This practice is rated as Good overall. (Previous rating September 2015 - Good)

The key questions at this inspection 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

We carried out an announced comprehensive inspection at Charter Medical Centre on 5 June 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. 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:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There were processes to identify, understand, monitor and address current and future risks including risks to patient safety. However, some of these processes were not always implemented effectively, including the recording and oversight of safety alerts, and the systems for the appropriate and safe handling of medicines.
• 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.
• The practice had a number of clinical staff with specialist interests. This included dermatology, diabetes, musculoskeletal, the menopause and elderly care and dementia.
• Patients found the appointment system easy to use and survey results were higher than average relating to access to appointments. The practice ensured patients had good access to care by offering extended hours surgeries and telephone consultations. They offered an automated appointment booking system both on the telephone and the practice website.
• The practice had good facilities and was well equipped to treat patients and meet their needs. We found that the practice had considered patients who found it hard to access services and had made a number of reasonable adjustments.
• 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 monitored their performance and was aware of areas where they were doing well and those that required attention. There was a strong focus on continuous learning and improvement at all levels of the organisation.

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:

• Strengthen the guidance provided for reception staff to include identification of symptoms for potentially seriously ill patients, such as sepsis.
• Strengthen the processes to record and monitor the risks to vulnerable patients registered at the practice.
• Review and improve the storage of completed staff induction checklists.
• Continue to monitor and take action where appropriate for low performance on QOF, including diabetes indicators.
• Strengthen the programme of clinical quality improvement activity, including to routinely review the effectiveness and appropriateness of the care provided.

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

We carried out an announced comprehensive inspection at The Charter Medical Centre on 18 September 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• There was a strong culture of learning and development.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand.
• The practice had a clear vision. A business plan was in place, which was monitored and regularly reviewed and discussed with all staff.
• High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• The practice was innovative and forward thinking. It had recently employed its own pharmacist and was involved in local projects to improve patient access to care and support.

We saw several areas of outstanding practice including:

• The practice had responded positively to the need to provide a service to an additional 9500 patients as a result of the closure of a local GP practice. It had worked closely with the clinical commissioning group and the local council to ensure a robust service delivery plan was put in place which included taking on the employment of some former nursing and administrative staff. Systems had been put in place to ensure continuity of care for these patients. It had been proactive in ensuring that staff and patients were communicated with and kept up to date about arrangements which had been put in place to manage the change.
• The practice had a good skill mix which included advanced nurse practitioners who were able to see a broader range of patients than the practice nurses.

• The practice had employed its own pharmacist to provide in-house expertise and advice on medicines management.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Charter Medical Centre is located in Hove and provides primary care medical services to approximately 17400 patients in the locality. The practice has eight general practitioners (GPs), all of whom form the partnership management team as the registered provider of services at the practice. The practice is also a training practice for GPs and paramedic practitioners. The services are governed by the Brighton and Hove Clinical Commissioning Group (CCG) and provide regulated activities for Diagnostic and Screening Procedures, Treatment for Disease, Disorder and Injury, Family Planning, Surgical procedures, Maternity and Midwifery.

We spoke with nine patients during our inspection, and they were all very complimentary about the services they received from the practice. We also received many positive comments from patients who had completed comment cards prior to our inspection, most expressed a high level of satisfaction with the practice and staff. We also spoke with the Patient Participation Group (PPG) representatives, who emphasised the support, engagement and effective working relationship the group had with the practice management team. We also saw the results of the patient satisfaction survey undertaken in March 2014 that showed patients were consistently pleased with the service they received.

We spoke with various members of the clinical team including four GPs, an Advanced Nurse Practitioner, two Nurses and a Phlebotomist and a Health Care Assistant, the Practice Manager and five of the non-clinical staff on duty. They told us that the management were open and approachable and that there was good team working amongst all the staff at the practice. Overall, we found that the practice was well-led and provided caring, effective, and responsive services to a wide range of patient groups, including those of working age and recently retired, mothers with babies and younger children, older people, patients with long-term conditions and complex needs, people in vulnerable circumstances and those people experiencing poor mental health.

The practice address is Charter Medical Centre 88 Davigdor Road Hove East Sussex BN3 1RF