Langport 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 looked for evidence that people were protected from abuse and avoidable harm.

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a strong proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

People’s complaints were infrequent, and feedback was actively encouraged, clearly documented, and thoroughly investigated. All feedback was reviewed to identify trends and themes that could drive improvements. Evidence showed that incidents, complaints and any negative feedback were routinely discussed in governance meetings, with the full team involved in reviewing outcomes to maximise learning and support change. Verbal complaints were also documented and responded to. We saw evidence of consistently documented clinical learning events.

There was a proactive identification of hazards and risks, which were robustly assessed and managed to avoid adverse outcomes. We saw numerous risk assessments in place to ensure the safety of people within the practice. Solutions to risks were developed collaboratively with the right people and the effectiveness of the controls were monitored and measured.

Staff were actively encouraged and appreciated for raising concerns about safety and ideas to improve. People felt part of a team where they could contribute towards safety and improvement. The primary response was always to learn and continuously improve the service.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority.

The service worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

Regular multi-disciplinary team (MDT) meetings were held to review the care of patients with complex conditions or those nearing end-of-life, ensuring holistic, well-coordinated care. Clinicians followed established care pathways for diagnosis, treatment, and referral to specialist services.

Referrals to secondary care, including urgent 2-week wait referrals for suspected cancer, were managed promptly and appropriately followed up. The service also caried out audits of the 2 week wait referrals to ensure adherence to best practice and continuous quality improvement. During our remote clinical searches, we reviewed workflow and correspondence including communications from secondary care, such as discharge summaries, these were processed efficiently to ensure continuity of care.

There were systems for processing information relating to new patients. The practice worked with other providers to deliver shared care and when people moved between services. Referrals and test results were managed in a timely way.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and maintained. A duty doctor was available to support the receptionists. Staff we spoke with provided examples of co-ordinated responses between clinical and non-clinical staff to manage medical emergencies.

Staff could recognise a deteriorating patient and knew the action to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service detected and controlled potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

Facilities, premises and equipment were designed and used to meet the needs of a range of all people who used the service.

Records showed fire alarms were routinely tested, and the practice had appointed fire marshals to direct patients and staff in the event of a fire. Staff completed fire training and regular fire drills which included an evacuation of the building.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan which was monitored and reviewed, all staff were aware of where this was kept and what to do in an emergency.

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

The continuing development of staff skills, competence and knowledge were recognised as being integral to ensuring high quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice.

There were appropriate numbers of staff with a mix of skills to deliver safe care, leaders were able to demonstrate how they reviewed staff rotas to address demand and how they covered busy periods such as annual leave and staff sickness

Monthly lunch and learn events were held providing clinicians with an opportunity to share knowledge, discuss best practice and promote collaborative learning in an informal setting.

The service had access to additional staff employed through their primary care network (PCN) which is a group of GP practices working together, alongside other health and social care providers to deliver more co-ordinated and comprehensive care to a defined local population. which included, a physiotherapist, pharmacist, health and wellbeing coach, and a physician associate.

There were a range of clinical and non-clinical roles within the practice. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed.

The service assessed and managed the risk of infection. They quickly detected and controlled the risk of it spreading and always shared concerns with appropriate agencies promptly.

The service had a designated infection, prevention and control lead and all staff had received relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. Clinical waste procedures were effective and there was a process to record staff vaccinations in line with national guidance.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines.

Staff managed prescription stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs.

Waste medicines were recorded and disposed of appropriately including medicines returned by patients. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

As part of our inspection, a set number of clinical record searches were undertaken remotely by a CQC GP specialist advisor. We reviewed the records of 5 people who were prescribed methotrexate (a medicine for treating autoimmune conditions). We found they had all been monitored in-line with national guidance. We also found people who were affected by medicine safety alerts had been contacted and informed of the risks, and prescriptions were reviewed appropriately.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring.

The provider had a dispensary within the surgery which provided medicines directly to people who used the service, this helped people receive their prescriptions promptly. There was a process for urgent prescriptions and to ensure that they would be issued the same day. Staff told us that if there was a problem with the payment for a prescription, they would still ensure the person received the medication and a payment plan would be discussed. The dispensary staff told us they could provide some emergency medicines to people who had forgotten to request a repeat prescription in line with an agreed list of medicines.

There were suitable processes for staff to follow when dispensing medicines. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials (antibiotics) issued by the service was lower than local and national averages (3% against the national average of 5%) this means improved patient outcomes due to fewer side effects of antibiotics.