Langley Medical Practice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Feedback from people using the practice was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. Reception staff were aware of the needs of the local community. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews.

Care plans and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) records were completed and reviewed regularly. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The practice planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance. The practice held regular meetings to review any new national guidance and safety alerts and to discuss learning from incidents and complaints.

The practice worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. Information was shared with all relevant staff via a range of methods, including, regular meetings, via secure software to update named staff about specific matters and within informal meetings, such as a regular morning coffee meeting which was open to all to attend.

The practice worked with other services including community services, commissioners, and voluntary organisations to ensure continuity of care, including where clinical tasks were delegated to other services.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. The practice supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. The practice also provided access to a social prescriber who assisted patients with a wide range of concerns, including: housing issues, bereavement, benefits help, isolation and low mood, housebound, social support, frailty managing at home, and issues with transport to appointments housing issues, bereavement, benefits help, isolation and low mood, housebound, social support, frailty managing at home, and issues with transport to appointments.

The practice routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

At our last inspection we found one area of outstanding practice. The practice provided in-house clinics for a range of specialist services that would normally require a referral to secondary care. The practice had reviewed the impact of providing those services and determined that collectively they represented a significant reduction in hospital referrals.

At this assessment we found that the practice narrowly missed national targets for 3 of the 5 child immunisation indicators regularly reviewed by CQC. The targets missed were just below the national minimum target of 90%, ranging between 87% - 89.3%. The practice was aware of this small decline in performance, which it attributed to a range of factors, including parental refusal of vaccinations, families moving out of the practice area before completing the schedule, and delays in obtaining historical vaccination records from recently registered families from overseas.

It had put in place plans to improve childhood immunisations performance, including:

• Maintaining a comprehensive log of all children with outstanding immunisations.
• Dedicated administrative and clinical staff to contact families where immunisations were missing to encourage engagement.
• In cases where there is no response, incomplete information, a child is not brought or a parent declines, escalation to a GP for further review and direct follow-up.
• Use of multilingual resources (from the British Society of Immunology) for provision of information to families about the benefits of immunisation.
• Improvements to search and recall systems to ensure accurate and timely identification of patients requiring immunisations.
• regular review of the process at a planned monthly governance meeting.

The practice had also narrowly missed the national targets for cervical screening for eligible patients within both monitored age groups, 25-49 and those aged 50-64. The practice advised us that for the younger age group, patients aged 25-49, its performance was above both local and national averages. Similarly, its performance for screening of eligible patients aged 50-64 was also above national averages.

Despite this performance, the practice had met the local GP cancer lead and had devised a range of strategies to improve performance in the coming years. The strategies developed and included:

• Use of a local charitable organisation to engage with patients. However, the charity withdrew at the end of 2023.
• Dedicated staff performing regular searches to identify non-attenders
• Clinical and non-clinical staff phoned non-attenders to encourage engagement.
• A cervical screening non-responder text was sent opportunistically when the patients were flagged as non-responders on the practice patient records system.
• During the Covid pandemic, and since, the practice had proactively targeted high-risk groups to attend and ensure screening was up to date.

From the clinical notes we reviewed, we found that people who used the practice experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

The practice told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.

All clinicians received training in Deprivation of Liberty Safeguards (DoLS) to assess patients’ capacity to make decisions about their own care and treatment. In addition, all staff received training in mental health awareness.