Archived: Langstone Way 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

We assessed 4 quality statements from this key question. During this assessment we found that the surgery provided safe care and treatment for patients. Following the last inspection of the service in August 2023, the provider was rated requires improvement for the provision of safe services. This was due to concerns regarding the surgery’s review and monitoring of patients on prescribed medication for long term conditions, the management of safety alerts and no evidence of certification showing recent testing of appliances and calibration of medical equipment used at the surgery. In addition, we identified that not all staff knew how to access policies and had training appropriate to their role. During this assessment we saw that the provider had made improvements to keep people safe, which included redefined processes for the review and monitoring of patients in receipt of high-risk medicines, and for patients who had long-term conditions. Staff we spoke with had an understanding or safeguarding and how to take appropriate action when required. Processes had also been put in place which ensured that patient safety and medicines alerts had been effectively assessed and actioned. Appropriate risk assessments had been undertaken by the surgery and there was an effective approach to managing infection and prevention control at the surgery. Processes had been establish to ensure that there was a system in place so that test results were managed in a timely manner. Finally, we had some concerns relating to the approach taken by GP's to ensure that the use of medicines reflected current and relevant best practise and professional guidance.

Our last assessment for this provider in 2023 we rated the provider as Requires Improvement for key question of safe. At this assessment, we have rated the provider as Good for providing safe services at this location.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s feedback in relation to the learning culture within the surgery was limited.

From the feedback we received, patients were aware on how they could provide feedback to the surgery and how to make a complaint.

Staff we spoke with told us they were aware of how to raise a significant event, and that they were confident in doing so.

The surgery has an ongoing log of significant events, which is reviewed weekly during the clinical staff meeting. When raising a significant event, staff will complete the log, identify the event and note internal staff/external stakeholders who have been contacted in relation to the event. This log is held electronically and a hard copy kept centrally within the surgery.

We identified 5 significant events had been logged in the last 12 months. Of the 5 identified, one related to the management of patient health and medication. The other four recorded events related to external stakeholder delays in providing the surgery with relevant registered patient information or system administration problems. We found evidence which indicated that significant events or incidents were investigated in a manner which identified the cause of risk to patients but saw that not all events investigated concluded with pre-emptive solutions to prevent against this or similar events occurring in the future. For example, we identified a significant event where the surgery had received many delayed (and in some cases duplicate) blood test results from a pathology service, all on the same day. All results were reviewed by a doctor within a specific timeframe, but there was no guidance drafted to detail what the surgery should do if an event of this nature were to occur again, or what steps should be taken to ensure timely receipt of test results from external pathology services, thereby minimising the risk of this event reoccurring. We noted the surgery contacted their local integrated care board regarding this event.

Staff knew the surgery’s safeguarding lead was, but not the deputy safeguarding lead. We spoke with two staff members, and they were able to demonstrate an understanding of safeguarding including how to identify and report concerns.

There was a safeguarding register, and this was reviewed annually by the surgery leaders. Safeguarding was a standing agenda item at the weekly internal clinical staff meetings. We saw evidence of this from meeting minutes that we viewed from the surgery.

Staff and leaders told us there was a system to ensure referrals to specialist services were documented, contained the required information and there was a system to monitor urgent referrals and any delays. They told us they worked to ensure a collaborative, joined up approach to managing patient care. This included a weekly ward round for residents at a local care home.
 

The providers’ safeguarding policy had recently been updated to include vulnerable adults. We noted that within the policy there was a named safeguarding lead and a deputy safeguarding lead. The names listed were different to the name given to us by staff members and the name quoted at the beginning of the policy. Staff files viewed showed staff up to date with safeguarding training and trained to the appropriate level as set out in the surgery’s policy.

After our site visit, the surgery provided us with separate vulnerable adults and children’s policies which detailed the process for staff to take if they have concerns that a patient they had encountered were vulnerable.

There were processes to manage patient pathways or transitions including referrals and sharing and receiving of information with external health services. Processes were in place to deal with incoming correspondence, and we found clinical correspondence and test results were up to date. On the day of our site visit, we viewed the outstanding tasks on the surgery’s clinical system and found no outstanding tasks awaiting action. Tasks are used within general practice to manage information and can include administrative actions as well as patient-specific actions, for example, to send referrals and review test results. The surgery had a 2 week wait referral procedure with a dedicated member of staff who had oversight of any delays to appointments and could follow up referrals and escalate as necessary.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We observed the surgery was equipped to respond to medical emergencies, including suspected sepsis and staff were suitably trained in emergency procedures. Staff had completed sepsis, basic life and anaphylaxis training where appropriate.

The surgery had carried out the necessary recruitment checks. We reviewed four staff files and found all the required employment checks had been completed.

We asked the provider to detail how they assured the competency of staff working at the practise in between annual reviews. The provider was able to discuss the process of supervision for staff who saw patients in a clinical setting.

The surgery did not at this time have a written policy for the review and supervision of the clinical work undertaken by staff such as physicians’ associates, clinical pharmacists and locum practice nurses.

We did not see evidence that were checks in place to ensure that reception staff were conducting patient triaging appropriately when signposting patients. Staff at reception had received training in customer care and but not all had received training in healthcare navigation.

Reception staff asked patients for a brief outline of symptoms before explaining that there could be an alternative option to seeing a doctor, such as a telephone appointment with a doctor, a physician’s associate or discussion with a pharmacist.

The surgery submitted information to us to evidence staff had completed mandatory training, such as safeguarding adults and children, infection prevention and control, fire safety and basic life support. However, the surgery did not always make sure that clinical staff had completed the necessary role specific training in a timely manner. Two of the staff files we viewed were of clinical members of staff, and we found that the most recent training for sepsis received by one of these members of staff dated back to December 2021. We saw that none of the four staff files had completed annual appraisals completed within the last 12 months.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff felt confident managing the storage, administration and recording of medicines. Interviews with the lead GP indicated there were processes for the management and monitoring of patients on repeat prescriptions including high risk medicines which required patients to attend for regular blood tests. We noted that these processes were effective in most cases, but we also identified from our clinical records search that these processes did not occur in all cases. The provider was aware of using information contained within their clinical system as a way of monitoring the performance of the surgery with regards to appropriate prescribing of medicines to its patients.

We observed medicines and vaccines were stored appropriately and securely. This included monitoring to ensure medicines were stored within correct temperatures. Emergency medicines and equipment were available. Blank prescriptions were stored securely and monitored and audited appropriately to ensure continued security.

We undertook a series of remote clinical searches on the surgery’s clinical record system to review if the surgery was assessing and delivering care and treatment in line with current legislation, standards and evidence-based guidance.

Overall, we found systems and processes in place minimised the risks associated with high-risk medicines. For example, as part of clinical records review, we looked at patients at the surgery that had been prescribed the medicine Methotrexate (a type of medicine used to treat inflammatory conditions), to ascertain whether patients were being monitored in line with clinical guidelines. Our searches identified four out of eight patients on this medicine had not received required monitoring in the last 6 months. Clinical guidelines relating to the prescribing of this medicine requires patients to have been monitored by way of a blood test every 12 weeks. Two patient records noted that the surgery had been in contact with these patients to contact the surgery to arrange a blood test and that no further prescriptions for this medicine had been issued. Of the remaining two patients, one had been given a short prescription until their blood test results had been received by the surgery and the surgery was working with the last patient to achieve compliance with this medicine.

We also conducted a clinical records search relating to past medicines safety alerts, in particular relating to the medicine Mirabegron (a medicine that treats the symptoms of an overactive bladder). Our clinical searches also identified six patients prescribed Mirabegron (a medicine to treat epilepsy and nerve pain) had not had their blood pressure taken in the last 12 months as part of their monitoring whilst on this medicine. We discussed these findings with the GP provider who told us that they would review these cases and inform us of actions taken. After the clinical records review, the surgery provided us with a list of remedial actions taken on the clinical records we had identified as requiring further work by the surgery to achieve clinical compliance with national guidance.

There were processes which ensured medicines were stored safely and securely with access restricted to authorised staff. This included processes for the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions). The provider was able to discuss processes in place to demonstrate appropriate supervision for the non-medical prescribers to ensure they were prescribing safely and within their competencies.

We did not look at outcomes as part of this assessment. The score for this quality statement is based on the previous rating for Safe.