We carried out an announced comprehensive inspection at Longview Medical Centre on the 19th January 2016. The overall rating for the practice was good and Safe required improvement. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Longview Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 16 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 19th January 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ‘Safe care and Treatment’ and regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ‘Fit and proper persons employed.’

Our key findings were as follows:

• The practice had addressed the issues identified during the previous inspection.

• They had provided up to date DBS checks on all staff working at the practice.Staff files had been updated to include all required records in place when being recruited and starting at the practice.

• The systems in place for monitoring equipment and medicines had been improved to include regular audits. Staff had been updated on emergency procedures to follow in the event of needing help.

• All significant events were recorded and investigated with the finding shared with staff to promotelearning at practice meetings.

• Staff had been updated to how children at risk were monitored within the practice.

• All patient complaints including verbal complaints were recorded and investigated in line with the complaint policy. The policy has been updated to include details on how patients could escalate concerns if required.

• They had reviewed governancearrangements with staff including systems for assessing and monitoring risk and the quality of supervision. They carried out monthly risk assessments reviewing any risks within the environment.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Longview Medical Centre on the 19th January 2016. Overall the practice is rated as good.

Our key findings were as follows:

• Some aspects of managing safety needed further review. The systems in place for monitoring equipment and medicines showed that some equipment had not been checked and was out of date. Some staff did not know how to operate their emergency call system in the event of needing help and were unsure where emergency equipment and medications were stored. There was an inconsistency to the auditing and checking of these facilities, some had regular checks, while some audits had not been carried out routinely and did not include the oxygen or defibrillator.

• Governance systems lacked clarity for some staff.

• Repeat prescribing was well managed and the practice contributed to regular audits performed by CCG medicines management teams.

• The practice had a system in place to report, record and investigate significant events. However some events had not been recorded and shared with the team which limited learning from all events.

• Staff files lacked evidence of necessary checks required to show safe recruitment and selection procedures. Some files lacked any evidence of Disclosure and Barring Services (DBS) check. (These checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.)

• The practice had a safeguard lead and staff were aware of how to report safeguarding concerns. However some staff lacked clarity in how children at risk were reviewed within the practice.

• The clinical staff proactively sought to educate patients to improve their lifestyles by regularly inviting patients for health assessments.

• Staff had been supported in accessing training to meet their needs. Staff retention at the practice was good offering great stability and continuity of care to patients.
• We saw some complaints were well managed however staff had not documented verbal complaints. The complaints policy was in need of being updated to include advice on how patients could escalate their complaint if required.
• Appointments were well managed. Review of appointment availability week by week showed the practice consistently met patient demand for GP appointments. The practice regularly offered in excess of the basic numbers required which enabled patients to always access appointments when needed.
• The practice was clean and tidy. The practice had good facilities in a purpose built building with access for patients with disabilities.
• Patients spoke highly about the practice and the whole staff team. They said they were treated with compassion, dignity and respect and felt involved in their care and decisions about their treatment.
• The practice has a Patient Participation Group (PPG) who met with the practice staff throughout the year. They made suggestions throughout the year to help improve the service provided by the practice.

There were areas of practice where the provider must make improvements. The provider

must;

• Take action to ensure its recruitment policy, procedures and arrangements are improved to ensure necessary employment checks are in place for all staff and the required information in respect of workers is held. (Reg 19 Schedule 3).

• The systems in place for monitoring equipment and medicines should be improved to ensure continuous safety checks. Risk assessments must be up to date and show what actions are taken to reduce risks. (Reg 12)

There were areas of practice where the provider should make improvements: The provider should:

• Ensure all significant events are reported, recorded and investigated and findings shared with staff to promote learning.

• Review with all staff how children at risk were monitored within the practice.

• Ensure all patient complaints including verbal complaints are recorded and investigated in line with the complaint policy. The policy should be updated to include details on how patients can escalate their concerns if required.

• Review governance arrangements with all staff including systems for assessing and monitoring risks and the quality of the service provision.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice