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Inspection Summary


Overall summary & rating

Good

Updated 15 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kings Langley Surgery on 8 June 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.

  • 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 were positive about the standard of care they received and about staff behaviours. They said staff were dedicated, pleasant and caring and that their privacy and dignity was respected.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and 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.
  • There was a clear leadership structure and staff felt supported by management. The practice 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:

  • Ensure that practice meetings are documented.
  • Ensure the infection control lead completes regular update training.
  • Ensure that an updated and comprehensive fire risk assessment is completed.
  • Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
  • Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including basic life support training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Lessons learnt were shared to make sure action was taken to improve safety in the practice.
  • When there were unexpected safety incidents, patients received reasonable support and truthful information. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 15 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable with or above the local and national averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for staff.
  • Staff worked with multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 15 August 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in January 2016 showed patients rated the practice similar to or above local and national averages for all 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 15 August 2016

The practice is rated as good for providing responsive services.

  • Practice staff 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.
  • Data from the National GP Patient Survey published in January 2016 showed patients rated the practice in line with or above local and national averages for access to the practice. Patients said they found it easy to make an appointment with a named GP and get through to the practice by phone and 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 15 August 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. 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 was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice sought feedback from staff and patients, which it acted on.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 15 August 2016

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.
  • Performance for diabetes related indicators was comparable with the CCG and national averages. The practice achieved 87% of the points available compared to the CCG average of 91% and the national average of 89%.
  • All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Families, children and young people

Good

Updated 15 August 2016

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 may be at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable to or lower than other practices in the local area for all standard childhood immunisations. Where the practice was below average, we found this was for a reason beyond their control.
  • 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.
  • The practice’s uptake for the cervical screening programme was 87% which was comparable to the CCG average of 83% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There were six week post-natal checks for mothers and their children.
  • A range of contraceptive and family planning services were available.

Older people

Good

Updated 15 August 2016

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • Older people had access to targeted immunisations such as the flu vaccine. The practice had 2,488 patients aged over 65 years. Of those 1,815 (73%) had received the flu vaccination in the 2015/2016 year.
  • The GPs completed weekly visits to local nursing and residential homes, some of which accommodated high dependency residents to ensure continuity of care for those patients.

Working age people (including those recently retired and students)

Good

Updated 15 August 2016

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 offered online services such as appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
  • There was additional out of working hours access to meet the needs of working age patients. There was extended opening at Kings Langley Surgery until 8pm every Monday and Tuesday and from 7am every Wednesday and at Long Meadow Surgery from 7am every Tuesday.
  • The use of a three GP sessions a day system instead of the usual two sessions operated at most practices ensured that on all days except Wednesdays from 1.30pm to 3pm surgeries operated constantly throughout the day at both Kings Langley and Long Meadow surgeries.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 August 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was comparable with the CCG average of 85% and the national average of 84%.
  • Performance for mental health related indicators was better than the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 96% and the national average of 93%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • Mental health trust well-being workers were based at Kings Langley Surgery every day except Tuesdays. An NHS counsellor was also available on Monday, Wednesday and Friday every week at Kings Langley Surgery.
  • There were GP leads for mental health and dementia.

People whose circumstances may make them vulnerable

Good

Updated 15 August 2016

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 those with a learning disability. There were 23 patients on the practice’s learning disability register at the time of our inspection. Of those, all had been invited for and six (26%) had received a health review in the past 12 months.
  • The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed 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.
  • Additional information was available for patients who were identified as carers and there was a nominated staff lead for these patients.
  • The practice had identified 246 patients on the practice list as carers. This was approximately 1.8% of the practice’s patient list. Of those, 133 (54%) were invited for and 26 (11%) had accepted and received a health review in the past 12 months.