All inspections: Langstone Way Surgery - Care Quality Commission

Surgery leaders had systems, practices, and several processes to keep people safe. Some processes were not complete, therefore increasing the risk of process failures reoccurring. The surgery had systems in place to manage risks to patient safety. Patients were regularly assessed, but at times care and treatment were not delivered in line with current legislation and evidence-based guidelines. The surgery had systems in place to ensure the appropriate and safe use of medicines, however these systems were not always adhered to. We conducted several clinical records searches (using a CQC GP clinical advisor) and found that processes in place to monitor patients with certain long-term conditions were not always monitored adequately. Patient satisfaction relating to the surgery was below both the national and local averages. Patient feedback received by the Commission showed a mixed picture of care received by patients, with recurring themes of lack of access to care and the attitude of some staff members highlighted within the feedback. There was improved governance processes in place at the surgery following our last inspection, however some processes such as clinic audits did not always identify improvement to patient outcomes. Staff told us that they learned from significant events, but the assessment team did not see evidence of this. Finally, staff and leaders were able to speak to us clearly and with confidence about their roles and how they supported each other to deliver quality care and treatments for their patient population.

We found breaches of regulation in relation to medicines management and good governance. We have asked the provider for an action plan in response to the concerns found.

We carried out an announced comprehensive inspection at Langstone Way Surgery on 21 August 2023. Overall, the practice is rated as Requires improvement.

The ratings for each key question are:

Safe – Requires improvement

Effective – Requires improvement

Caring – Requires improvement

Responsive – Requires improvement

Well-led – Inadequate

Following our previous inspection on 21 February 2022, the practice was rated Requires improvement overall and for the effective, responsive and well-led key questions. The practice was rated inadequate for providing safe services and good for providing caring services.

The practice was served a warning notice under Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a requirement notice under Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We completed a warning notice follow-up visit on 28 June 2022. During this visit, we found that the items listed above had been actioned accordingly and therefore the warning notice had been met.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Langstone Way Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This comprehensive inspection was carried out to follow up on the issues noted previously, when we found the practice did not have effective systems and processes to ensure:

Care and treatment were being provided in a safe way.
Good governance, in accordance with the fundamental standards of care.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

Conducting staff interviews using video conferencing.
Reviewing patient records to identify issues and clarify actions taken by the provider.
Requesting evidence from the provider.
A site visit.

Our findings

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 Requires improvement overall.

We found that:

The health and safety risk assessment completed by the practice highlighted that a legionella risk assessment was due in January 2023. However, this had not been completed. Following inspection, we saw this had been booked for 27 September 2023.
Portable appliance testing had not been completed within the expected time period, by June 2023. However, we saw that this had been booked for 30 August 2023.
Equipment calibration had not been completed within the expected time period, by 9 August 2023. However, we saw that it had been booked for 7 September 2023.
There was no formalised process in place for managing GP workflow during times of absence.
The practice did not always monitor patients who were prescribed medicines for long-term conditions.
The practice had a policy and system in place to manage Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts; however, this was not fully effective.
The practice mostly completed single-cycle audits. The limited two-cycle audits that we saw did not have a clear aim as to the purpose they served and whether any improvements happened as a result.
Some staff we spoke with did not feel senior management were visible or fully effective in their approaches to leadership.
Not all of the staff were able to name the safeguarding lead at the practice. Additionally, some staff did not know where to access the practice safeguarding policy.
Despite efforts made by the practice to address issues regarding access to GP appointments, this remained an ongoing issue, and patients remained dissatisfied with the experience of obtaining appointments.
The practice reported they took actions in response to patient feedback. However, it was not fully clear whether these changes had a positive impact as feedback and survey results did not reflect positive patient experiences.
The practice implemented a system to highlight the most vulnerable patients and stratified these patients into either Gold, Silver or Bronze access.
The practice had a Patient Participation Group (PPG); however, the practice reported that membership was low.

We found one breach of regulations. The provider must:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition to the above, the provider should:

Amend prescribing intervals when appropriate monitoring has not been completed.
Develop a system to include different options to contact patients in relation to medicines monitoring.
Ensure appropriate reviews and appraisals are available in staff personnel files.
Retain copies of DNACPRs on patient records.
Review the current system in place to ensure the correct appointment type is made for patients based on individual clinical need and past medical history.

A final version of this report, which we will publish in due course, will include full information about our regulatory response to the concerns we have described.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

We carried out an announced inspection of Langstone Way Surgery on 20 October 2022. We have not revised the ratings from our previous inspection, which remain:

Overall, the practice is rated as Requires improvement.

The ratings for each key question are:

Safe - Inadequate

Effective - Requires improvement

Caring - Good

Responsive – Requires improvement

Well-led – Requires improvement

The full report of our previous inspection on 28 June and 4 July 2022 can be found on our website at: https://www.cqc.org.uk/location/1-540666441/reports

At our previous inspection we identified concerns over monitoring of patients prescribed high-risk medicines.

We served a Warning Notice under Section 29 of the Health and Social Care Act 2008 in relation to breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The practice told us it had taken immediate steps to address our concerns and subsequently sent us a plan of the actions taken.

Why we carried out this inspection

We carried out this focused inspection on 20 October 2022 looking at the identified breaches set out in the Regulation 12 Warning Notice, under the key question Safe, and to review the action taken by the practice. We found that the practice had taken sufficient action to rectify the concerns we found at the previous inspection on 28 June and 4 July 2022 regarding the practice’s monitoring of patients who were prescribed high-risk medicines. We did not review the Regulation 17 Requirement Notice and have not revised ratings for the practice. We will consider those issues when we carry out a further follow up inspection in due course.

How we carried out the inspection

Throughout the pandemic, the Care Quality Commission (CQC) has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

A remote clinical review of patients’ records on 20 October 2022, and discussion between the lead GP and a CQC GP specialist advisor (GP SpA) regarding actions taken in response to the Warning Notice.

Our findings

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 practice, patients, the public and other organisations.

We found that:

The practice had completed the required monitoring of patients prescribed Mirabegron and ensured that they were routinely checking blood pressure readings prior to issuing a new prescription. National Institute for Health and Care Excellence (NICE) guidelines recommend that a patient’s blood pressure should be taken before commencing treatment and regularly during treatment.
Whilst the practice had taken steps to action the concerns highlighted following our previous inspection on 28 June and 4 July 2022, it was unclear whether all patients prescribed high-risk medicines still required these. For example, we found some patients who had not been prescribed Mirabegron for several months or years, but this medicine still appeared on the patient’s medicines list.

We shall programme a further inspection in due course to check and confirm the changes made have been fully established.

In addition to the above, the practice should:

Ensure all patients prescribed high-risk medicines are regularly reviewed to ascertain whether or not the medicine is still required.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

We carried out an announced inspection of Langstone Way Surgery on 28 June and 4 July 2022. We have not revised the ratings from our previous inspection, which remain:

Overall, the practice is rated as Requires improvement.

The ratings for each key question are:

Safe - Inadequate

Effective - Requires improvement

Caring - Good

Responsive – Requires improvement

Well-led – Requires improvement

The full report of our previous inspection on 21 February 2022 can be found on our website at: https://www.cqc.org.uk/location/1-540666441/reports

At our previous inspection we identified concerns over monitoring of patients prescribed high-risk medicines. Additionally, we found that Medicines and Healthcare products Regulatory Agency (MHRA) alerts were not always actioned appropriately by the practice and GPs were not always communicating potential risks to affected patients who were prescribed such medicines. Also, there were a number of outstanding items that required actioning following a fire risk assessment completed by an external contractor in November 2021 and an undated infection prevention and control (IPC) audit submitted by the practice during inspection on 21 February 2022 highlighted concerns regarding sharps disposal protocols. We also found the practice did not have an effective system in place to ensure that GP workflow was monitored appropriately during periods of absence.

We served a Warning Notice under Section 29 of the Health and Social Care Act 2008 in relation to breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a Requirement Notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The practice told us it had taken immediate steps to address our concerns and subsequently sent us a plan of the actions taken.

Why we carried out this inspection

We carried out this focused inspection on 28 June and 4 July 2022 looking at the identified breaches set out in the Regulation 12 Warning Notice, under the key question Safe, and to review the action taken by the practice. Whilst we found that the practice had taken a number of steps to rectify the concerns we found at the previous inspection on 21 February 2022, there remained ongoing concerns regarding the practice’s monitoring of patients who were prescribed high-risk medicines. We did not review the Regulation 17 Requirement Notice and have not revised ratings for the practice. We will consider those issues when we carry out a further follow up inspection in due course.

How we carried out the inspection

Throughout the pandemic, the Care Quality Commission (CQC) has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

A site visit on 28 June 2022 to review actions taken by the practice in response to the fire risk assessment completed by an external contractor, as well as reviewing the management of waste (in particular, sharps disposal);
A remote clinical review of patients’ records and the clinical correspondence system on 4 July 2022, and discussion between the lead GPs and a CQC GP specialist advisor (GP SpA) regarding actions taken in response to the Warning Notice.

Our findings

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 practice, patients, the public and other organisations.

We found that:

The practice had completed the required monitoring of patients prescribed warfarin and ensured that they were routinely checking internalised normalised ratio (INR) levels prior to issuing a new prescription. A patient’s INR is calculated by obtaining a blood sample and is a measurement of how quickly a patient’s blood clots. When prescribing medicines that have blood thinning properties, it is vital that these doses are calculated correctly using a patient’s INR to prevent excessive bleeding. Regular monitoring and reviewing helps to ensure that the patient receives the correct therapeutic dose. However, the practice did not always appropriately monitor all patients who were prescribed high-risk medicines. In particular, patients who were prescribed mirabegron (a high-risk medicine prescribed for patients with an overactive bladder) did not always receive the appropriate monitoring.
Action had been taken since our last inspection such that the practice had identified and contacted all patients prescribed Sodium-Glucose Co-Transporter-2 (SGLT-2) inhibitors to warn them of the potential associated risk of Fourniere’s gangrene (a form of potentially fatal necrotising fasciitis that affects the genital, perineal or perianal regions of the body). SGLT-2 inhibitors are a medication used to treat patients with type 2 diabetes. Additionally, the practice had introduced a prompt to their clinical records system, which alerted the GP to the potential risks of SGLT-2 inhibitors and to remind them to provide the patient with appropriate information in relation to these risks. The practice had made changes to the title of the information leaflet given to patients prescribed SGLT-2 inhibitors so that this was more easily located for locum GPs.
The practice had actioned a number of items from the fire risk assessment, which was completed by an external contractor in November 2021. However, the provider was unable to provide assurance fire extinguishers had been serviced within the last 12 months.
Action had been taken since our last inspection such that the practice was able to demonstrate that they stored sharps appropriately, and the storage of sharps boxes was kept in a designated locked area to await collection. Additionally, the practice also provided evidence of a dated IPC audit which had been completed following our previous inspection on 21 February 2022.
Action had been taken since our last inspection such that the GPs at the practice had adopted a buddy system for checking other GP’s inboxes. This was completed daily, regardless of whether the other GP was at work, to ensure nothing in their workflow was missed. We did not see evidence of any outstanding correspondence in any GP mailbox on the clinical records system which was overdue.

We shall programme a further inspection in due course to check and confirm the changes made have been fully established.

We found one breach of regulations. The provider must:

Ensure that care and treatment is provided in a safe way.

In addition to the above, the practice should:

Ensure all fire extinguishers are serviced on a yearly basis.

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

We carried out an announced inspection at Langstone Way Surgery (the practice) on 21 February 2022. Overall, the practice is rated as “Requires improvement”.

The ratings for each key question were rated as:

Safe – Inadequate

Effective – Requires improvement

Caring – Good

Responsive – Requires improvement

Well-led – Requires improvement

Following our previous inspection on 3-9 June 2021, the practice was rated “Requires improvement” overall and for the key questions “Safe”, “Effective” and “Responsive”. The practice was rated “Good” for “Caring” and “Inadequate” for “Well-led”.

The practice was served a warning notice under Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a requirement notice under Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We completed a warning notice follow-up visit on 9 September 2021. During this visit, we found that the items listed above had been actioned accordingly and therefore the warning notice had been met.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Langstone Way Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This comprehensive inspection was carried out to follow up on the issues noted previously, when we found the practice did not have effective systems and processes to ensure:

Care and treatment were being provided in a safe way.
Good governance, in accordance with the fundamental standards of care.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A site visit

Our findings

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 Requires improvement overall.

We found that:

The practice had not actioned items listed in response to the fire risk assessment completed by an external contractor in November 2021, despite a practice target date of 18 January 2022. Whilst the majority of low priority items identified were given a target date of completion within 24 weeks of the fire risk assessment (as per external contractor guidance), there was one medium risk item which had an external contractor target date of 12 weeks to complete, which remained outstanding and had not been completed.
Although the practice had completed an infection prevention and control audit, this was not dated. In addition, it was unclear regarding the safety of managing waste, namely around sharps disposal. A waste and clinical disposal contract was submitted following inspection, which was dated 21 April 2021; however, as the infection prevention and control audit initially submitted was undated, it is unclear as to whether this later submitted document was completed before or after the infection prevention and control audit. Therefore, we cannot be fully assured of the practice’s safe management of waste.
The practice did not have a robust system in place to cover GPs workflow in their absence. The inbox of a part-time GP was examined as part of the inspection, and a number of pathology results remained outstanding. An informal process of checking inboxes was in place; however, this was reported to happen only when time permitted.
The practice was not always reviewing patients’ blood test results before issuing their next high risk medicine prescription in order to ensure it was safe to prescribe.
Systems operated by the practice did not provide enough assurance that significant events and patient feedback, such as complaints, were used effectively to improve the quality of the service.
The system for managing Medicines and Healthcare products Regulatory Agency (MHRA) alerts was not always fully effective.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic, but some patient dissatisfaction was highlighted in data from the National GP Patient survey and NHS Choices reviews.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
Staff interviewed felt supported by management and reported leaders in the practice were approachable.

We found one breach of regulations. The provider must:

Ensure that care and treatment is provided in a safe way.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

In addition to the above, the practice should:

Ensure that all staff personnel files contain the necessary relevant information, including copies of appropriate medical indemnity insurance.
Identify and action learning needs that arise from significant events and complaints.

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

We carried out an announced inspection of Langstone Way Surgery on 14 September 2021. We have not revised the ratings from our previous inspection, which remain:

Overall, the practice is rated as Requires improvement.

The ratings for each key question are:

Safe - Requires improvement

Effective - Requires improvement

Caring - Good

Responsive – Requires improvement

Well-led – Inadequate

The full report of our previous inspection on 9 June 2021 can be found on our website at:

https://www.cqc.org.uk/location/1-540666441/reports

At our previous inspection we identified concerns over governance at the practice, regarding the management of Medicines and Healthcare products Regulatory Agency (MHRA) alerts and a concerning backlog of correspondence in clinician inboxes. We found the practice did not have an effective system in place to ensure that MHRA alerts were consistently communicated and actioned. In addition, we were not assured clinical correspondence was reviewed and actioned in a timely manner.

We served a warning notice under Section 29 of the Health and Social Care Act 2008 in relation to breaches of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a requirement notice in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The practice told us it had taken immediate steps to address our concerns and subsequently sent us a plan of the actions taken.

Why we carried out this inspection

We carried out this focused inspection on 14 September 2021 looking at the identified breaches set out in the Regulation 17 warning notice, under the key question Well-led, and to review the action taken by the practice. We found the practice had taken sufficient action to deem the warning notice met. We did not review the Regulation 12 requirement notice and have not revised ratings for the practice. We will consider those issues when we carry out a further follow up inspection in due course.

How we carried out the inspection

Throughout the pandemic, the Care Quality Commission (CQC) has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

A site visit on 14 September 2021 to review patients’ records with the practice manager and to consider the actions taken by the provider;
A remote clinical review of patients’ records and the clinical correspondence system on 09 September 2021, and discussion between the lead GP and a CQC GP specialist advisor (GP SpA) regarding actions taken in response to the warning notice.
A remote review of relevant policies and protocols developed or revised by the provider since our last visit.

Our findings

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 practice, patients, the public and other organisations.

We found that:

The practice had identified and contacted all patients prescribed Sodium-Glucose Co-Transporter-2 (SGLT-2) inhibitors to warn them of the potential associated risk of Fourniere’s gangrene.
The practice had made contact with all patients prescribed omeprazole and clopidogrel and changed these patients from omeprazole to lansoprazole where appropriate (one patient declined despite being made aware of the risks as they did not wish to change).
The practice had developed and implemented an in-house policy and protocol for managing MHRA alerts, and provided evidence that this was discussed at clinical meetings as a standard agenda item.
The practice had cleared the backlog of correspondence which was outstanding on the Docman system.

