The Care Quality Commission
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Archived: The Practice North Street

Overall: Requires improvement read more about inspection ratings

129 North Street, Brighton, East Sussex, BN1 2BE (01273) 328080

Provided and run by:
Chilvers & McCrea Limited

All Inspections

24 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

The Practice North Street was inspected in June 2015 where they were rated requires improvement in safe, effective, responsive and well-led services. They were rated as good in caring. As a result we carried out a further announced comprehensive inspection at The Practice North Street on 24 May 2016. We found the practice to require improvement in safe, effective, caring, responsive and well-led services. Overall the practice is rated as requires improvement.

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

  • The practice had taken positive action following a previous inspection including ensuring that medicines were stored securely and that the use of high risk medicines was monitored and managed. They had also worked to improve the use of care plans for patients with long term conditions.
  • The practice had also ensured that staff, clinical and multi-disciplinary meetings were being held regularly.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Risks to patients were assessed and well managed, with the exception of those relating to fire safety.
  • Infection control was not always being managed effectively and not all staff were appropriately trained or up to date with infection control training.
  • Published data showed patient outcomes were low compared to the national average, however unverified data from the practice from 2015/16 showed significant improvements in this area.
  • Some audits had been carried out and we saw evidence that audits were driving improvements to patient outcomes. However, there was no clear programme of continuous clinical audit.
  • Patients said they were treated with compassion, dignity and respect. However, results from the GP patient survey showed that not all patients felt listened to or involved in their care in relation to GP consultations.
  • There were some issues with availability of nursing appointments and there was no healthcare assistant in post so health checks were not being offered proactively unless a patient requested one.
  • The practice had only recently begun to identify which of their patients were also carers and there was some information in the practice on support for carers.
  • There was no clear vision, strategy or business plan.
  • The practice approach to engaging with patients continued to be limited, with no PPG and unclear action as a result of patient surveys and information collated from patient feedback sources.

The areas where the provider must make improvements are:

  • Ensure that fire risk assessments are actioned and updated.
  • Ensure that the results of infection control audits are appropriately actioned to ensure evidence of continuous improvement.
  • Ensure that all staff are appropriately trained and updated in relation to infection control, including the lead for infection control having attended appropriate training for this role.
  • Ensure that there is a centralised system in place to monitor the adoption of NICE guidance.
  • Ensure that the practice engages with patients through the use of patient participation and patient surveys and that there is clear action taken to improve the patient experience, particularly in relation to GP consultations.
  • Ensure there is clear leadership and adequate staff to meet patient needs within the practice and that staff roles and responsibilities are clear during a period of change.

In addition the provider should:

  • Ensure that there is a programme of continuous clinical audit in place.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

2 June 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Practice North Street on 2 June 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement in being well-led, responsive and for providing safe and effective services. It was good for providing a caring service.

The Practice North Street provides primary medical services to people living in central Brighton. At the time of our inspection there were approximately 2000 patients registered at the practice with locum GP and locum nurse cover. Support was available from The Practice Group/Chilvers and McCrea Ltd regional and central structures that had been put in place.

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. 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.

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed although they were not always consistently well managed.
  • Data showed patient outcomes were below average for the locality. Although some audits had been carried out, we saw limited evidence that audits were driving improvement in performance to improve patient outcomes.
  • The practice had not proactively sought feedback from staff or patients.
  • The practice had systems to keep patients safe including safeguarding procedures and means of sharing information in relation to patients who were vulnerable.
  • Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy.
  • Patients’ needs were assessed although it was unclear if care was planned and delivered following best practice guidance as care plans were not being reviewed and updated.
  • Staff had received training appropriate to their roles. Any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
  • The practice had the appropriate equipment and procedures to manage foreseeable patient emergencies.

However there were areas of practice where the provider needs to make improvements.

The areas where the provider must make improvements are;

  • Ensure that medicines are stored safely and that the use of high risk medicines are monitored and managed.
  • Ensure that locum training is monitored in line with requirements for permanent staff.
  • Devise and implement a plan for improving patient outcomes, including ensuring appropriate coding and recall systems are in place and ensure full cycle audits of practice are undertaken consistently.
  • Ensure that patient registers are proactively managed and that care plans are in place for patients with long term conditions.
  • Ensure home visits meet the needs of the patient population.
  • Ensure that plans are developed for a Patient Participation Group and that other ways are developed of gathering feedback from patients including hard to reach patients and groups.

The areas where the provider should make improvements are:

  • Develop plans to implement regular multidisciplinary meetings, particularly for patients on the palliative care register and those living in vulnerable circumstances.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice