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Inspection carried out on 13 February 2018

During an inspection to make sure that the improvements required had been made

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 carried out on 22 June 2017

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

When we visited Langley Corner Surgery on 16 February 2016 to carry out a comprehensive inspection we rated them as good overall. However, we found the practice required improvement for the provision of safe services and said that they must:

  • Ensure that significant events are recorded and information is disseminated within the practice so that lessons can be learnt at all levels.

  • Ensure that cleaning schedules are reviewed, and that cleanliness is monitored.

  • Ensure clinical waste is correctly documented in order to minimise the risks of improper disposal.

  • Ensure that relevant and appropriate training is provided to staff in accordance with the practice training policy; including safeguarding and  the Mental Capacity Act (MCA) 2005.

  • Ensure that an appropriate number of staff are trained to operate the evacuation chair, in order to assist patients who have mobility problems.

  • Ensure that the practice has suitable available medical supplies to deal with a medical emergency for a child.

  • Ensure that recruitment checks, including proof of identification, are completed and retained as set out in the practice recruitment policy.

We also said they should;

  • Carry out inclusive audits to improve patient outcomes that involve all clinical staff.

  • Continue to review, assess and monitor access to appointments.

This inspection was an announced focused inspection carried out on 22 June 2017 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 at our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. This report should be read in conjunction with the full report of our inspection on 16 February 2016, which can be found on our website at www.cqc.org.uk.

On this inspection we found the provider had taken steps to address the regulatory breaches previously identified. However, the action taken had not adequately addressed all the issues.  The practice continues to be rated as good overall and continues to require improvement for safe services.

Our key findings were as follows:

  • All staff had received children and adult safeguarding training and training in the mental Capacity Act 2005 at a level appropriate to their role. However we noted during this inspection that not all staff had received training in Information Governance

    appropriate to their role.

  • The cleaning schedules had been reviewed and cleaning standards were being routinely monitored.

  • The practice had reviewed their use of an evacuation chair and had decided it was not required for the safe evacuation of infirm people for the first floor of the building in an emergency.

  • The practice had suitable available medical supplies to deal with a medical emergency for a child.

  • The practice had reviewed their processes for carrying out audits. They held regular audit meetings to which all staff where encouraged to attend. They had an audit register and we saw evidence that in the last two years they had conducted 11 clinical audits of which three were full cycle audits where the improvements made were implemented and monitored. For example, following an initial audit of postnatal depression checks they introduced a new template and guidance for clinicians doing postnatal maternity checks to ensure the appropriate  questions were asked. Evidence from the second audit showed the percentage of women being asked all the appropriate questions had risen from 54% to 95% and the practice had seen a small increase in the number of women referred to specialist services.

  • The practice had reviewed the accessibility and availability of appointments to patients. They had conducted an audit of appointments being offered and an audit of appointment availability. The practice told us that approximately 20 patients a day who phoned for an on the day appointment were unable to get one. These patients were either referred to the local walk-in centre or phoned back by a GP depending on the patients preference. The practice told us they regularly reviewed their data.

  • The practice did not record adequate details of investigations carried out on significant events and there was no evidence the practice had considered what action they might be required to take or had taken under their duty of candour.

  • The practice had not taken adequate action to ensure that staff unable to attend a significant event meeting were aware of the learning points raised. This was a persistent breach of regulations.

  • The practice system for checking the emergency medicines available in their branch practice was inconsistent.  

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

Importantly, the provider must:

  • Ensure they record adequate details of investigations carried out on significant events to support the requirments of their Duty of Candour

  • Ensure the learning points from investigations into significant events were shared with all appropriate staff.

In addition 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 16 February 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Langley Corner Surgery on 16 February 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 a system in place for reporting and recording significant events but we found these systems could be improved.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safeguarded from abuse.
  • 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 said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. There was a strong focus upon providing a caring service at all levels within the practice. This included that all patient deaths were reviewed in order to provide a supportive service, and for learning and best practice.
  • 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. However not all patients said it was easy to make an appointment with a GP.
  • Patients’ needs were assessed and individualised care was planned and delivered following best practice guidance.
  • Some risks to patients were assessed and well managed. However, systems and processes to address risks were not implemented well enough to ensure patients and staff were kept safe.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. They 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 play area for children.
  • 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.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • There was a strong focus on continuous learning and improvement within the practice.
  • The practice had collated and categorised all support information available to patients, and stored this into individual folders both at the surgery and on the practice website.

We saw one area of outstanding practice:

  • The practice had become a certified 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 areas where the provider must make improvement are:

  • Ensure that significant events are recorded and information is disseminated within the practice so that lessons can be learnt at all levels.
  • Ensure that cleaning schedules are reviewed, and that cleanliness is monitored.
  • Ensure clinical waste is correctly documented in order to minimise the risks of improper disposal.
  • Ensure that relevant and appropriate training is provided to staff in accordance with the practice training policy; including for safeguarding and for the Mental Capacity Act (MCA) 2005.
  • Ensure that an appropriate number of staff are trained to operate the evacuation chair, in order to assist patients who have mobility problems.
  • Ensure that the practice has suitable available medical supplies to deal with a medical emergency for a child.
  • Ensure that recruitment checks, including proof of identification, are completed and retained as set out in the practice recruitment policy.

The areas where the provider should make improvement are:

  • Carry out inclusive audits to improve patient outcomes that involve all clinical staff.
  • Continue to review, assess and monitor access to appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone. The evidence tables published alongside our inspection reports from April 2018 onwards replace the information contained in these files.