mothers, babies, children and young people

Ardingly Court Surgery worked with health and social care partners to identify and support patients at risk.

The working-age population and those recently retired

The practice had introduced Saturday morning surgeries and weekly open access clinic to respond to the access needs of the working age population. The practice was part of the EPIC project to develop innovative ways to extend access to general practice in Brighton and Hove.

People experiencing a mental health problems

The practice supports services for patients with mental health problems. Systems were in place to safeguard patients. The practice aimed to work effectively with local health and social care partners to meet the holistic needs of patients.