The Care Quality Commission
  • Doctor
  • GP practice

The Orchard Surgery

Overall: Good read more about inspection ratings

276 High Street, Langley, Slough, Berkshire, SL3 8HD (01753) 542424

Provided and run by:
The Orchard Surgery

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about The Orchard Surgery on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about The Orchard Surgery, you can give feedback on this service.

13 September 2021

During an inspection looking at part of the service

We undertook a focused inspection of this service in January 2020. The inspection looked at the key questions: effective, responsive and well-led. Following our previous inspection, the practice was rated ‘Good’ overall, however, we identified concerns relating to access to the service and lower than average patient feedback. We, therefore, rated the responsive key question as Requires Improvement. We issued a Requirement Notice for Regulation 17: Good governance as a result of this inspection.

The full comprehensive report on the January 2020 inspection can be found by selecting the ‘all reports’ link for The Orchard Surgery on our website at www.cqc.org.uk.

We carried out a desk-based review on the 13 September 2021 to confirm that the practice had carried out their plan to improve the areas that we had identified in our previous inspection.

At this review we found that since our last inspection and despite the COVID-19 pandemic, the practice had made improvements. Using information provided by the practice, we have amended the rating for this practice to reflect these changes. The practice is now rated as Good for the provision of responsive services, all the population groups are now rated Good and the overall rating of Good remains.

At this inspection, we found:

• Actions had been taken to address the breaches of regulation identified in the Requirement Notice issued for Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice was able to demonstrate improvements had been made to the access to the service. Although the national GP patient survey results continues remain lower than the local and the national averages, these had improved on previous results.

• The practice has continued to make improvements since our previous inspection in January 2020, working closely with the local Primary Care Network (PCN) to enhance access to the service. The practice had also invested in an upgraded telephony system to improve its telephone access and had introduced an electronic consultation option to ensure patients were signposted to the right place for their care.

• The practice has taken steps to address the cervical screening low uptake rates. As a result, the practice’s performance for cervical screening has improved since the last inspection. However, it remains below the national target.

• Services were planned and delivered in a way that met the needs of the local population. For example, in-house phlebotomy services were introduced for the convenience of the practice population.

Whilst we found no breaches of regulations, the provider should:

  • Continue to explore & improve patient satisfaction relating to access to the practice.
  • Continue to monitor the impact of newly introduced methods of access to the practice.
  • Continue to improve cervical screening uptake to be in line with national target.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

14 January 2020

During an inspection looking at part of the service

We decided to undertake an inspection of this service on 14 January 2020 following our annual review of the information available to us, in May 2019. This inspection looked at the following key questions; was the service providing effective, responsive and well led services for the registered patient population. We decided not to inspect whether the practice was providing safe or caring services as there was no information from the annual regulatory review which indicated this was necessary.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

At this inspection we found:

  • The practice provided effective care to patients.
  • Patient care was coordinated with staff internally and externally to ensure appropriate planning and consideration of their needs.
  • Staff were developed and supported to ensure services were of high quality.
  • There was difficulty for some patients to book appointments and to access the phone system. Patient concerns regarding access to services were being reviewed and action taken to improve their experience.
  • There was consideration of the various needs of the local patient population.
  • Cancer screening rates were low.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • Governance systems were operated including quality improvement initiatives.
  • The practice was engaged in local initiatives and worked effectively alongside partners in the local healthcare system.

The areas where the provider must make improvements:

  • Assess, monitor and improve the quality and safety of the services provided

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

15 September 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Our previous comprehensive follow up inspection in January 2016 found issues relating to the responsive delivery of service and we asked the practice to make further improvements in the appointment booking system. We found The Orchard Surgery required improvement for the responsive domain. The practice was rated good for providing safe, effective, caring and well-led services.

This follow up focussed inspection on 15 September 2016 was undertaken to check whether the practice had made necessary changes following our inspection in January 2016. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report of 6 January 2016.

At our inspection on the 15 September 2016 we found the practice had made improvements since our last inspection. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of responsive service.

Specifically we found:

  • The practice had taken number of steps to improve the appointments booking system and access to a named GP. For example, the practice had increased GPs sessions from 25 to 37 sessions per week and introduced 12 online GPs appointments for same day which were released 60 minutes before the practice opening times.
  • The practice had increased the number of online appointments and there was a dedicated member of staff who was monitoring appointment booking system. This included the duration it takes to answer the telephone calls.
  • The practice had carried out an internal survey in August 2016, which showed improved results and patients were satisfied with their access to care and treatment.
  • The practice was in the process of installing two additional telephone lines, recruited four administration staff, a health care assistant and a clinical pharmacist to take the lead role in carrying out medicine reviews which would increase GP capacity allowing the practice to offer additional GP appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

6 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Orchard Surgery, Willow Parade, 276 High Street Langley, Slough, Berkshire, SL3 8HD on the 6 January 2016. 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 May 2015 found breaches of regulations relating to the safe, effective, caring and responsive 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 May 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 January 2016, we found the practice had made significant improvements since our last inspection in May 2015 and that they were meeting the regulations which had previously been breached.

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

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

  • All the partners and staff worked hard to undertake a complete review of the service since the previous inspection and made sustainable improvements.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded, monitored and reviewed.
  • Risks to patients were assessed and well managed.
  • We found that completed clinical audits cycles were driving positive outcomes for patients.
  • 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.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain were available and easy to understand.
  • Patients said they found it difficult to make an appointment with a named GP and had to wait a long time to get through to the surgery by telephone each morning. Urgent and online appointments were available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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 provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

  • Further review the appointments booking system and the waiting time it takes to get through to the practice by telephone. Improve the availability of non-urgent appointments with a named GP.
  • Implement a system to promote the benefits of breast screening and flu vaccination rates for the over 65s to increase patient uptake.
  • Ensure to develop and implement clear action plans, to improve the outcomes for learning disabilities patients.
  • Take action to review their approach and support for patients with carers responsibility.

I confirm that this practice has improved sufficiently to be rated ‘Good’ overall. The practice will be removed from special measures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

13 May 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of The Orchard Surgery on 13 May 2015. This was the first inspection under the new CQC comprehensive inspection approach and was undertaken to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. We have rated the overall practice as inadequate.

Specifically, we found the practice inadequate for providing safe services, responsive and being well led. It was also inadequate for providing services for all the six population groups. Improvements were also required for providing caring and effective services.

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. We found concerns in safeguarding, infection control, training, medicine management, access and quality and monitoring systems.
  • The majority of the patients we spoke with were not satisfied with access to appointments. Patients reported considerable difficulty in getting through the telephone system and said it was difficult to get an appointment.
  • We found the practice had not taken all measures to identify, assess and manage risk. For example, the practice did not have robust systems for checking and recording fridge temperatures. The practice did not have adequate systems in place to ensure practice nurses administered vaccines using directions that had been produced in line with legal requirements and national guidance. The practice did not have systems in place to monitor the issue of access, to determine whether the actions the practice had taken had any positive impact on patients.
  • There was no clear vision and strategy with realistic plans to achieve the vision, values and strategy.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand.

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

Action the provider MUST take to improve:

  • Ensure medicine management systems are reviewed and reflect national guidelines.
  • Ensure appropriate infection control systems are in place, in line with national guidelines.
  • Provide safeguarding training to all staff at the required level for their role.
  • Ensure there are systems in place to regularly assess and monitor the quality of the services provided. Develop a regular completed clinical audit process and implement actions.
  • Ensure there are processes in place to identify, assess and manage risks relating to health, welfare and safety of patients.
  • Ensure staff receive regular appropriate training, specific to their role.
  • Undertake and record risk assessments. Including those relating to health and safety and risks to patient safety.
  • Develop a regular completed clinical audit process and implement actions.
  • Implement a process to review significant events annually and disseminate learning to practice staff
  • Review responses from patients regarding the accessing appointments in order to make improvements to the service provided.

Action the provider should take to improve:

  • Review the staffing levels of nursing staff and the allocation of urgent appointments to the nursing team.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

30 January 2014

During a routine inspection

During our visit we were unable to speak to patients. A patient questionnaire was sent out and feedback received was generally positive. Patients were asked if they were treated with respect and dignity and responses included 'Most definitely. It is part of the practice ethos and put into practice from the moment you arrive and until you depart' and 'Yes. They are always polite and patient and listen to my questions and try to answer all.' Another patient told us 'All the 'front of house' and medical staff always treat me with respect and dignity and do their best to ensure that my experience when I visit the surgery is a positive one.'

The feedback received from the patient questionnaire was complimentary of the service provided to them and of the staff in the practice. Some comments included 'There is a patient centred approach from members of the medical team, support and admin team', 'The Doctors are very good and staff very helpful', 'The Partners are all very approachable and provide a quality service' and 'Receptionists and all staff are friendly.'

Patients told us they had felt safe and confident with the care provided at the practice. We found the practice did not have a robust recruitment process in place putting patients at risk of receiving a service from staff members who were not sufficiently vetted.

We found patients were made aware of the complaints system and patient's complaints were fully investigated and resolved, where possible, to their satisfaction