This practice is rated as Good overall. (Previous rating March 2018 – Overall Good, with the domain of Safe as requires improvement).

This was because:

Regulation 12, There was evidence that safe care and treatment was not being provided. In particular:

• there was not a safe system for the management of prescription paper

And there were a small number of areas in the domain which the provider should improve:

• The infection control policy and procedure did not provide staff with sufficient information in regard to the management of outbreaks of communicable diseases.
• Infection control audits did not show that where issues were identified and actions raised to rectify concerns, there was no detail these actions had been completed.
• The system for regular monitoring patients prescribed high risk medicines was not implemented fully. Patients may not have had the appropriate checks at the correct time.
• The system for receiving and acting on safety alerts was working well within the dispensary, and was shared and acted upon, but detail of other alerts received were not recorded and managed in the same way.

In addition, we followed up on:

• The overarching training record for staff was incomplete and did not reflect the training that staff had undertaken.
• There was a potential that unauthorised people had access to paper records held at the practice.

The key question at this inspection was rated as:

Are services safe? – Good

We carried out an announced focused inspection at Langport Surgery on 27 November 2018. We reviewed the areas of concern and followed up on the areas of improvement the provider should have put in place following the comprehensive inspection in March 2018.

At this inspection we found for the domain of Safe:

• A safe system for the management of the prescription paper had been implemented with detailed auditable record keeping.
• The infection control policy and procedure had been updated and included guidance to staff regarding the management of outbreaks of communicable diseases.
• The infection control audit document had been reviewed and updated to include recording when actions had been completed.
• There was a system for the regular review of patients on high risk medicines.
• The provider had implemented a whole practice system for monitoring and acting upon safety alerts.

The actions taken to improve other areas were:

• An overarching training record was in place to ensure the provider had good oversight of staff training so they could monitor that staff were effectively trained and skilled to carry out their roles.
• Systems were in place to reduce the risk that unauthorised people could not access patient’s paper records.

The areas where the provider should make improvements are:

• The provider should continue with ensuring the safety and monitoring the use of prescription pads in line with NHS England’s Management and control of prescription forms 2018 guidance.

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.

This practice is rated as Good overall.

(Previous inspection November 2014 – Good overall)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Langport Surgery on 14 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice participated in a local quality framework, Somerset Practice Quality Scheme (SPQS), rather than the national Quality and Outcomes Framework (QOF), to monitor practice performance and outcomes for patients. This meant that quantitative QOF data for 2016/17 indicated some patient outcomes were below average compared to the national average. However, SPQS information provided qualitative evidence of improvements in some areas of patient care; and examples of positive feedback from patients as a result of different ways of working.
• The practice was able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy. Arrangements for dispensing medicines at the practice kept patients safe. However, arrangements for medicines management did not ensure the security of blank prescription stationery.
• 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.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and quality improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way for patients.

The areas where the provider should make improvements are:

• Review arrangements for addressing safety alerts to ensure there is a record that all are received and that all actions are completed.
• Review arrangements for infection prevention and control (IPC).
• Review arrangements for recording training to ensure a record of all completed training is included.
• Review arrangements for the security of medical records to ensure unauthorised access is prevented.

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 Langport Surgery on 17 November 2014. Overall the practice is rated as good.

Specifically we found it good for well-led, effective, caring and responsive services. It was also good for providing services for older people, people with long-term conditions, mothers, babies, children and young people, working-age population and those recently retired, people in vulnerable circumstances who may have poor access to primary care and people experiencing poor mental health.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and knew how to report incidents and near misses. Information about safety measures were recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed. Staff were trained and knew how to recognise signs of abuse in older people, vulnerable adults and children. They were also aware of their responsibilities and knew how to share information, properly record documentation of safeguarding concerns
• 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 told us they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
• Information about the services provided and how to complain was available and easy to understand.
• The practice had good facilities and was 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 upon.
• The practice was a GP training practice. There was a practice focus on the development of individuals and involvement in research projects.

We saw several areas of outstanding practice including:

• The practice worked well with other health care services outside of the local area, and with other public bodies such as the fire service, police and rescue services as the area experienced flooding in 2014.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice