Longton Hall Surgery

Updated 23 June 2017

Longton Hall Surgery is registered with the Care Quality Commission as a GP partnership and is located in Blurton, Stoke on Trent. The provider holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. The practice is a member of the NHS Stoke On Trent Clinical Commissioning Group (CCG).

The practice is situated in a single storey building leased from a private landlord and managed by three male GP partners. The partners are assisted by two salaried female GPs, one advanced nurse practitioner, one nurse prescriber, one practice nurse and a health care assistant. The clinical team is supported by a practice manager, a secretary and a team of administrators and receptionists. The practice is an approved GP teaching practice and supports medical students.

The practice serves a population of around 6450 patients living in the Stoke On Trent CCG area. The practice age distribution is comparable to CCG and England averages, with the exception of female and males aged 30-39 years, which is slightly lower than CCG and England averages. The practice has a lower percentage of unemployed patients (3%) compared to the CCG average of 7% and the national average of 4%.

The practice is open from 8.30am to 6.00pm Monday to Friday. The practice offers extended hours on a Tuesday evening from 6.30pm to 9pm. The practice is closed from 12.30pm to 2pm on a Thursday for staff meetings. Routine appointments can be booked in person, by telephone or on-line. Home visits are available to patients with complex needs or who are unable to attend the surgery. The out-of-hours service provider is Staffordshire Doctors Urgent Care Limited accessed through dialing 111.

Consultation times with GPs are available in the morning from 8.30am to 11.30am and from 3pm to 5.30pm in the afternoon. Consultation times with nurses are available in the morning from 8.30am to 12.30pm and from 2.30pm to 5.30pm in the afternoon.

In preparation for the inspection we identified that the practice had changed their partnership, although applications to vary the CQC registration to reflect the changes had not been received. The provider was in the process of submitting the relevant applications.

Updated 23 June 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Longton Hall Surgery on 4 July 2016. The overall rating for the practice was Good with requires improvement in providing safe services. The full comprehensive report from the 4 July 2016 inspection can be found by selecting the ‘all reports’ link for Longton Hall Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 13 June 2017 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 4 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

• The provider had improved their system and processes for ensuring they had received all alerts issued by external agencies about medicines that may affect patients’ safety. However, they were not consistently running searches to identify patients that may be at risk associated with the alerts.

• The provider had ensured recruitment checks for most staff met legislative requirements.

• The provider had improved the system for ensuring that the monitoring of patients who took long term medicines on a shared care basis had taken place before medicines were prescribed.

• The provider had reviewed and updated their risk register of vulnerable patients and these patients were clearly identified to staff on the practice computer system.

• A programme of continuous clinical and internal audit to monitor quality and to make improvements had been implemented.

We also saw the following best practice recommendations we previously made in relation to providing effective and caring services had been actioned:

• The provider had improved the identification of patients on their register who were carers and were looking to embark on a carers’ scheme.

• The provider had ensured that all staff had timely access to training including safeguarding adults and infection control.

However, there was still an area of practice where the provider could make improvements.

The provider should:

• Ensure searches are carried out to identify any patients that may be at risk associated with all alerts received from external agencies that may affect patient safety, for example from the Medicines and Healthcare products Regulatory Agency (MHRA), and actioned.

• Include parents and siblings of children recorded on the safeguarding register.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 August 2016

The practice is rated as good for the care of people with long-term conditions.

• The practice offered specialist clinics to address the needs of patients with long-term conditions such as diabetes.

• Performance for the five diabetes related indicators was comparable to the local and national averages. For example, the percentage of patients with diabetes, on the register, in whom a blood pressure reading was recorded was 79% compared with the local average of 80% and the national average of 78%.

• Longer appointments and home visits were available when needed. The practice had improved access with nurse appointments available on Tuesday evenings and Saturday mornings for patients to attend annual reviews outside of working hours.

• The practice held in-house education events to include diabetes and epilepsy.

• Patients had a structured annual review to check their health and medicines needs were being met and were supported by a multi-disciplinary team.

• Nurses were available to carry out reviews in patients’ own homes if they were unable to attend the practice.

Updated 19 August 2016

The practice is rated as good for the care of families, children and young people.

• The practice provided a range of sexual health and family planning services.

• Patients aged 16 and under had access to same day appointments. Appointments were available outside of school hours and the premises were suitable for children and babies.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had protection plans in place. Children who did not attend appointments were followed up or reported to the health visitor who visited the practice on a weekly basis. Formal safeguarding meetings were held quarterly.

• Immunisation rates were comparable to local averages for all standard childhood immunisations. Flu immunisations were available for pregnant women and small children.

• The practice’s uptake for the cervical screening programme was 81%, which was in line with the CCG average of 80% and the national average of 82%.

• A midwife visited the practice weekly to discuss any problems and collected documentation concerning new referrals.

Updated 19 August 2016

The practice is rated as good for the care of older people.

• The practice offered flexible appointments. The practice had recently changed its appointment system to improve GP continuity and improved access for older patients being accompanied to appointments by their family members.

• The practice had a call and recall system to ensure older people attended their appointments when necessary.

• Patients aged 75 and older had a named GP. Home visits by a GP were also available on a daily basis and by a nurse on a Thursday morning for patients with enhanced needs.

• The practice had been proactive in producing care plans for vulnerable older people.

• The practice leaflet was available in large print.

Updated 19 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified. The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, the practice offered extended hours on a Tuesday evening until 9pm with a GP or nurse, and on Saturday mornings from 9am to 11.40am to allow flexibility for patients.

• A range of online services were available, including booking and cancelling appointments, prescriptions and access to health medical records. Telephone consultations were also available.

• The practice utilised the electronic prescribing system (EPS) which meant prescriptions could be sent directly to the patient’s chosen pharmacy at the time of the consultation.

• The practice had a social media page for patients to access.

Updated 19 August 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice held a register of patients experiencing poor mental health and patients with dementia.

• Staff had recently received training in dementia to understand and support patients with dementia and their carers. The practice was in the process of becoming a dementia friendly accredited practice to enhance services for their patients.

• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had improved access by having a timed appointment system rather than a walk in service to avoid patients having to wait in a busy waiting room.

• Patients experiencing poor mental health were told how to access various support groups and voluntary organisations. Double appointments were available to allow sufficient time to deal with any complex issues.

Updated 19 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice displayed information in the waiting area about how to access local support groups and voluntary organisations.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. They held a register of vulnerable patients but the registers required review to ensure information was accurate.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.

• The practice held a carers register and written information was available to direct carers to avenues of support available to them. The practice acknowledged the need to increase the number of carers on their register.

• Staff received training sessions from the community learning disability nurse. They had also held an informal training session on experiencing visual impairment and physical disability within the practice. As a result, they had identified problems and ideas to improve patient experience.

• The majority of patients’ first language was English, however a translation service was available if needed and there was an open registration policy in place.