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Inspection Summary


Overall summary & rating

Good

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of the Langford Medical Practice, 9 Nightingale Place, Bicester, Oxon, OX26 6xx on the 6 October 2015. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

Our previous inspection in February 2015 found breaches of regulations relating to the safe and effective delivery of services. There were also concerns and regulatory breaches relating to the management and leadership of the practice, specifically in the well led domain. The overall rating of the practice in February 2015 was inadequate and the practice was placed into special measures for six months. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

At the inspection in October 2015, we found the practice had made significant improvements since our last inspection in February 2015 and that they were meeting all of the regulations which had previously been breached.

The ratings for the practice have been updated to reflect our findings.

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

  • All the partners, staff and members of the Patient Participation Group worked hard to undertake a complete review of the service since the previous inspection and make sustainable improvements.
  • Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, and appropriately reviewed and addressed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • There was a leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
  • Governance systems and processes required further improvement to monitor and assess the whole service in relation to risk and improvements.

There were also areas where the provider could make improvements and they should:

  • Embed and maintain a continuous clinical audit programme.
  • Ensure all complaints are recorded and detailed actions of complaints are documented.
  • Clearly document potential risks to the move of the dispensary from the branch practice.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 December 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed.

Following our previous inspection the practice had commissioned a review of its medicine management systems by an external consultant. This resulted in the medicines management and controlled drug procedures being updated.

Effective

Good

Updated 10 December 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 10 December 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for several aspects of care. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information for patients about the services available was easy to understand and accessible. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 10 December 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and clinical commissioning group to secure improvements to services where these were identified. Patients said they found it easy 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. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Not all complaints were recorded and actions needed to be more clearly documented.

Well-led

Good

Updated 10 December 2015

The practice is rated as good for being well-led. Since the previous inspection they carried out a complete review of the provision of services in addition to fixing the previously identified issues. It had a clear vision and strategy which was designed with input from all of the staff and the Patient Participation Group (PPG). Staff were clear about the vision and their responsibilities in relation to this.

There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings. There were systems in place to monitor and improve quality and identify risk. However, we noted that the planned move of the dispensary had not been clearly risk assessed, including an understanding of the risks and benefits.

The practice proactively sought feedback from staff and patients, which it acted on. The PPG was engaged in driving forward changes. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

Older people

Good

Updated 10 December 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

The dispensary uses medical compartment boxes for a small number of patients and these were hand delivered by practice staff.

People with long term conditions

Good

Updated 10 December 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 10 December 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Working age people (including those recently retired and students)

Good

Updated 10 December 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

A diabetic clinic is run monthly on Saturday mornings, enabling patients that routinely commute to work away from Bicester, to be seen by the practice staff.

People whose circumstances may make them vulnerable

Good

Updated 10 December 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 92.31% of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.