We carried out an announced comprehensive inspection at Langstone Way Surgery on 19 February 2019.

The practice was previously inspected on 8 May 2018 and was rated good overall. The Safe key question was rated requires improvement because we identified a breach of regulations. Specifically we found the practice had not assessed the risks associated with fire, the practice did not have a process in place to identify whether locum clinical staff had undertaken a Disclosure and Barring Service check and did not have a process to ensure all required pre-employment checks were undertaken prior to staff being employed. The full comprehensive report from this inspection can be found by selecting the ‘Reports’ link for Langstone Way

Surgery on our website at https://www.cqc.org.uk/location/1-540666441.

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 requires improvement overall.

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

• The practice did not always follow guidance for the safe management of medicines.
• The practice did not have an overarching policy in place to govern how significant events were managed.
• The practice had a business continuity plan in place but this had not been reviewed for more than three years and did not include details of arrangements with a buddy practice.

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

• There was no assurance that patients needs were consistently assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.

We rated the practice as requires improvement for providing well-led services because:

• The practice did not have clear and effective processes for managing risks, issues and performance.
• We saw little evidence of systems and processes being reviewed to identify and share learning.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider should make improvements are:

• Review processes in place for undertaking criminal record checks to ensure these have been completed for staff who require them.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Good overall. (Previous inspection July 2015 – Good). 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

We carried out an announced comprehensive inspection at Langstone Way Surgery on 27 July 2015. The practice was rated good overall and requires improvement for safe. The full comprehensive report from this inspection can be found by selecting the ‘all reports’ link for Langstone Way Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 8 May 2018 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 in our previous inspection on 27 July 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found:

• Data from the Quality and Outcomes Framework (QOF) demonstrated that the practice was performing in line with local and national averages for patient outcomes in most clinical areas although exception report rates were significantly higher than local and national averages for some clinical indicators.
• The practice had some systems to manage risk so that safety incidents were less likely to happen. However, we noted that even though the practice told us that it had been subject to two attempted arson attacks in the recent past, a fire risk assessment had not been undertaken within the previous three years.
• The practice had not carried out appropriate Disclosure and Barring Service checks on locum clinical staff and had not ensured that these checks had been carried out by any other registration body, for instance, NHS England.
• Staff acting as chaperones had received Disclosure and Barring Service checks and had received appropriate training for the role.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided but processes used to record annual health reviews and those used to except patients with mental health conditions and some long term conditions were not effective.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• There was a positive and open culture and staff felt supported by the practice leaders.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely.

The areas where the provider should make improvements are:

• Consider providing training to non-clinical staff to raise awareness of ‘red flag’ symptoms of acute, life threatening conditions that might be reported by patients.
• Review arrangements for receiving requests for repeat prescriptions to ensure that patient identifiable information is secure.

• Review processes used to exception report patients with long term conditions with a view to more accurately reflecting the actual level of care provided to patients.

• Consider putting a process in place to ensure that staff acting as chaperones follow practice policy by recording their attendance during consultations.
• Consider providing additional training to staff responsible for submitting performance data to ensure that data is accurate and is provided in a timely manner.
• Review how clinical staff record details of annual reviews in the patient management system.
• Consider putting arrangements in place to encourage patients to attend annual health reviews.
• Follow through with plans to ensure that all non-clinical staff receive annual appraisals.

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 Langstone Way Surgery on the 27 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring, responsive and well-led services. The practice required improvement for providing safe services. It was also good for providing services for older people, people with long term-conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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 infection control.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• 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 there was continuity of care, with urgent appointments available the same day.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Ensure infection control leads are provided with infection control training and the practice maintains cleaning schedules. To ensure that infection control audits are carried out in accordance with national guidelines.

In addition the provider should:

• Provide equality and diversity and fire safety training to its staff team.

• Continue to raise patient’s awareness of the availability of the Patient Participation Group (PPG) (A PPG is a group of patients registered with a practice who work with the practice to improve services and the quality of care), and online booking facilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice