Langley Corner Surgery

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