Letter from the Chief Inspector of General Practice

We carried out an inspection in May 2016 to follow up on concerns raised at a previous inspection in January 2015. We found some aspects of the service had improved but others continued to be in breach of regulation. Specifically, we found the provider requires improvement for safe and effective services, good for caring and responsive services and inadequate for well led. We rated the practice as requires improvement overall. Following the inspection in May 2016, the practice sent us an action plan explaining what actions they were going to take to meet regulations.

We carried out an announced comprehensive follow up inspection at Long Barn Lane Surgery on 17 January 2017. We carried out this inspection to check the practice was meeting the regulations and to consider whether sufficient improvements had been made. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed, with the exception of fridge temperature recording.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Child immunisation rates were below national average for most of the standard immunisations.
• Some patient health screening data showed the practice was below the national average, although they were in line with local averages.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

The areas where the provider should make improvements are:

• Ensure governance arrangements include monitoring of daily fridge temperature  recording.

• Ensure patients referred under the two week wait referral process are followed up.

• Ensure all staff, who are eligible, have received a yearly appraisal.

• Continue to encourage patients to attend for smoking cessation, health screening and childhood immunisations.

• Continue to review patient feedback and address concerns relating to care and treatment and telephone access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Long Barn Lane Surgery on 18 May 2016. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

Our previous inspection in January 2015 found breaches of regulations relating to the safe and well led delivery of services. The overall rating of the practice in January 2015 was ‘requires improvement’. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

At the inspection in May 2016, we found the practice had made some improvements since our last inspection in January 2015. However, the practice is required to make further improvements and is rated as ‘requires improvement’ overall. The practice had not addressed some of the issues identified during our last inspection in January 2015 and rated as ‘inadequate’ for the provision of a well led service. Specifically, we found the practice to ‘requires improvement’ for the provision of a safe and effective services. It was rated ‘good’ for providing caring and responsive services. The concerns which led to these ratings apply to all population groups using the practice.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded, monitored and reviewed.
• Risks to patients and staff were assessed and well managed in some areas, with the exception of those relating to suitability of premises, the adult safeguarding policy, the management of legionella and the monitoring of emergency equipment to deal with emergencies.
• Data showed patient outcomes were comparable to the national average. However, the practice was required to improve outcomes for patients with learning disabilities, patients with dementia and patients at risk of unplanned admission.
• We found that completed clinical audits cycles were driving positive outcomes for patients.
• 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. However, some staff had not completed mandatory training including fire safety and infection control training.
• Results from the national GP patient survey showed that the majority of patients said they were treated with compassion, dignity and respect, and they were involved in their care and decisions about their treatment when compared to the local and national averages. All patients we spoke with on the day of inspection confirmed this.
• Information about services and how to complain were available and easy to understand.
• Patients we spoke to on the day of inspection informed us they were able to make an appointment with a named GP, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. However, the practice was required to improve wheelchair and pram access.
• 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.
• The practice had made some improvements in areas relating to poor governance systems and succession planning. For example, two new GP partners had joined the partnership in April 2016 and the practice had developed a new robust strategic business plan.
• The practice had not always reviewed policies and procedures to identify, assess and manage risks to health, safety and welfare and it was unclear at what frequency these would be reviewed.

The areas where the provider must make improvements are:

• Review and implement all policies and procedures required to identify, assess and manage risks to health, safety and welfare.
• Ensure that they carry out health and safety related risk assessments of both locations to monitor safety of the premises such as control of substances hazardous to health, manual handling, disability access and suitability of the premises.
• Ensure all staff have undertaken mandatory training relevant to their role and improve record keeping of training certificates.
• Review and improve the systems in place to effectively monitor face to face reviews of patients with dementia, care plans for patients with learning disabilities and patients at risk of unplanned admission.
• Further review, assess and monitor the governance arrangements in place to ensure the delivery of safe and effective services. For example, monitoring of emergency equipment and management of legionella.

In addition the provider should:

• Ensure a risk assessment is in place for staff undertaking chaperoning duties while their Disclosure and Barring Scheme (DBS) check application is in progress.
• Ensure to develop an action plan to address and improve the level of exception reporting.
• Review the process of identifying carers to enable them to access the support available via the practice and external agencies.
• Review the system in place to promote the benefits of smoking cessation in order to increase patient uptake.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected Long Barn Lane Surgery on 21 January 2015. This was a comprehensive inspection. We also inspected the branch surgery of the practice at Southcote clinic.

We rated the practice as requiring improvement. Many aspects of the services delivered were good but improvements must be made to improve safety. General cleaning standards were unsatisfactory and not consistently monitored, blank prescriptions were not recorded when issued to GPs, the treatment room in use at the branch surgery was not adequate and policies and procedures designed to identify, assess and manage risk were not kept up to date.

Our key findings were as follows: The practice provided good care and treatment to its patients. National data showed the practice performed well in managing long term conditions. Staff were aware of the needs of their patients including those experiencing income deprivation. The practice was responsive to potentially vulnerable patients. There was a strong leadership team and an open culture which was inclusive. Patients were consulted to assist the leadership team in making improvements to the service. The practice was aware that some patients found it difficult to access the service by telephone and online appointment booking was being promoted. Improvements were required to maintain appropriate standards of cleanliness, manage prescriptions, ensure treatment rooms were fit for purpose and ensuring policies and procedures relating to health and safety were kept up-to-date.

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

The areas where the provider must make improvements are:

• monitoring of general cleaning at both the main surgery and branch clinic to ensure appropriate standards of cleanliness are achieved.
• review the suitability of the treatment room at Southcote clinic to ensure it is fit for purpose.
• to carry out monitoring of fridge temperatures for the fridge in use at Southcote clinic.
• undertake consistent reviews of all policies relating to the identification, assessment and management of risk to ensure these remain up to date and accurate.
• to introduce a recording and tracking system for blank prescription forms and prescription pads

The areas where the provider should make improvement are:

• increasing the range of audits completed and introduce an audit plan.
• developing a clear plan for medical staffing to secure the long term future of the practice
• signing, dating and identifying a review timetable for the practice nursing protocols

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice