We carried out an announced comprehensive inspection at The Lander Medical Practice on 21 March 2019 as part of our inspection programme.

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, the public and other organisations.

We have rated this practice as good overall, requires improvement for providing safe services and good for providing effective, caring, responsive and well led services.

We have also rated the practice as good for providing effective and responsive care to older people, people with long term conditions, families, children and young people, working age people, those whose circumstances may make them vulnerable and those experiencing poor mental health.

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

• Some staff records that we saw did not contain appropriate recruitment checks in line with current guidance.
• Not all staff had up to date infection prevention training appropriate to their roles.
• Some Patient Group Directions (PGDs) and Patient Specific Directions (PSDs), although rectified on the day of the inspection were incomplete.
• Blood tests were not carried out prior to the prescribing of some high-risk medicines.
• Due to the way significant events were recorded it was not always easy to see how the learning outcomes had been shared with the team.

We rated the practice as good for providing effective, caring, responsive and well led services because:

• Patients received effective care and treatment that met their needs. The practice could demonstrate good patient outcomes were delivered.
• Staff treated patients with kindness and respect and involved them in decisions about their care. The practice ethos was to provide an accessible and approachable patient-orientated service.
• Patients could access care and treatment in a timely way. The practice organised and delivered services to meet their patients’ needs.

Although there were no breaches of regulations, the practice should:

• Review all training in general, to ensure that staff receive training appropriate to their roles.
• Continue to review and monitor PGDs and PSDs to ensure that they are correctly signed and, where appropriate, included in the patient record.
• Continue to review and maintain the process for monitoring patients on high-risk medicines to ensure that appropriate blood tests are done prior to repeat prescribing by clinicians.
• Consider implementing a log for safety alerts that is accessible to all staff.
• Continue the process of staff appraisals to ensure that all staff receive an appraisal every 12 months.
• Continue measures to increase the number of carers identified to above the national average of 2%
• Should continue to work towards achieving the national target of 80% of eligible women attending for cervical screening

Please refer to the detailed report and the evidence tables for further information.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lander Practice on 20 August 2015. Overall the practice is rated as Good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

We saw one area of outstanding practice:

The practice had their own physiotherapy department employing five senior physiotherapists in a purpose built clinic with three cubicles and fully equipped gymnasium. Patients were referred to this department by the GPs and they could take urgent and routine referrals. In the past year they had treated 1,402 patients, 23% as urgent cases and 77% as routine. This service assisted patients to return to and remain in work. Patients feedback on this service was 98% excellent and 2% good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice