The Care Quality Commission
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  • GP practice

Archived: Laburnum Surgery

Overall: Inadequate read more about inspection ratings

Laburnum Medical Group, 14 Laburnum Terrace, Ashington, Northumberland, NE63 0XX (01670) 813376

Provided and run by:
Laburnum Surgery

All Inspections

29, 30,31 October 2019

During a routine inspection

This practice is rated as inadequate overall. (Previous rating May 2019 – requires improvement, but inadequate for the effective key question.)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Good

Are services well-led? - Inadequate

The service was inspected on 16 July 2015. Following this inspection, a report was issued identifying a failure to comply with Regulation 19 (fit and proper persons employed). The provider took action to address the breach of regulation.

The service was inspected on 05 and 08 June 2018. Following this inspection, a report was issued identifying a failure to comply with Regulations: 17 (good governance); 18 (staffing); 19, (fit and proper persons employed).

The service was inspected on 18 and 22 February 2019. Following this inspection, a report was issued identifying a continuing failure to comply fully with Regulation 17 (good governance). The provider had taken action to address the breaches of regulations 18 and 19, and most aspects regulation 17. However, we identified additional concerns at this inspection.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected.
  • information from our ongoing monitoring of data about services and,
  • information from the provider, patients and other organisations.

We have rated this practice as inadequate overall.

We have rated the practice as inadequate for providing safe services, because the practice did not have effective and reliable systems and processes for:

  • Assessing, monitoring, managing and recording risks to patient safety.
  • Keeping their safeguarding procedure up-to-date.
  • Keeping patients safeguarded from abuse.
  • Ensuring the appropriate and safe management of medicines.
  • Responding to safety alerts.
  • Making sure their records, systems and processes supported the practice to learn, when things went wrong.
  • Making sure individual care records were maintained in line with current guidance.
  • Sharing information with other agencies, to enable them to deliver safe care and treatment.

We have rated the practice as inadequate for providing effective services because:

  • The practice was able to demonstrate they had a more structured approach to quality improvement activities, and clinical and prescribing audits had been carried out, to review the effectiveness and appropriateness of the care provided. However, we were not assured the provider’s arrangements were effective or reliable, because they had failed to identify and address the concerns we found during this inspection.
  • The practice had improved outcomes for patients with mental health needs. However, some patients had not received effective care and treatment that met their needs. There had been an increase in the number of patients with diabetes who were exception-reported. While the practice had complied with the Quality Outcome Framework exception rules that at least three reminders should to be sent to patients, the practice had not always followed up those patients who failed to respond to these recall letters. Some patients’ immediate and ongoing needs had not been fully assessed, or appropriately reviewed and, for some patients, action had not been taken to ensure their needs were being met.
  • The practice’s childhood immunisation uptake rates were below the World Health Organisation (WHO) national target of 95% (the recommended standard for achieving herd immunity) and below the minimum target of 90%.
  • The practice’s cervical screening rate, at 68.1%, was below the Public Health England programme target of 80%.

Although staff actively tried to support patients to live healthier lives, it was not always clear how they did this, from the sample of patients’ medical records we looked at.

We rated the practice as requires improvement for providing caring services because:

  • Data from the most recent National GP Patient Survey of the practice, indicated that patient satisfaction levels, in relation to how staff treated them, were lower than both the local clinical commission group and national averages. Also, the arrangements for identifying carers were not effective as the number of patients on the practice’s carers’ register was low.

We rated the practice as good for providing responsive services because:

  • The practice organised and delivered services to meet their patients’ needs.
  • Patients could access care and treatment in a timely way.

We have rated the practice as inadequate for providing well led services because:

  • The delivery of high-quality care was not assured by the practice’s leadership and governance arrangements, and we found evidence of new, as well as continuing, breaches of the regulations.
  • The concerns we found during this inspection had not been identified in the practice’s new quality framework, under-mining its credibility as an effective means of driving forward improvements at the practice.
  • There were weaknesses in the practice’s governance arrangements, which had led to failures to proactively identify and address issues of concern as they arose.
  • Risks and issues were not always identified promptly and dealt with appropriately. There were gaps in the practice’s audit arrangements, resulting in a lack of oversight about the effectiveness and safety of some of the practice’s systems and processes, and quality of care and treatment.
  • The practice’s governance arrangements were not always effective in maintaining and improving the quality of patient care.
  • The practice’s systems for identifying, capturing and managing risk and issues, were not always effective.
  • There was some evidence of systems and processes for learning and continuous improvement. However, improvements were not always identified. Action to introduce improvements were reactive, rather than proactive.

In addition to the above, we found that:

  • Effective processes were in place to keep the premises safe and free from the risk of infection.
  • Staff reported leaders were approachable and that the team worked very well together.
  • Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
  • The practice could demonstrate an overall improved Quality and Outcomes Framework (QOF) performance for 2018/19. In addition, the provider had also improved their performance for some of the cancer indicators.
  • Overall, the practice could demonstrate that staff had the skills, knowledge and experience to carry out their roles.
  • Patients could access care and treatment in a timely way.

This service was placed in special measures in September 2018 and May 2019. In this third inspection, in October 2019 we found that insufficient improvements have been made such that there remains an overall rating of inadequate. As we found insufficient improvements had been made, we took action in line with our enforcement procedures and cancelled the provider’s registration.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

29, 30 and 31 October 2019

During a routine inspection

This practice is rated as inadequate overall. (Previous rating May 2019 – requires improvement, but inadequate for the effective key question.)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Good

Are services well-led? - Inadequate

The service was inspected on 16 July 2015. Following this inspection, a report was issued identifying a failure to comply with Regulation 19 (fit and proper persons employed). The provider took action to address the breach of regulation.

The service was inspected on 05 and 08 June 2018. Following this inspection, a report was issued identifying a failure to comply with Regulations: 17 (good governance); 18 (staffing); 19, (fit and proper persons employed).

The service was inspected on 18 and 22 February 2019. Following this inspection, a report was issued identifying a continuing failure to comply fully with Regulation 17 (good governance). The provider had taken action to address the breaches of regulations 18 and 19, and most aspects regulation 17. However, we identified additional concerns at this inspection.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected.
  • information from our ongoing monitoring of data about services and,
  • information from the provider, patients and other organisations.

We have rated this practice as inadequate overall.

We have rated the practice as inadequate for providing safe services, because the practice did not have effective and reliable systems and processes for:

  • Assessing, monitoring, managing and recording risks to patient safety.
  • Keeping their safeguarding procedure up-to-date.
  • Keeping patients safeguarded from abuse.
  • Ensuring the appropriate and safe management of medicines.
  • Responding to safety alerts.
  • Making sure their records, systems and processes supported the practice to learn, when things went wrong.
  • Making sure individual care records were maintained in line with current guidance.
  • Sharing information with other agencies, to enable them to deliver safe care and treatment.

We have rated the practice as inadequate for providing effective services because:

  • The practice was able to demonstrate they had a more structured approach to quality improvement activities, and clinical and prescribing audits had been carried out, to review the effectiveness and appropriateness of the care provided. However, we were not assured the provider’s arrangements were effective or reliable, because they had failed to identify and address the concerns we found during this inspection.

  • The practice had improved outcomes for patients with mental health needs. However, some patients had not received effective care and treatment that met their needs. There had been an increase in the number of patients with diabetes who were exception-reported. While the practice had complied with the Quality Outcome Framework exception rules that at least three reminders should to be sent to patients, the practice had not always followed up those patients who failed to respond to these recall letters. Some patients’ immediate and ongoing needs had not been fully assessed, or appropriately reviewed and, for some patients, action had not been taken to ensure their needs were being met.

  • The practice’s childhood immunisation uptake rates were below the World Health Organisation (WHO) national target of 95% (the recommended standard for achieving herd immunity) and below the minimum target of 90%.
  • The practice’s cervical screening rate, at 68.1%, was below the Public Health England programme target of 80%.

Although staff actively tried to support patients to live healthier lives, it was not always clear how they did this, from the sample of patients’ medical records we looked at.

We rated the practice as requires improvement for providing caring services because:

  • Data from the most recent National GP Patient Survey of the practice, indicated that patient satisfaction levels, in relation to how staff treated them, were lower than both the local clinical commission group and national averages. Also, the arrangements for identifying carers were not effective as the number of patients on the practice’s carers’ register was low.

We rated the practice as good for providing responsive services because:

  • The practice organised and delivered services to meet their patients’ needs.
  • Patients could access care and treatment in a timely way.

We have rated the practice as inadequate for providing well led services because:

  • The delivery of high-quality care was not assured by the practice’s leadership and governance arrangements, and we found evidence of new, as well as continuing, breaches of the regulations.
  • The concerns we found during this inspection had not been identified in the practice’s new quality framework, under-mining its credibility as an effective means of driving forward improvements at the practice.
  • There were weaknesses in the practice’s governance arrangements, which had led to failures to proactively identify and address issues of concern as they arose.
  • Risks and issues were not always identified promptly and dealt with appropriately. There were gaps in the practice’s audit arrangements, resulting in a lack of oversight about the effectiveness and safety of some of the practice’s systems and processes, and quality of care and treatment.
  • The practice’s governance arrangements were not always effective in maintaining and improving the quality of patient care.
  • The practice’s systems for identifying, capturing and managing risk and issues, were not always effective.
  • There was some evidence of systems and processes for learning and continuous improvement. However, improvements were not always identified. Action to introduce improvements were reactive, rather than proactive.

In addition to the above, we found that:

  • Effective processes were in place to keep the premises safe and free from the risk of infection.
  • Staff reported leaders were approachable and that the team worked very well together.
  • The practice could demonstrate an overall improved Quality and Outcomes Framework (QOF) performance for 2018/19. In addition, the provider had also improved their performance for some of the cancer indicators.
  • Overall, the practice could demonstrate that staff had the skills, knowledge and experience to carry out their roles.
  • Patients could access care and treatment in a timely way.
  • Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Ensure patients are protected from abuse and improper treatment.
  • Establish effective systems and processes to ensure good governance, in accordance with the Fundamental Standards of Care.

The areas where the provider should make improvements:

  • Assess whether a decision made by one of the GPs to record patients’ notes on their iPhone complies with the practice’s information governance policy and, if it does not, take appropriate action to address this matter.
  • Reduce levels of antibiotic prescribing, to bring them into line with the local clinical commissioning group and national averages.
  • Amend the emergency medicines risk assessment to include a list of medicines which are not suitable for the practice to stock.
  • Reduce the QOF exception reporting rates for patients with diabetes which are higher than the local clinical commissioning group and national averages.
  • Improve uptake rates for childhood immunisations, cervical, breast and bowel screening, to bring them in line with the local CCG averages and national screening programme targets.
  • Update the training record of the member of staff carrying out the coding of patient’s medical records, to include evidence of the training they have completed.
  • Improve how patients who are carers are identified.
  • Continue to improve arrangements for engaging with patients.
  • Take steps to address the specific feedback some patients have provided, in relation to the way in which staff treat them.

This service was placed in special measures in September 2018 and May 2019. In this third inspection, in October 2019 we found that insufficient improvements have been made such that there remains an overall rating of inadequate. As we found insufficient improvements had been made, we took action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. We will now move to close the service by issuing a notice of proposal to cancel the provider’s registration.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

18 February 2019 and 22 February 2019

During a routine inspection

This practice is rated as requires improvement overall. (Previous rating June 2018 – inadequate.)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at Laburnum Surgery, on 18 and 22 February 2019. At this inspection we followed up three breaches of regulations identified during our previous inspection, in June 2018.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected.

  • information from our ongoing monitoring of data about services and,

  • information from the provider, patients and other organisations.

We have rated this practice as requires improvement overall.

We have rated the practice as requires improvement for providing safe and well led services because:

Although most of the shortfalls we identified at our last inspection had been fully addressed, we found there were still areas where the provider needed to improve, to demonstrate they could sustain improvements over time. In particular:

  • Leaders were not fully engaged in local safeguarding processes.

  • Leaders could not demonstrate staff were up-to-date with their routine immunisations.

  • There were some shortfalls in the practice’s systems for the appropriate and safe use of medicines.

  • The practice’s rate of antibiotic prescribing continued to be significantly higher than the local clinical commissioning group (CCG) and national averages.

  • Checking that the practice’s vaccine refrigerators were maintained in a clean condition, and that checks of the vaccine refrigeration temperatures were accurate and carried out consistently.

  • The practice needs to continue to improve how they engage with patients.

  • The practice needs to demonstrate that they can sustain improvements to their governance arrangements over time

We have rated the practice as inadequate for providing effective services because:

Although most of the concerns we identified at our last inspection had been fully addressed, we found there were still areas where the provider needed to improve, to demonstrate they could sustain improvements over time.

  • The practice could not demonstrate they had a comprehensive planned programme of quality improvement.

  • Outcomes for people who use services were below expectations, when compared to similar services, and this affected all population groups.

The lack of a systematic programme of clinical and internal audit impacted on all of the population groups. Also, the outcomes for working age patients and patients who experience poor mental health were below expectations, when compared to similar services and because of this, we have rated these two population groups as inadequate.

We rated the practice as good for providing caring services because:

  • Staff treated patients with kindness and respect, and involved them in decisions about their care.

We rated the practice as good for providing responsive services because:

  • The practice organised and delivered services to meet their patients’ needs.

  • Patients could access care and treatment in a timely way.

The overall rating for this practice was requires improvement due to concerns in providing safe, effective and well-led services. However, the population groups were rated as good for providing responsive services because patients could access timely and responsive care and treatment.

We found that:

  • The provider had complied with the requirement notices we issued relating to: establishing and operating appropriate staff recruitment procedures; providing staff with appropriate support and appraisal, to enable them to carry out their duties. The provider had also complied with most aspects of the requirement notice relating to good governance.

  • The practice had improved their systems and processes for keeping patients safe and safeguarded from abuse.

  • The practice learnt and made changes when things went wrong.

  • The practice had improved their arrangements for monitoring and reviewing activities, enabling them to have a better understanding of risks.

  • The practice’s systems and processes for ensuring the safe management of medicines had improved since our last inspection. This included improvements in the arrangements for antimicrobial stewardship. However, there were still some shortfalls in the practice’s arrangements for ensuring the appropriate and safe use of medicines.

  • The practice’s arrangements for reviewing the effectiveness of the care staff provided to patients had improved since our last inspection. However, the practice did not have a planned systematic programme of clinical and internal audit, to help monitor and improve standards of care.

  • The practice could demonstrate an improved Quality and Outcomes Framework (QOF) performance for 2018/19. However, outcomes for some of the population groups were still below expectations when compared to similar services.

  • Overall, the practice could demonstrate that staff had the skills, knowledge and experience to carry out their roles.

  • Overall, patients could access care and treatment in a timely way.

  • Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.

  • The practice had improved and strengthened their governance and management arrangements. However, there were still shortfalls in these arrangements.

  • The practice had developed a credible strategy to help them provide high-quality, sustainable care, and address the key challenges they faced.

  • The practice had systems and processes for learning and continuous improvement.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the Fundamental Standards of Care.

The areas where the provider should make improvements:

  • Record the outcome of their assessment of the ongoing prescribing competence of the nurse practitioner working at an advanced level.

  • Improve how patients who are also carers are identified.

  • Improve their arrangements for engaging with patients.

  • Improve systems and processes for monitoring the practice’s QOF performance and reduce those exception reporting rates that are higher than the local clinical commissioning group and national averages.

  • Improve uptake rates for cervical, breast and bowel screening to bring them in line with the local CCG averages and national screening programme targets.

  • Develop a succession plan, to help assure the future delivery of services.

  • Engage with the local safeguarding network.

  • Prepare a comprehensive schedule of quality improvement activities, to help drive targeted improvements at the practice.

This service was placed in special measures in September 2018. Insufficient improvements have been made such that there remains a rating of inadequate for providing effective services. Therefore, we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration, or to varying the terms of their registration, within six months, if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months and, if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location, or cancel the provider’s registration.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

5 June and 8 June 2018

During a routine inspection

This practice is rated as inadequate overall. (Previous comprehensive rating – July 2015 – Good).

The key questions are rated as:

Are services safe? inadequate

Are services effective? requires improvement

Are services caring? – good

Are services responsive? – good

Are services well-led? - inadequate

We carried out an announced comprehensive inspection at Laburnum Surgery on 05 and 08 June 2018 due to risks identified through our internal monitoring processes and as part of our planned inspection programme.

At this inspection we found:

  • Staff demonstrated a very caring approach to their patients and it was clear they treated them with compassion, kindness, dignity and respect.

  • The practice had some systems in place to manage risk, so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved processes to keep patients safe. However, the practice’s protocol for responding to safety alerts was not always implemented effectively. Significant events were not routinely shared externally, using the local safeguarding, incident and risk management system, to promote system-wide learning. There were some gaps in the practice’s arrangements for identifying, assessing and managing risk.

  • Clinicians assessed patients’ needs and delivered person-focussed care and treatment. However, they did not routinely review the effectiveness of the care provided to ensure it was in line with current legislation, standards and guidance. The practice did not have a structured system in place which helped ensure clinicians kept up-to-date with current evidence-based practice. The practice was unable to demonstrate it was actively following the latest National Institute for Health and Care Excellence (NICE) sepsis guidance.

  • Most patients found the appointment system easy to use and reported they could access care when they needed it.

  • There was some evidence the practice engaged with their patients and used the feedback to improve services. However, patient engagement was limited and the practice did not have an active patient participation group.

  • Overall, staff had the skills, knowledge and experience to carry out their roles. However, appropriate arrangements had not been made to monitor the continuing competency of the long-term locum nurse practitioner operating in an advanced role. Also, appropriate records had not been maintained of the induction provided to locum staff.

  • Appropriate recruitment checks had not always been carried out.

  • There was some evidence of business planning, and risk and performance management. However, some of the practice’s governance systems and processes did not work effectively. Business planning had taken place but this did not sufficiently address the challenges faced by the practice and areas for improvement. Multi-disciplinary team meetings, to review the needs of patients with complex and end-of-life needs, had not been held on a regular basis in line with the practice’s meeting programme. Although the practice had a meeting structure, this was not always followed in practice.

  • Some quality improvement activity had been undertaken. However, clinical audit activity was limited.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Establish effective systems and processes to ensure good governance, in accordance with the fundamental standards of care.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal to enable them to carry out their duties.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

  • Act to improve uptake rates for cervical, breast and bowel cancer screening in line with local clinical commissioning group averages. Continue to take action to improve childhood immunisation rates.
  • Review and improve patient engagement.
  • Review and improve reception staff training for their role in the management of patients with severe infections, such as sepsis.
  • Arrange for the practice’s CQC rating to be displayed on the practice’s website.
  • Reduce those exception reporting rates which are higher than the local clinical commissioning group and England averages.

I am placing this service into special measures. Services placed into special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

26 September 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Laburnum Surgery in July 2015. The full comprehensive report on that inspection can be found by selecting the ‘all reports’ link for Laburnum Surgery, on our website at www.cqc.org.uk. At that inspection, the practice was rated as requires improvement. An announced follow up inspection was carried out in March 2016, and the practice was rated as good overall.

We carried out this focussed inspection on 26 September 2017, because the information we use to support our monitoring and decision-making indicated that the practice had higher rates of antibiotic prescribing, when compared to the local clinical commissioning group and England averages. Overall the practice is rated as good. Our key findings were as follows:

  • The practice was taking steps to reduce their rates of antibiotic prescribing and had some systems and processes in place to help them do this. However, we found there were additional actions that staff should be taking, to strengthen the practice’s ‘antimicrobial stewardship’ arrangements. (‘Antimicrobial stewardship’ is an organisational approach to achieving the best clinical outcome for the treatment of a patient’s infection, whilst also having a minimal impact on resistance).

  • At our previous inspection in March 2016, we asked the provider to arrange for the member of staff who was the practice’s infection control lead to complete more advanced infection control training. Whilst we were able to confirm at this inspection that all staff had completed training in infection control, the practice manager had been unable to source more advanced training for their infection control lead. Because it is important for infection control leads working in GP practices to have the knowledge and competencies required to take on this role, we are asking the provider to arrange for their infection control lead to undertake more advance training in infection control.

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

Consider strengthening their ‘antimicrobial stewardship’ arrangements by:

  • Arranging for all clinical staff to complete training in antibiotic prescribing.

    Adopting a recognised toolkit to help them assess and improve the effectiveness of their antibiotic prescribing.

  • Making time in clinical and/or educational meetings for the whole clinical team to review their antibiotic prescribing practice and learn lessons to help drive improvements.

Arrange for the practice’s infection control lead to complete more in-depth training in infection control.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17 March 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced inspection of this practice on 16 July 2015. A breach of legal requirements was found. After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

  • Regulation 19 of the HSCA (Regulated activities) 2014 Fit and proper persons employed.

We undertook this focused inspection on 17 March 2016 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. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Laburnum Surgery on our website at www.cqc.org.uk.

Our key findings were as follows:

  • The practice had addressed the issues identified during the previous inspection.

  • Systems to manage and monitor the prevention and control of infection were in place.

  • Disclosure and Barring Service checks (DBS) had been completed for all staff.

  • Checks were made on NMC and GMC registration and that medical indemnity insurance was current.

  • A fire drill had been carried out in the last year.

  • Each member of staff had their own individual training record which set out what training they had received and when, therefore making it easy to see when refresher training was due.

  • The most current published data from 2014/15 showed an improvement in the childhood immunisation rates and that they were now mostly in line with CCG/national averages.

  • The practice had a system in place for handling complaints and concerns. Complaints received had been fully investigated and responded to by the practice.

  • The were governance arrangements in place.

    However, there was one area of practice where the provider needs to make improvements.

    The provider should:

  • Provide specific infection control training for the infection control lead at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

16 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Laburnum Surgery on 16 July 2015. Specifically, we found the practice to require improvement for providing safe and responsive services and for being well led. They were rated as good for providing effective and caring services.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was a system in place for reporting, recording and monitoring significant events.
  • Some risks to patients and staff were not assessed and systems and processes were not fully implemented to keep patients safe. For example, the practice did not follow its recruitment policy. Some staff had not undergone recruitment checks.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. We saw a system of clinical audit to improve outcomes for patients. However, child immunisation rates were significantly lower than the clinical commissioning group (CCG) averages for some groups.
  • Staff had received training appropriate to their roles. There was an appraisal system in place.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Data showed that patients rated the practice lower or in line with the CCG averages for being caring.
  • Most patients we spoke with and those who completed CQC comment cards indicated they felt they could obtain appointments, including urgent appointments, when needed.
  • The practice had a system in place for handling complaints and concerns; however this was not fully developed.
  • The practice proactively sought feedback from patients and conducted an annual patient satisfaction survey.
  • There was a vision and a strategy for the future and a leadership structure and staff felt supported by management. However, some of the systems and processes which should have been in place to keep patients and staff safe were not in place.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure recruitment procedures are established and that they operate effectively.

In addition the provider should:

  • Improve the way staff training is recorded.
  • Carry out infection control training for staff.
  • Improve the way complaints are investigated and responded to.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

18 November 2013

During a routine inspection

People expressed their views and were involved in making decisions about their care and treatment. We saw staff dealt with enquiries from patients as discretely as possible. Patients told us they were happy with the treatment they received. One patient told us, 'The reception staff and doctors are really friendly. They are good at explaining things.'

We spoke with three patients who were all complimentary about the care they received. One patient told us, 'They make you feel welcome and ask you what problems you have.' Another patient said the doctor had given her the correct advice about taking her child to hospital, where they had received prompt and appropriate treatment.

The practice had in place safeguarding policies for both children and vulnerable adults. There was an identified lead clinician with clear roles and responsibilities to oversee safeguarding within the practice.

The practice was well organised and presented as clean, tidy and well maintained. There was easy access for people with a disability, as most services were located on the ground floor. The practice undertook a fire risk assessment and confirmed they carried out and logged weekly fire tests.

Staff told us that they felt well supported in their work. One staff member told us, 'I have never worked anywhere where the GPs treat you so much as an equal. It is all very friendly.' We saw copies of attendance sheets for various training including safeguarding and updates on information systems.