We shall programme a further inspection in due course to check and confirm the changes made have been fully established.

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

We carried out an announced inspection visit at Langstone Way Surgery (the practice) on 9 June 2021. Overall, the practice is rated as “Requires improvement”.

The ratings for each key question were rated as:

Safe - Requires improvement

Effective - Requires improvement

Caring - Good

Responsive – Requires improvement

Well-led - Inadequate

We had previously inspected the practice on 19 February 2019, when we rated it “Requires improvement” overall and for the key questions “Safe, “Effective” and “Well-led”. The practice was rated “Good” for “Caring” and “Responsive”.

The reports of previous inspections can be found by selecting the ‘all reports’ link for Langstone Way Surgery on our website at https://www.cqc.org.uk/location/1-540666441.

Why we carried out this inspection

This comprehensive inspection was carried out to follow up on the issues noted previously, when we found the practice did not have effective systems and processes to ensure:

Care and treatment were being provided in a safe way.
Good governance, in accordance with the fundamental standards of care.

How we carried out the inspection

Throughout the pandemic, the Care Quality Commission (CQC) has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently. We carried out the inspection visit on 9 June 2021, following a remote records review and online contact with the practice on 3 June.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff interviews using video conferencing.
Completing clinical searches on the practice’s patient records system and discussing findings with the practice.
Reviewing patient records to identify issues and clarify actions taken by the practice.
Requesting evidence submitted by the practice.
A short site visit.

Our findings

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 practice, patients, the public and other organisations.

We have again rated the practice as Requires improvement overall.

The population groups are rated as follows:

Older people – Requires improvement

People with long term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students) – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) – Requires improvement

We found that:

The practice did not have a robust system in place to manage MHRA drug safety alerts. We found examples of drug alerts which had not been actioned in relation to all relevant patients.
Patients’ medical records and treatment was not always regularly reviewed and updated. We found 5,705 items of correspondence in the clinical records system, with insufficient evidence of them having been actioned appropriately.
Published Quality Outcomes Framework (QOF) performance data showed the practice’s rates for various personalised care adjustments (PCAs) were significantly above local and national averages. A PCA can be applied to a patient’s record to remove them from the indicator denominator in QOF defined interventions. This can be due to unsuitability (i.e. the patient has an allergy to a specific medication or it is contra-indicated), patient choice (following a shared decision-making conversation), the patient not responding to offers of care, a specific service is not available or if the patient is newly diagnosed or newly registered with the practice. The practice told us it acted in accordance with NHS business rules but was unable to demonstrate it was exercising required clinical judgement in the applying of PCAs. Nor was it able to demonstrate it was reviewing the PCAs on a regular basis.
Systems operated by the practice did not provide enough assurance that significant events and patient feedback, such as complaints, were used effectively to improve the quality of the service.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic, but some patient dissatisfaction was highlighted in data from the National GP Patient Survey and NHS Choices reviews.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
Staff interviewed felt supported by management and reported leaders in the practice were approachable.

We found two breaches of regulations. The practice must:

Ensure that care and treatment is provided in a safe way.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

In addition to the above, the practice should:

Take necessary actions highlighted by the last fire risk assessment.
Review and implement actions to improve the uptake of childhood immunisations and cervical screening.
Continue with actions identified to improve patients’ satisfaction over responsive aspects of the service.
Ensure that significant events and patient feedback are proactively used to drive continuous learning within the practice, and that such learning is documented accordingly.

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

We carried out an announced comprehensive inspection at Langstone Way Surgery on 19 February 2019.

The practice was previously inspected on 8 May 2018 and was rated good overall. The Safe key question was rated requires improvement because we identified a breach of regulations. Specifically we found the practice had not assessed the risks associated with fire, the practice did not have a process in place to identify whether locum clinical staff had undertaken a Disclosure and Barring Service check and did not have a process to ensure all required pre-employment checks were undertaken prior to staff being employed. The full comprehensive report from this inspection can be found by selecting the ‘Reports’ link for Langstone Way

Surgery on our website at https://www.cqc.org.uk/location/1-540666441.

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 requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

The practice did not always follow guidance for the safe management of medicines.
The practice did not have an overarching policy in place to govern how significant events were managed.
The practice had a business continuity plan in place but this had not been reviewed for more than three years and did not include details of arrangements with a buddy practice.

We rated the practice as requires improvement for providing effective services because:

There was no assurance that patients needs were consistently assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.

We rated the practice as requires improvement for providing well-led services because:

The practice did not have clear and effective processes for managing risks, issues and performance.
We saw little evidence of systems and processes being reviewed to identify and share learning.

We rated the practice as good for providing caring and responsive services because:

Staff dealt with patients with kindness and respect and involved them in decisions about their care.
The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider should make improvements are:

Review processes in place for undertaking criminal record checks to ensure these have been completed for staff who require them.

The areas where the provider must make improvements are:

Ensure that care and treatment is provided in a safe way.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

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

This practice is rated as Good overall. (Previous inspection July 2015 – Good). The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Langstone Way Surgery on 27 July 2015. The practice was rated good overall and requires improvement for safe. The full comprehensive report from this inspection can be found by selecting the ‘all reports’ link for Langstone Way Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 8 May 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 July 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found:

Data from the Quality and Outcomes Framework (QOF) demonstrated that the practice was performing in line with local and national averages for patient outcomes in most clinical areas although exception report rates were significantly higher than local and national averages for some clinical indicators.
The practice had some systems to manage risk so that safety incidents were less likely to happen. However, we noted that even though the practice told us that it had been subject to two attempted arson attacks in the recent past, a fire risk assessment had not been undertaken within the previous three years.
The practice had not carried out appropriate Disclosure and Barring Service checks on locum clinical staff and had not ensured that these checks had been carried out by any other registration body, for instance, NHS England.
Staff acting as chaperones had received Disclosure and Barring Service checks and had received appropriate training for the role.
The practice routinely reviewed the effectiveness and appropriateness of the care it provided but processes used to record annual health reviews and those used to except patients with mental health conditions and some long term conditions were not effective.
Staff involved and treated patients with compassion, kindness, dignity and respect.
There was a strong focus on continuous learning and improvement at all levels of the organisation.
There was a positive and open culture and staff felt supported by the practice leaders.

The areas where the provider must make improvements are:

Ensure care and treatment is provided in a safe way to patients.
Ensure that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely.

The areas where the provider should make improvements are:

Consider providing training to non-clinical staff to raise awareness of ‘red flag’ symptoms of acute, life threatening conditions that might be reported by patients.
Review arrangements for receiving requests for repeat prescriptions to ensure that patient identifiable information is secure.
Review processes used to exception report patients with long term conditions with a view to more accurately reflecting the actual level of care provided to patients.
Consider putting a process in place to ensure that staff acting as chaperones follow practice policy by recording their attendance during consultations.
Consider providing additional training to staff responsible for submitting performance data to ensure that data is accurate and is provided in a timely manner.
Review how clinical staff record details of annual reviews in the patient management system.
Consider putting arrangements in place to encourage patients to attend annual health reviews.
Follow through with plans to ensure that all non-clinical staff receive annual appraisals.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Langstone Way Surgery on the 27 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring, responsive and well-led services. The practice required improvement for providing safe services. It was also good for providing services for older people, people with long term-conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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

Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
Risks to patients were assessed and well managed, with the exception of infection control.
Patients’ needs were assessed and care was planned and delivered following best practice guidance.

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 was available and easy to understand.
Patients said there was continuity of care, with urgent appointments available the same day.
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.

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

Importantly the provider must:

Ensure infection control leads are provided with infection control training and the practice maintains cleaning schedules. To ensure that infection control audits are carried out in accordance with national guidelines.

In addition the provider should:

Provide equality and diversity and fire safety training to its staff team.

Continue to raise patient’s awareness of the availability of the Patient Participation Group (PPG) (A PPG is a group of patients registered with a practice who work with the practice to improve services and the quality of care), and online booking facilities.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Archived: Langstone Way Surgery

All Inspections

During an assessment under our new approach

21 August 2023

During a routine inspection

20 October 2022

During an inspection looking at part of the service

28 June 2022

During an inspection looking at part of the service

21 February 2022

During a routine inspection

14 September 2021

During an inspection looking at part of the service

09 June 2021

During an inspection looking at part of the service

19 February 2019

During a routine inspection

8 May 2018

During a routine inspection

27 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)