We carried out an announced comprehensive inspection at Langton Grange Medical Centre on 22 January 2019 as part of our inspection programme. We did not inspect the branch surgery at Whittington as part of this inspection.

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 good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• 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 way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We found one area of outstanding practice:

• The practice had initiated a GP led dedicated care plan for older people living in a supported environment. The GP would visit any new patient and develop the plan with them. The plan took account of all current best practice and joined together all future planning requirements across many agencies. This was kept at the patients place of residence and was on yellow paper so it could easily be identified. We saw evidence that the practice was in discussion with the 111 service to update the call protocol to identify when a yellow plan was in use within the specified post code area, to support reduced hospital admissions. The plan had been well received by local care organisations and had also been recognised as an ideal plan to use for a locality wide frailty initiative.

The areas where the provider should make improvements are:

Continue to review the impact of changes made by the practice to improve timeliness of patient access.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected this service on 21 April 2015 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found the practice to be good in the safe, effective, caring, responsive and well-led domains. We found the practice provided good care to older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health.

Our key findings 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 general risk assessments relating to the environment and working practices.
• 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 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.
• The majority of patients told us they were able to book appointments when required. However, other patients told us it was difficult to contact the practice by telephone, and often when they got through, all of the same day appointments had been taken.
• The practice had good facilities and was well 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.

We saw several areas of outstanding practice including:

• There was a clear understanding among staff about safety and learning from incidents. Concerns, near misses, significant events (SE’s) and complaints were appropriately logged, investigated, actioned and reviewed. All staff were actively encouraged to raise issues and attend the meetings where significant events and vulnerable patients were discussed. Staff were confident to raise issues and were fully informed about any learning that needed to take place to prevent incidents happening again.
• The practice had achieved the Quality Practice Award by the Royal College of General Practitioners in 2010. Quality Practice Award is the highest attainable award available from the college encompassing a large clinical component and assessment of patient experience.

The provider should:

• Carry out risk assessments to manage and monitor the risks to patients, staff and visitors.
• Ensure that any discussions relating to changes to National Institute for Health and Care Excellence guidance and implications for the practice are recorded for future reference.
• Seek to identify patients who also have caring responsibilities during consultations.
• Review the access to and availability of appointments, and how the reception desk and telephones are manned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice