Archived: Langstone Way Surgery

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

We assessed 3 quality statements from this key question. We found that there had been improvements made to how care was delivered at the surgery following the August 2023 inspection of this location. We also identified that there were further improvements were required to the monitoring of outcomes of care and treatment, that patients’ needs were not always assessed in a timely manner and care and treatment was not delivered in line with current legislation, standards and evidence-based guidance.

Our last assessment for this provider in 2023 we rated the provider as Requires Improvement for key question of Effective. At this assessment, the rating for this key question remains the same.

The service was in breach of legal regulations in relation to medicines management. We have asked the provider for an action plan in response to the concerns found.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient feedback via the 2024 National GP Patient Survey (GPPS) indicated 95% patients felt their needs were met during their last general practice appointment. This was comparable to the local average GP practice score of 82% but lower than the national average GP practice score of 90%.

As part of our assessment, the surgery agreed to participate in contacting patients to seek their views on care provided at the surgery. These responses was sent directly to us. As part of our analysis of these responses, we identified there to be an issue between the practice sending prescriptions to local pharmacies and patients receiving their medication in a timely way. Some responses we received told us that they had to repeatedly contact the surgery to issue repeat prescriptions for on-going medication, as when they went to the local pharmacy to collect their medicine, they found that the authorisation to the pharmacy to dispense medication had not been sent by the surgery.

The practice told the assessment team that they prioritise the safe and effective processing of prescription requests, and that all prescription requests received are actioned the same day by a doctor. The exception to this is when the practice requires further clarification (from the patient or other healthcare organisation) regarding why a prescription has been requested.

The surgery supported people to live healthier lives and where possible, reduce their future needs for care and support. Staff said patients had access to social prescribers, health and well-being coaches, mental health practitioners, a care-coordinator and a local weight loss programme.

On our site visit, we noted there was information signposting (patients who attended the surgery) to local community services which could be beneficial to them within the waiting area. Staff were available to direct patients where to seek further advice.

The surgery undertook weekly face-to-face rounds at the local nursing home which was within a five-minute walk from the surgery location. There was a process in place whereby advance communication between the nursing home and the surgery ensured that the surgery knew in advance of any concerns regarding residents’ health before a GP from the surgery was on site.

The surgery did not always plan and deliver people’s care and treatment following evidence-based care and treatment. We found evidence of this in the way the surgery monitored patients prescribed the medicine Mirabegron. As part of this assessment, we undertook a clinical search which focused on the number of patients coded as having chronic kidney disease who had their urea and electrolytes (UE )monitored in the last nine months (in accordance with national guidelines) and found that also identified 4 patients who records indicated that the required blood test needed to monitor UE levels had not occurred. These patient records did indicate that the surgery had been in contact with three patients in the month prior to our assessment and one patient and the surgery were waiting for correspondence from secondary care in relation to ongoing care relating to their diagnosis.

The GP provider told us the surgery had systems and processes to keep clinicians up to date with current evidence-based practice. Staff had access to the National Institute for Health and Care Excellence (NICE) guidelines and monthly clinical meetings. In addition, staff had protected time to attend training. There was evidence that the surgery invited external speakers to address their clinical meetings, where we view meeting minutes that showed a specialist member of staff from the Royal National Orthopaedic Hospital talk to staff at the surgery about matters concerning podiatry.
 

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The surgery had effectively monitored some patients’ outcomes. The lead GP explained they had systems in place to monitor patients with long term health conditions and the clinical team had regular discussions about performance at the weekly clinical meetings. We asked the surgery to provide us with examples of clinical audits that had been undertaken since our last inspection. The surgery provided us with one clinical audit where we observed from the narrative sent and discussion with the lead GP that there were improved outcomes for patients for patients with a raised blood pressure with regards to further testing and monitoring of their condition. The surgery’s uptake for cervical screening showed that the surgery had attained an 80% up take of screening from April 2024 – September 2024. This figure was provided to us from the surgery using data obtained from their clinical system.

As part of the assessment, several set clinical record searches were undertaken by a CQC GP specialist advisor. These searches undertaken were visible to the surgery. One search looked at a sample of the records of patients with a range of conditions to ensure the required monitoring for patients was taking occurring. One of the searches we undertook related to pre- diabetes checks. We conducted a search for patients with the possible diagnosis of diabetes following a blood test result and identified 7 patients. We sampled 5 patient records and found the surgery were following national guidelines on interval testing for persons with a raised HbA1c (average blood glucose) in line with national guidance. Whilst we found no issues with the interval testing of patients with a raised HBA1c, we queried the surgery’s actions in relation to the monitoring of two patients (whose first blood readings indicated that the patient was diabetic), which did not correspond with national guidance as there were no explanatory notes within the patient record. The GP provider was able to discuss with us why they had taken the course of action they did for these two patients.

A second search undertaken looked at the number of patients who had received a medication review during the last three months. We identified 14 patients who had received a medication review as coded on their patient records. We reviewed 5 patient records and identified that one out of the five records reviewed had written notes explaining what had been done as part of the medication review. We identified that most medicine reviews undertaken at the surgery that we reviewed had been undertaken by the ex-GP partner after he had left the partnership. We asked to see a job description for this individual but was told that there was not one. We were told that the individual was doing specific tasks only. We spoke to the surgery about their responsibility not only as a provider of healthcare services but as an employer. We subsequently received a detailed job description for the individual in question.
 

The surgery told people about their rights around consent. Clinicians understood the requirements of legislation and guidance when considering consent and decision making. We saw that consent was documented. Clinicians supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision.

We did not look at specific outcomes as part of this quality statement. This has been covered in the narrative of feedback from staff and leaders. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.