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Inspection Summary


Overall summary & rating

Good

Updated 13 March 2018

We carried out an announced comprehensive inspection at Langley Corner Surgery on 16 February 2016 and a focused follow up inspection on 22 June 2017. The practice was rated good overall. However, we found that the practice continued to require improvement for the provision of safe services because breaches of regulation were identified. The full comprehensive reports on the inspections can be found by selecting the ‘all reports’ link for Langley Corner Surgery on our website at www.cqc.org.uk.

Specifically, we said they must:

  • Ensure they record adequate details of investigations carried out on significant events to support the requirements of their duty of candour.
  • Ensure the learning points from investigations into significant events were shared with all appropriate staff.

In addition we said the provider should:

  • Ensure all staff receive training in Information Governance appropriate to their role.

  • Ensure action plans produced as part of the infection control process, including waste management, are monitored to help identify when agreed actions have been completed.

  • Ensure they have adequate systems for checking the emergency medicines in their branch practice.

After the previous focused inspection on 22 June 2017, the practice wrote to us to say what they would do to meet legal requirements. We undertook this focused inspection on 13 February 2018 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

Overall the practice continues to be rated as good and is now good in the safe domain.

Our key findings for this inspection were as follows:

  • The practice had reviewed and updated their significant events policy and the incident recording form, which had been improved to include all details of the event through to learning points and a specific question regarding duty of candour. We saw examples where the practice had taken appropriate action under the duty of candour and had thoroughly recorded such events.

  • Learning points from investigations were shared with all staff within a weekly practice meeting where all staff where expected to attend. Minutes were circulated to all staff following the meeting.

  • We saw evidence that the practice had started a process to conduct six monthly reviews of all learning points and changes of policy, which was shared with all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 March 2018

Effective

Good

Updated 28 April 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average for the locality and compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement, although not all clinical staff were involved in the audit schedule.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 28 April 2016

The practice is rated as good for providing caring services.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • The practice had taken steps to ensure the waiting room was welcoming and calming, including art activity for adults, paintings on display from a local sixth form college, and a secure area with a selection of toys and books for children.

  • Information for patients about the services available was easy to understand and accessible. The practice had categorised and simplified information into folders available both practice websites and in the waiting room. These were to ensure patients were able to access the extra support they needed from local organisations, for example information and support groups relating to the community, family and disability.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice cared for their patients who had suffered bereavement and also ensured that all deaths were reviewed for learning and best practice.

Responsive

Good

Updated 28 April 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. For example, the practice collaborated with the local authority to open a new branch in order to provide GP access to a nearby area.

  • Patients said there was continuity of care, with urgent appointments available the same day. However not all patients said it was easy to make an appointment with a GP.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. This included disabled access (including automatic doors), a portable hearing loop and baby changing facilities. They also shared their premises with a mental health liaison practitioner, midwife, counselling service, and ultrasound services.
  • 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.

  • The practice GPs regularly visited two care homes and delivered an enhanced service to the residents. In order to assist effective visits, the GP took a laptop to the care home in order to access and update patient notes immediately. This prevented any delay of care and treatment and ensured the GP had up to date information.

Well-led

Good

Updated 28 April 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. Staff told us they felt encouraged to make suggestions for improvement of the practice.

  • The practice had a number of policies and procedures to govern activity and held regular team and 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 proactively sought feedback from staff and patients, which it acted on. This included a system for patients to easily inform the practice whether they would recommend or not recommend the surgery following their experience that day.

  • The patient participation group was active. They told us that a partner and the practice manager always attended their meeting and they had been involved in improvements at the practice, for example a re-design of the waiting room.

  • There was a strong focus on continuous learning and improvement at all levels. The practice provided staff with positive comments from patients by displaying these on the coffee table within the staff rest room. All staff we spoke with felt this added to the positive atmosphere at the practice.

  • The practice had become a certified CACHE (Council for Awards in Care, Health and Education) training centre for Health Care Assistants (HCA). They provided external and internal candidates the opportunity to obtain an accredited qualification as a HCA, up to diploma level.

  • The practice team was forward thinking and sought to improve patient outcomes using new technology such as voice recognition. One of the partners told us this technology was being trialled in order to record patient notes and dictate letters. They told us they hoped it would improve their effectiveness, and also provide assistance to GPs who were less able to type for long periods of time.
Checks on specific services

People with long term conditions

Good

Updated 28 April 2016

The practice is rated as good for the care of people with long-term conditions.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average for the locality and compared to the national average for areas including diabetes and hypertension.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • 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 GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • The practice offered a range of enhanced services to people with long term conditions. This included asthma and diabetes clinics.

Families, children and young people

Good

Updated 28 April 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 were at risk, for example, children and young people who had a high number of A&E attendances.

  • The practice had made the decision to train all staff to child safeguarding level three (GPs are required to receive level three, clinical staff level two and non-clinical level one)

  • Immunisation rates were relatively high for all standard childhood immunisations. The practice had a policy to notify the health visitor for follow up if a child repeatedly missed their immunisation appointment.

  • 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.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 28 April 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 patients, and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 28 April 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 was proactive in offering online services including booking appointments and an electronic prescribing service.

  • The practice offered a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 April 2016

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

  • Data showed that 88% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients 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.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 28 April 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 homeless patients, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

  • 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.