We carried out an announced comprehensive inspection at Bridgeside Surgery on 11 March 2019 as part of our inspection programme. At a previous comprehensive inspection in January 2016 the practice was rated as good overall and in all key questions and population groups.

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 have rated this practice as requires improvement overall.

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

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have appropriate systems in place for the safe management of medicines and medicines stationary.
• No environmental risk assessment had been carried out. Control of substances hazardous to health (COSHH) risk assessments had not been carried out and cleaning materials were not stored safely.
• Action to mitigate the risk of fire had not been carried out. Staff had not received fire training since 2017 and there was no record of fire drills since 2015.
• A risk assessment for staff in relation to the need for disclosure and barring service (DBS) checks did not take account of those staff with chaperoning duties.

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

• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles. There were gaps in staff training, including in relation to the appropriate level of child safeguarding training for clinical staff.

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

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• 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 persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridgeside Surgery on 12 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 assessed and well managed.
• 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 said they were able to make an appointment with a named GP and that there was continuity of care, with urgent appointments 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 provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

The provider should make the following improvements:-

• Ensure that the progress made in relation to clinical audits is complimented by the introduction of a system to facilitate effective monitoring and management of all audits conducted. This should include all audits conducted by trainee GPs.

• Ensure that the risk assessment in relation to Legionella reflects all of the elements described in the practice policy.

• Ensure that actions undertaken in relation to Medic and other alerts received, are subject to a formal, auditable decision making process.

• Ensure that a system is introduced to facilitate effective recording, monitoring and management of recruitment processes and training.

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 Bridgeside Surgery on the 2 December 2014. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe and well led services. The concerns which led to these ratings apply to everyone using the practice. Therefore the different population group are also rated as requires improvement. The practice was rated as good for providing a caring effective and responsive service.

Bridgeside Surgery provides general medical services to people living in Hailsham. The practice is situated in a residential area. At the time of our inspection there were approximately 5,200 patients registered at the practice with a team of two GP Partners. A third GP was in the process of registering as a partner with the practice via the CQC.

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. However, there was no written strategy as to how the practice would cope with key members of staff leaving and increasing patient numbers due to new housing developments in the area. Recruitment files we reviewed did not contain the required information and staff appraisals had not taken place on an annual basis. However, there was a culture of openness and transparency within the practice and staff told us they felt supported. The practice was committed to providing high quality patient care and patients told us they felt the practice was caring and responsive to their needs.

The practice has an overall rating of requires improvement.

Our key findings were as follows:

• Patient feedback about the practice and the care and treatment they received was very positive.
• Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy
• The practice routinely carried out clinical audits and investigated significant events and complaints.
• Staff told us there was an open/no blame culture and they were supported in their roles.
• An active patient participation group was working in partnership with the practice and there was evidence the practice was listening to it patients.
• There were a range of appointments to suit most patients’ needs and on-line facilities for booking appointments and repeat prescriptions.
• Patients told us they were able to get the time needed with their GPs and did not feel rushed. However, this meant that some patients reported delays in appointment times due to appointments over-running with other patients.

There were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that all recruitment checks are carried out including risk assessments and recorded as part of the staff recruitment process and that the recruitment policy reflects accurately the procedures necessary. Ensure there is a written risk assessment where decisions have been made regarding staff not receiving a criminal check via the Disclosure and Barring Services (DBS)
• Ensure staff are supported through appraisals.
• Ensure the practice carries out a risk assessment for legionella and has a corresponding policy.
• Ensure all staff have appropriate policies, procedures and guidance to carry out their role.
• Ensure that audit cycles are fully recorded in order to demonstrate actions taken have enhanced care and record where improvements to the service have been made.

In addition the provider should:

• Ensure that patient information is clearly displayed for requesting chaperones
• Ensure that patient information is clearly displayed in relation to the complaints system and contains information of other organisations that can support a complainant.
• Develop a written strategic plan for the practice to include succession planning and how the practice will cope with new building developments which would mean a growing population size.
• Ensure portable electrical equipment is routinely tested and examined and record information relating to this.
• Ensure that staff are trained in safeguarding vulnerable adults.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice