Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of the Langford Medical Practice, 9 Nightingale Place, Bicester, Oxon, OX26 6xx on the 6 October 2015. 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 February 2015 found breaches of regulations relating to the safe and effective delivery of services. There were also concerns and regulatory breaches relating to the management and leadership of the practice, specifically in the well led domain. The overall rating of the practice in February 2015 was inadequate and the practice was placed into special measures for six months. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

At the inspection in October 2015, we found the practice had made significant improvements since our last inspection in February 2015 and that they were meeting all of the regulations which had previously been breached.

The ratings for the practice have been updated to reflect our findings.

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

• All the partners, staff and members of the Patient Participation Group worked hard to undertake a complete review of the service since the previous inspection and make sustainable improvements.
• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, and appropriately reviewed and addressed.
• 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 that they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• There was a leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• Governance systems and processes required further improvement to monitor and assess the whole service in relation to risk and improvements.

There were also areas where the provider could make improvements and they should:

• Embed and maintain a continuous clinical audit programme.
• Ensure all complaints are recorded and detailed actions of complaints are documented.
• Clearly document potential risks to the move of the dispensary from the branch practice.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

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 on 10 February 2015. We inspected Langford Medical Practice and the linked dispensary at Ambrosden Surgery. 

Overall the practice is rated as inadequate. The practice is rated as inadequate for providing safe services and the well led domain. The practice is rated as requires improvement for providing effective services. The population groups for older people, people with long term conditions, families children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health are rated as inadequate based on the overall rating of the practice. The practice is rated as good for providing a caring and responsive service.

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

• Some checks to the maintenance of the building had taken place, but necessary actions are not always carried out.
• Appropriate pre and post employment checks of staff are not always carried out.
• Staff do not always complete mandatory training in a timely fashion.
• We found medicine management systems did not always follow national guidance. There are not always appropriate procedures in place relating to medicines.
• Patient outcomes are average for the locality. Patients' needs are assessed and audits had taken place.
• Patients said that they are treated with compassion, respect and dignity and are involved in their care and decisions about their treatment.
• The practice recognises the needs of different people in accessing the service.
• The practice has some policies and procedures in place. However, some members of staff are not aware of how to access these and some of these had not been updated or fully completed.
• Information about how to complain is available and easy to understand.

The areas where the practice must make improvements are:

• Ensure medicines management systems are reviewed in line with national guidance
• Implement adequate recruitment procedures in order to ensure that no person is employed, unless that person is physically and mentally fit for work.
• Undertake and record a risk assessment to determine which roles require a DBS check and make a DBS application for those staff who require one.
• Ensure that recruitment information and other appropriate records are available for all staff employed at the practice.
• Develop suitable systems to ensure staff are appropriately supported in relation to their responsibilities, including by receiving appropriate training and supervision.
• Ensure that there are effective systems to identify, assess, and manage risks relating to the health, welfare, and safety of patients, and others who may be at risk.
• Ensure that all staff have access to appropriate policies, procedures, and guidance to carry out their role, such as information about whistleblowing and safeguarding.
• Develop and implement complete procedures for dealing with emergencies which are reasonably expected to arise from time to time. This includes a fully completed and up to date business continuity plan.
• Take action to review the whole regulation where breaches were identified in relation to medicines management that were raised in the previous compliance report of October 2014.

On the basis of this inspection and the ratings given to this practice the provider has been placed into special measures. This will be for a period of six months when we will inspect the provider again. Special measures is designed to ensure a timely and coordinated response to practices found to be providing inadequate care.

Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid having its registration cancelled.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Langford Medical Practice is a GP practice situated in Bicester in Oxfordshire and has 9,238 registered patients. The practice also has a branch surgery that dispenses medicines. The dispensing practice is based in Ambrosden, a village in Cherwell, Oxfordshire. It is approximately 2.5 miles away from the practice. The two practices share the same patient list.

The practice provided a range of services for patients. We spoke with patients about their experiences of care at this practice and also received written feedback from patients about the quality of services. All patients gave positive feedback about the practice and staff. The last patient survey, undertaken in 2014, showed us patients were satisfied with the care and treatment they received.

The practice opted out of providing out of hours primary medical services for its patients. Outside normal surgery hours Langford Medical Practice patients were able to access emergency care from an alternative out of hours provider.

Langford Medical Practice was patient-focused in its approach to care and treatment. The practice understood the different needs of the population it served and acted on these to ensure they supported patients appropriately. They had established links with the traveller community and had identified there was a high prevalence of depression in the local population. The practice used a variety of audits to assess and meet the needs of their patient population group. They completed audits for the prevalence and management of atrial fibrillation and chronic obstructive pulmonary disease (COPD) in July 2012 and July 2013. They used the information to ensure they had up to date data about their patient population group and make a decision if they needed to offer additional services. They also used the information to determine whether they had sufficient staff to meet the needs of patients with these conditions in their patient population.

The practice provided information and support to help patients understand their care and treatment and help them make informed choices. Patients were treated with dignity and respect. There was clear leadership within the practice, with a focus on continuous professional development. The practice actively sought comments and feedback from patients and acted on these to improve the service. However, we had some concerns related to the management of medicines and infection control. For example, the practice did not ensure expired medicines were not available to be used. There were not sufficient infection control audits to assist the practice identify, monitor and reduce the risk and spread of infection.

As part of the inspection we looked at management records as well as policies and procedures. We observed how staff cared for and interacted with patients and spoke with patients about their experiences of care at the practice. We also spoke with a range of staff, including GPs, nurses, a phlebotomist and administrative staff. We also met with the Oxfordshire Clinical Commissioning Group.

The provider was in breach of the regulations related to the management of medicines and infection control. We visited Langford Medical Practice, 9 Nightingale Place, Bicester, and Oxon, OX26 6XX. We also visited Ambrosden Surgery, Ambrosden, Bicester, and Oxon, OX25 2RH where there was a dispensary.