LONGROYDE SURGERY

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This is the first assessment for this service since its registration with CQC. This key question has been rated as Good.

At this assessment we found that there was a good learning culture and people could raise concerns. Incidents and complaints were discussed with staff and used to make improvements. The practice was well-maintained and clean. There was a safeguarding lead and appropriate safeguarding processes in place. Staff received regular appraisals and training to enable them to maintain high-quality care. We found that although the practice told us they carried out clinical supervision with nurses, health care assistants and non-medical prescribers, this was not documented and there was no evidence of these supervisions. There was, however, always a GP on site in case further guidance or advice was needed. We discussed this with the practice who implemented a change in policy and adjusted the way they would carry out clinical supervision moving forward, and we saw evidence of this change at the onsite assessment.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found the service had a proactive and positive culture of safety, based on openness and honesty, they listened to concerns about safety and investigated incidents and complaints.

Staff told us they felt there was an open and honest culture, they said they were encouraged to raise concerns when things went wrong. The provider had processes for staff to report incidents, near misses and safety events. For example, an urgent referral was completed, and patient details were not checked, the referral contained the incorrect phone number therefore the message was not sent to the patient. The practice investigated this incident and decided on a new protocol of filling in urgent referrals while the patient was present so that information could be checked. Serious incidents or learning events were discussed with the applicable people as they happened, they were discussed and documented in the weekly clinical meetings and were a standing item in the practices annual meeting

People were able to make complaints via the practice website, and the practice also had complaints leaflets available in the reception area. Complaints were recorded and investigated, and the outcomes were discussed with staff. The practice had received 5 complaints within the last year, and we saw evidence that each complaint had been documented, discussed and the patient responded to, these responses contained information for the Parliamentary Health Service Ombudsman (PHSO) and were all sent within the time limits set out in the practice policy. When speaking with staff they were able to explain the complaints procedure.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.
There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care. At the time of the assessment the practice had 10 patient records to be summarised.
Referrals and test results were managed in a timely way. We spoke to staff about the referrals process, and they were able to explain how referrals were processed and monitored. A weekly audit was run for urgent referrals and tasks scheduled to ensure the practice had oversight. All new cancer diagnoses were discussed in weekly clinical meetings. When collecting feedback via the Give feedback on Care section on the Care Quality Commission’s website, we received several completed feedback forms that stated how quick and responsive the practice was when it came to referrals, and how they kept patients informed.
The reception team managed incoming correspondence; incoming letters were dealt with daily. The practice had a team member who was tasked with coding. The clinical team coded their own test results.
Incoming pathology and blood results were dealt with and actioned by the doctors. To ensure no result was missed when a clinician was off, the doctor who was in for the day would check all results and action as needed.
 

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns where appropriate.

The practice had a dedicated safeguarding lead for children and adults. They discussed safeguarding concerns in the weekly clinical meetings and the safeguarding lead attended monthly meetings where safeguarding issues were discussed with other safeguarding leads within the local area as well as a separate meeting with the health visitor.

When speaking with staff they were able to identify what constitutes as a safeguarding concern and told us they felt confident enough to raise concerns. They were aware of the practice’s safeguarding handbook and knew where to find details of safeguarding contacts. Staff were trained in safeguarding to the level appropriate to their role.

Non-clinical staff members had chaperoning responsibilities, these staff members had the appropriate training and had completed the appropriate level Disclosure and Barring Service (DBS) check.

The practice had procedures in place to follow up any people who failed to attend appointments. Any children who were classed as ‘was not brought’ were discussed with the safeguarding lead.

The service provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Results from the National GP Patient survey 2024 showed that 92% of patients were involved as much as they wanted to be in decisions about their care and treatment during their last appointment. This result is slightly higher than the national and local average of 91%.

We saw evidence that staff understood their role in involving people in making decisions about their care. Risks were identified and discussions with people were documented in patient records. When looking at the Give feedback on Care submissions through the Care Quality Commission website, we received multiple submissions in which patients stated they always felt involved in decisions made about their health.

Staff we spoke to knew where to locate emergency drugs and equipment, they were able to explain how to act in an emergency and how they could alert other team members if they needed help. Emergency equipment was checked regularly, and risk assessments were completed to decide on which emergency medication should be stocked by the practice. Staff could recognise a deteriorating patient and knew what actions to take. They had received training in basic life support, anaphylaxis and sepsis awareness.

Leaders, managers and staff reported that, in delivering care, they collaborated closely with people to enhance their understanding and management of risks, ensuring that their needs and care decisions were more effectively addressed.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The practice was well maintained and there were systems in place to ensure equipment was safe. We found that there were up to date health and safety, fire and legionella risk assessments. When risk assessments were completed, any actions were discussed and completed in reasonable time limits. The monthly water tap flushing logs were completed by an external company and the results were then discussed by management.

Based on evidence provided and observations made during our visit, we noted that equipment was regularly maintained, serviced, stored safely and deemed suitable for use. For example, the fire extinguishers had been serviced in line with guidance.

There was evidence the practice had systems for safely managing healthcare waste. The practice had sharps bins stored correctly, and sharps were separated into the correct coloured sharps bin.

