This practice is rated as Good overall. (Previous inspection July 2017 - Good)

We carried out an announced comprehensive inspection at Longfield Medical Practice on 9 May 2018.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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.
• Most 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 improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• All clinicians should use the risk stratification tool as recommended by the National Institute for Health and Care Excellence guidelines to identify and manage patients with severe infections, for example, sepsis.
• The practice should develop the induction training programme for newly recruited staff so their ongoing competence can be assessed.
• More detailed records should be kept of any meetings held to ensure good communication.
• A record should be kept of any actions taken following guidance issued by the National Institute for Health and Clinical Excellence.

Please refer to the Evidence Tables for further information.

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 Longfield Medical Practice on 10 January 2017. The full comprehensive report on the 10 January 2017 inspection can be found by selecting the ‘all reports’ link for Longfield Medical Practice on our website at www.cqc.org.uk. The overall rating for the practice was good however we rated the practice as requires improvement for providing responsive services as the arrangement in place for managing the following issue was not adequate:

• The availability of non-urgent appointments had not been reviewed in light of patients raising concerns about not being able to get through to the practice by phone in order to book an appointment.

In addition we identified the following issues the service should improve:

• A record was not always kept of clinical staff meetings to ensure issues identified were followed up and monitored.

• Practice specific policies and procedures did not always reflect the practices carried out by staff or identify their source, i.e. National Institute for Health and Care Excellence.

• The mental and physical health care needs of patients with mental health problems were not always monitored closely to ensure their care needs were being fully met.

In line with agreed timescales the practice supplied documentary evidence to demonstrate how they intended to improve their practices in relation to the overview of responsive services since the last inspection.

This inspection was an announced focussed inspection carried out on 25 July 2017 to confirm that the practice had carried out their plan to meet the improvements that we identified in our previous inspection on 10 January 2017.

At this inspection we found that sufficient improvement had been achieved to update the rating for the provision of responsive services to good. This report covers our findings in relation to those improvements.

Our key findings were as follows:

• A record was now kept of clinical staff meetings.

• The physical and mental health care needs of patients with mental health problems were monitored more closely.

• Policies and procedures were currently being reviewed.

• Additional staff had been recruited and a new telephone system had been installed to improve patient’s access to the 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 at Longfield  Medical Practice on 15 March 2016. The overall rating for the practice was requires  improvement. The full comprehensive report on the 15 March 2016 inspection can be found by selecting the ‘all reports’ link for Longfield Medical Practice on our website at www.cqc.org.uk.

We carried out this announced comprehensive inspection at Longfield Medical Practice on 10 January 2017. Overall the practice is now rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff were trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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 in the patient waiting area although it was on the practice website.
• Patients said they found it difficult to get through to the practice by telephone to book an appointment.
• 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 on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had a newly established patient participation group.

The areas where the provider should make improvement are:

• A record should be kept of clinical staff meetings to ensure issues identified are followed up and monitored.

• Practice specific policies and procedures should reflect the practises carried out by staff and identify their source, i.e. National Institute for Health and Care Excellence.

• The mental and physical health care needs of patients with mental health issues should be monitored more closely to ensure their needs are being fully met.

• The availability of non-urgent appointments should be reviewed in light of patients raising concerns about not being able to get through to the practice by phone in order to book an appointment.

rofessor 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 Longfield Medical Practice on 15 March 2016. Overall the practice is rated as requires improvement.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver care and treatment.
• 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 they found it difficult to make an appointment with a named GP.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Full clinical audits were not routinely carried out. We saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• Information about services was available but not in different languages.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity.
• The lift regularly broke down. When this happened rooms in a neighbouring practice in the same building were used for patients who could not use the stairs. These rooms were not always appropriate as clinical equipment was not always available.
• There was a leadership structure and staff felt supported by management.
• The practice did not have a patient participation group.
• The Friends and Family test (FFT) for January and February 2016 indicated that while patients generally gave a positive response to how likely they were to recommend the practice, four raised concerns about the difficulty patients experienced when they tried to book an appointment. This was also raised in the GP patient survey which reflected that 23.8% of patients said they could get through easily to the surgery by phone (CCG average 68.2%, national 73.3%).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Longfield Medical Practice on 26 April 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.