Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Longford Primary Care Centre on 7 June 2016. A total of two breaches of legal requirements were found. After the comprehensive inspection, the practice was rated as requires improvement overall.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Longford Primary Care Centre on our website at www.cqc.org.uk.

We undertook an announced comprehensive inspection on 3 May 2017 to check that the practice now met legal requirements. Overall the practice is now rated as requires improvement.

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

• There was an effective system in place for reporting and recording significant events. Incidents and significant events were discussed at monthly meetings where all staff came together to ensure learning outcomes were shared.
• We saw that there were measures in place to safeguard children and vulnerable adults from abuse, and these were in line with current legislation and requirements.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were similar to or lower than CCG and national averages. The most recent published results (for 2015/2016) showed the practice had achieved 80% of the total number of points available, compared with the Clinical Commissioning Group (CCG) and the national averages of 95%. The practice provided evidence of their QOF data for the year 2016/2017 which was not yet published which showed their overall achievement had increased to 87%, a significant improvement.
• There was evidence of quality improvement including clinical audit. The practice also participated in benchmarking and best practice sharing with other local GPs.
• The induction programme for non-clinical staff did not include safeguarding training. The practice manager told us that newly appointed non-clinical staff did not work unsupervised until all of their mandatory training had been completed. We were provided with evidence immediately following the inspection that all staff had completed this training, and that the induction programme had also been updated to include this.
• We observed members of staff were courteous and very helpful to patients and treated them with dignity and respect. Feedback we received from patients on the day of the inspection reflected this.
• The practice was keen to improve patient satisfaction and had carried out a patient questionnaire at both the main location and the branch site during December 2016. The results of the survey did show an improvement in overall patient satisfaction, but also identified areas where further improvement was needed. During the inspection the practice was following an action plan to address some of these areas, but there was not yet evidence of the impact of these changes. There was also a lack of specific action to improve patient experiences of consultations with clinical staff.
• Two of the patients we spoke with on the day of the inspection told us that access to appointments had improved during the past six months and all eight patients we spoke with said they found it easy to get an appointment. All eight patients told us they were satisfied overall with the service they received from the practice and particularly commented on the caring and friendly nature of staff.
• Information was available to help patients understand the complaints system. A printed leaflet about how to make a complaint was available to help patients understand the system if they had a concern. Information about making a complaint was also published on the practice website.
• The practice had recruited two new GP partners and made significant improvements in its performance during the previous year. We saw that the areas of concern raised during the previous CQC inspection had been rectified. The practice had a supporting business plan and was committed to continue addressing the challenges it faced.

The areas where the practice should make improvements are:

• Assure itself that newly appointed staff members have completed the training required to work safely.
• Continue to review QOF performance in order to target areas for improvement.
• Continue to encourage patients to engage with cervical, breast and bowel screening programmes.
• Improve care planning for mental health patients.
• Continue to review patient satisfaction results and take measures to improve these.

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 Longford Primary Care Centre on 7 June 2016. Overall the practice is rated as requires improvement.

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

• Staff knew how to raise concerns and report incidents and near misses. Significant events were investigated and we saw that these were a standing item on the practice’s monthly GP meeting agendas. We reviewed details of significant events that had taken place during the past year and saw that appropriate action had been taken by the practice.
• The practice was operating with a reduced number of GPs due to two partners having passed away and a third having recently resigned. The practice was in the process of recruiting a new GP partner and had made arrangements to ensure the number and mix of staff on duty met patients’ needs as far as was possible, however the shortage of GPs represented a significant challenge in meeting the demand for services.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were lower than average compared to local and national averages. Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.

• Patients we spoke with said they had enough time with the GP, but commented that it could be difficult to make an appointment. The National GP Patient Survey showed that not all patients were satisfied with how they were treated. The practice was above average for its satisfaction scores on consultations with nurses; whereas scores for GPs, reception staff, and appointment access were generally below average.

• While GP meetings were held monthly to discuss significant events, complaints, and clinical issues; the practice did not hold regular meetings that included all staff.

The areas where the provider must make improvements are:

• Ensure there are effective systems in place to assess and monitor the emergency medicines in stock, enabling clinicians to respond appropriately in the event of a medical emergency.

• Assure itself that a suitable health and safety risk assessment has been carried out for the premises in which it operates.

• Ensure the system for managing high risk medicines is effective and keeps patients safe.

In addition the provider should:

• Review and strengthen its overall system for monitoring responses to safety alerts to ensure that any required actions are addressed.

• Improve the system for identifying and supporting carers.

• Carry out a systemic and targeted programme of clinical quality improvement such as full cycle clinical audits to monitor and improve outcomes for patients.

• Continue to encourage patients to engage with cervical, breast and bowel screening programmes.

• Review messaging for patients to ensure that arrangements for use of the branch surgery when the main site is closed are clear.

• Record and investigate verbal complaints.

• Assure itself that long serving members of staff remain suitable to work with patients.

• Review staff files to ensure that information held about staff members is complete.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our inspection we spoke with seven patients and five members of staff.

Patients were satisfied with the appointment system and when necessary were given an appointment on the same day. Patients told us they were able to get through to the surgery on the telephone easily and said reception staff were friendly and helpful. One patient told us: “It’s never a problem getting through on the phone for an appointment.”

We saw that patients’ views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. When patients received care or treatment they were asked for their consent and their wishes were listened to.

The practice was clean and well organised. Processes were in place to minimise the risk of infection. There were also processes in place for monitoring the quality of service provision. There was an established system for regularly obtaining opinions from patients about the standard of the service they received.

There was a complaints procedure in place and although none of the patients we spoke with had needed to complain, they knew how to do so. One patient told us: “I’ve never had to complain and never expect to need to.”

The practice is located within Longford Primary Care Centre with other primary medical services. As a tenant of the building, some services, for example, cleaning, are the responsibility of the Clinical Commissioning Group (CCG) who own the facility.

This practice is rated as Good overall. (Previous rating 3 May 2017 – Requires improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr Princewill & partners on 16 October 2018. The reason for this inspection was to follow up from a previous inspection on 3 May 2017 when the areas of effective and caring had been identified as requiring improvement which had led to an overall rating of requires improvement.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Whilst the national GP patient survey did not reflect levels of satisfaction in line with local and national averages in all areas, patients we spoke with on the day told us they did find the appointment system easy to use and reported that they were able to access care when they needed it. The practice had also taken action to address the lower than average levels of satisfaction and continued to monitor this by conducting their own surveys which had shown positive results and captured the views of a larger cohort of patients.
• There was evidence of a strong focus on continuous learning and improvement at all levels of the organisation and staff confirmed this.
• The practice had addressed the difficulties in recruiting GPs and had been successful in recruiting two new partners and advanced nurse practitioner and established a stable and cohesive workforce.
• The practice had achieved significant improvements in long term conditions through a more focussed approach involving all members of the practice team devolving responsibilities as appropriate.

The areas where the provider should make improvements are:

• Continue to work with their action plan to meet capacity needs.
• Continue to monitor and review ways of increasing patient satisfaction with the service.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

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