The practice carried out weekly fire alarm testing and 6 monthly fire drills. When speaking with staff they were able to explain what they would do in the case of a fire, where the emergency meeting point was and who their fire marshals were. Staff had completed fire safety training

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, the practice did not record any clinical supervision. We discussed this with the practice who advised they were implementing a new procedure, whereby moving forward all supervision would be recorded and the process would be more formalised.

The practice undertook a range of clinical audits, including prescribing audits. However, these audits were conducted anonymously across the entire patient population. As a result, there was no evidence of prescribing audits specifically relating to the non-medical prescribers.Audit findings were discussed during weekly clinical meetings; however, because the audits were conducted anonymously they could not be used to support quality assurance activities at an individual level.

There were a range of clinical and non-clinical roles within the practice. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed.

We reviewed 5 staff recruitment files. We found that these were well managed. Disclosure and barring service (DBS) checks were carried out on staff before they started with the practice. These were then redone every 3 years. All 5 staff files we looked at contained references, immunisation records as well as other required documentation. Where applicable there were copies of the individual’s qualification certificates. Staff confirmed they received annual appraisals and discussed goals and development needs in these; this was evidenced in their staff files.

Staff told us they were given protected time to complete training and when viewing the practice training portal, we could see that most of the staff’s training courses were up to date. There were 2 courses outstanding which was mentioned to the practice, and we received evidence of these being completed by staff shortly after the site visit.

Staff received a formal induction that was relevant to their role and responsibilities on starting at the practice. There was also a process in place for performance reviews.

Staff told us there were enough staff to manage workloads and prevent any backlog of tasks. There were effective staffing arrangements to ensure that in the event of any sickness or holiday, tasks were covered.

The practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The practice had an Infection Prevention and Control (IPC) lead and a policy in place, staff training was up to date and tailored to their roles. The IPC policy contained an up-to-date annual IPC statement. The practice had carried out an IPC audit in April 2025, and this had not identified any issues to action. However, on our assessment we noted although hand soap was available it was not in wall mounted soap dispensers. The practice provided us with evidence shortly after the assessment to show they had bought wall-mounted dispensers.

Cleaning arrangements were through a third party; they provided the products and equipment. They logged any cleaning that was carried out and the practice were able to view records of this. The cleaning company did not carry out any documented audits, however management had asked them to start providing recorded audits.

The practice could evidence that most staff members had proof of their immunisation’s status. Any staff members who had not been able to provide evidence had been referred to occupational health.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

The service had implemented systems and processes to support safe monitoring and prescribing of medications. However, our clinical searches identified issues with the robustness in some areas.

We saw evidence staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or if they experienced any unexpected symptoms. Staff managed prescription stationery appropriately and securely.

Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines.

The practice had recently had a power cut, this led to a break in the cold chain as the fridge temperature became too high. The practice telephoned the manufacturer of the vaccines for some advice on whether these could be used. Any vaccines that were no longer usable were disposed of in the correct manner. The fridge temperature was logged daily and there was a secondary data logger in use.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics.

As part of our inspection a Care Quality Commission (CQC) GP specialist advisor (SpA) undertook searches of patient records on the practice’s clinical system. Overall, the searches showed that medicines had generally been effectively managed by the practice. Where issues were identified, the practice was proactive in addressing these.

Finding included:

Review of Methotrexate (a disease-modifying anti-rheumatic drug): We identified 18 patients and found they all had received the required monitoring in the last 6 months. We looked at 5 patient records in more detail and found that prescribers were appropriately checking monitoring prior to prescriptions being issued.

Aldosterone antagonists (potassium sparing diuretic): We identified 18 patients with heart failure who were prescribed this medication. Of these, 3 patients had not had the required monitoring. We looked at 3 patient records in further detail and found that two of these patients were minimally overdue monitoring, 1 of these patients had been booked in for an appointment and the other had been actively being contacted by the practice. However, 1 patient was 2 months overdue monitoring, we looked further and could see that a request for an appointment to be booked had been sent out when they were 2 months overdue, when discussing this with the practice, they advised this was due to the patient being seen early for their last required monitoring, which had led to this unfortunately not showing up on their system when it should have.

We looked at safety alerts for the following medication:

Summary of findings for safety alert search for teratogenicity in women of childbearing age prescribed Topiramate (a medication used to treat seizures): We identified 5 patients and checked 2 records. We saw that the practice had appropriate measures in place to ensure patients completed their annual risk acknowledgement form.

Citalopram (An anti-depressant)- We identified 2 patients and found that there was good oversight of these patients.

Potential missed diagnosis of diabetes: We identified 12 patients that potentially had a missed diagnosis of diabetes. We looked at 5 patient records in more detail and found that all 5 patients had received their annual reviews. We found that 3 out of these 5 had the follow up, however this was outside of the recommended guidance for testing of between 2 and 12 weeks. The practice acknowledged this and advised this was something they would need to review.

We also assessed how many medication reviews had been completed within the last 3 months; the practice had carried out 482 reviews, 95 were for patients over the aged of 75 years. While looking at certain long-term conditions, we also assessed whether medication reviews had been completed. We saw that in each condition we looked at there was around half the sample who had their medication review carried out. We discussed this with the provider who informed us that they were aware of this issue, and this was on the agenda to complete in collaboration with the pharmacist who worked for the primary care network.