Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Longshore Surgeries on 08 October 2014. We visited the main surgery and one of the two branch sites.  The inspection team was led by a CQC inspector and included two GP specialist advisors, a practice manage specialist advisor, a CQC pharmacist inspector and an Expert by Experience. 

We found that Longshore Surgeries provided a good service to patients in all of the five key areas we looked at. The practice provided a good service to patients across all age ranges and to patients with varied needs due to their health or social circumstances.

Our key findings were as follows:

• Longshore Surgeries were a caring practice with high quality committed GPs who provided a high level of personal care to their patients through the use of the “personal list” system. The staff were very committed to acting in the best interests of the patients.
• Patients were satisfied with the service and felt they were treated with dignity, care and respect and involved in in decisions about their care and treatment.
• There were systems in place to provide a safe, effective, caring, responsive and well led service.
• The needs of the practice population were understood and services were offered to meet these needs.  The practice was proactive in helping people in vulnerable circumstances and had ensured they had access to healthcare and had arrangements in place to make sure their health was monitored regularly.       
• The practice had chosen to become a training practice for registrar GPs and had developed a philosophy to ensure staff were well trained. This approach had enabled the practice to recruit staff and a partner GP. This had benefitted patients because the practice was better able to respond to the increased patient population demand.

We saw an area of outstanding practice where the practice has persevered over a few years to establish a regular GP visiting clinic at a traveller site. This proactive approach by the surgery had ensured that patient were registered with a GP practice and had access to primary care. In addition we found that this had prevented unnecessary visits to hospital Accident & Emergency departments. 

However, there were also areas of practice where the provider should make improvements:

• The practice should ensure that when significant events are reviewed, any related learning points become a formalised part of the process and are recorded.
• The practice should ensure they keep under review known patient risks relating to the treatment of underactive thyroid, patients prescribed Warfarin and those patients receiving Lithium treatment.  
• The practice should review their security arrangements for the accounting and recording of prescription pads and access to the branch dispensary.
• The practice should implement a system to check the quality of cleaning undertaken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating March 2015 – Good)

The key questions at this inspection 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 Longshore Surgeries on 21 November 2018. This was part of our planned inspection programme.

At this inspection we found:

• The practice had an effective system in place for raising and responding to significant events. When these happened, the practice learned from them and improved their processes.
• The practice had some systems to manage risk. However, some actions from the fire risk assessment and the Legionella risk assessment needed to be completed, although dates had been confirmed. However, we noted some hot water temperature checks were not above the minimum recommended temperature. The practice had not completed a premises/security and health and safety risk assessment, and checks were not formalised or documented.
• The practice had some equipment which had not been calibrated. This was acted on immediately by the practice with the decision to postpone all non-urgent electrocardiograms (ECGs) and to refer patients who needed an urgent ECG. Patients who had a nebuliser on loan were contacted, and the nebuliser had been returned. The practice decided to stop loaning nebulisers to patients.
• The practice was highest in the Clinical Commissioning Group (CCG) for the prevalence of six long term conditions and in the top five practices for the prevalence of a further seven long term conditions. The practice routinely reviewed the effectiveness and appropriateness of the care it provided and care and treatment was delivered according to evidence-based guidelines.
• The practice was aware of their areas of lower performance and had acted to try and improve these areas. For example, they were a high prescriber of opiates and had acted to start to reduce their prescribing in this area. They worked with the CCG in relation to their prescribing. They had improved their system for the recall of health checks for patients with a learning disability.
• The practice had a positive relationship with a local traveller community and over time had established and maintained a weekly onsite clinic. There had been significant improvement in the uptake of cervical screening and immunisation. Feedback from the travellers we spoke with were extremely positive, particularly about the complete trust they had in the GPs, how they were seen in their own homes and the ability the GPs had in speaking and engaging with travellers of all ages.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patients were informed and involved in decisions about their care and treatment.
• Patients did not all find the appointment system easy to use. The practice was aware of this, had acted to improve this and continued to review how this could be further improved.
• There was a strong focus on traditional GP led, patient centred care and continuous learning and improvement at all levels of the organisation. Staff and trainees felt very supported by the leadership team.

We saw an example of outstanding practice:

• The practice had a positive relationship with a local traveller community and over time had established and maintained a weekly onsite clinic. There had been significant improvement in the uptake of cervical screening and immunisation. In 2003, the immunisation rate was approximately 33%; in 2017, 55% had been fully immunised and 45% had been partly immunised. This was due to some families moving and new families moving in and the need to build trust. This was based on 41 children. In June 2018, 100% of children had been immunised, which was 40 children. Feedback from the travellers we spoke with were extremely positive, particularly about the complete trust they had in the GPs, how they were seen in their own homes and the ability the GPs had in speaking and engaging with travellers of all ages.

The areas where the provider

must

make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to improve the uptake of health checks for people with a learning disability.
• Improve the documentation of staff induction records.
• Continue to work with the CCG in relation to prescribing, particularly with the prescribing of long term high dose opiates.
• Improve the system to ensure that medical equipment is calibrated.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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