The Care Quality Commission
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  • GP practice

Archived: Long Melford Surgery

Overall: Requires improvement read more about inspection ratings

The Long Melford Surgery, Cordell Road, Long Melford, Sudbury, Suffolk, CO10 9EP (01787) 378226

Provided and run by:
Long Melford Surgery

All Inspections

18 April 2023

During a routine inspection

We carried out an announced inspection at Long Melford Surgery on 18 April 2023. Overall, the practice is rated as requires improvement.

Safe - requires improvement

Effective - requires improvement

Caring - good

Responsive - requires improvement

Well-led - requires improvement

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Long Melfgord Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up on breaches of regulation from the previous inspection.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit to both the main and branch sites.

Our findings

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 found that:

  • The leadership had improved and systems had been developed and put in place to provide safe and effective care and treatment was delivered for patients. However, these systems needed to be embedded for assurance they would be sustained.
  • The practice had developed comprehensive systems and processes to identify and mitigate risks.
  • The practice performance in relation to patient feedback around access was poor and, in some domains was significantly below local and national averages. The practice had carried out their own feedback survey in January 2023 which showed an 85% positive response to the same questions asked in the GP national survey.
  • The practice had suffered a number of challenges following the installation of a new clinical system in November 2021. They told us this had contributed to inconsistencies in their data. They had implemented a monitoring system to review patients records and improve the data recorded.
  • The local integrated care board (ICB) had worked with the practice to develop an action plan that showed improvements had been made, however, these were still not completed. These improvements need to be embedded and monitored to ensure they would be sustained.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

Whilst we found no breaches of regulations, the provider should:

  • Continue to encourage patients to participate in national cancer screening.
  • Continue to seek patient feedback and learn from findings to improve their patients experience.
  • Continue to work through the areas not completed on the action plan including the improvements made to patient records keeping and medicine reviews.
  • Continue to embed the quality improvement plan and audits for assurance they will be sustained.

I am taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

05 September 2022

During an inspection looking at part of the service

We previously carried out an announced inspection at Long Melford Practice on 19 July 2022. Overall, the practice was rated as inadequate and placed into special measures. As a result of the concerns identified, we issued a Section 29 warning notice on 29 July 2022 in relation to a breach of Regulation 12 Safe Care and Treatment, requiring them to achieve compliance with the regulation by 5 September 2022.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Long Melford Practice on our website at www.cqc.org.uk

Why we carried out this inspection

We undertook a focused inspection on 5 September 2022 to check that the practice had addressed the issues in the warning notice and now met the legal requirements. This report only covers our findings in relation to those requirements and will not change the ratings.

At the inspection, we found that the requirements of the warning notice had not been met.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to work remotely without conducting a site visit. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider

Our key findings were:

  • The systems and processes in place had been improved to support safe use of medicines. However, some of these actions had not had sufficient time to be fully completed and some patients were still awaiting review.
  • There was progress towards an improved system to manage patient safety alerts. However, we noted the practice had not fully reviewed historic alerts to ensure they understood and incorporated the risks associated with the alert.
  • The practice had prioritised the issuing of emergency steroid cards after our previous inspection; we found some improvements had been made but there were still gaps in the system.
  • The practice was in the process of reviewing patients to ensure that regular, appropriate and comprehensive medicines reviews were undertaken.
  • We noted that the practice had installed a new clinical system in November 2021, they told us this had been challenging and may have contributed to the inconsistency of data. The practice had upcoming training which they hoped would address concerns identified and support improvements in their action plan.
  • After the inspection of July 2022, the practice, with the support of the Integrated care Board (ICB), shared an action plan and we could see improvements in some areas. These improvements need to be embedded and monitored to ensure they are safe and effective and will be sustained.

The provider must:

  • Ensure care and treatment is provided in a safe way to patients.

For further information see the requirement notice at the end of this report.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

19 July 2022

During a routine inspection

We carried out an announced inspection at Long Melford Practice on 19 July 2022. Overall, the practice is rated as inadequate.

Safe - Inadequate

Effective - Inadequate

Caring - Good

Responsive - Inadequate

Well-led - Inadequate

Following our inspection published January 2017 the practice was rated as requires improvement overall and for safe and well-led services. The practice was rated as good for effective, responsive and caring services. At our inspection on 25 July 2017 the practice was rated good overall and for safe and well led services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Long Melford Practice on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection. We undertook this inspection as part of our regulatory role and in response to information we had received.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A site visit to both the main and branch site
  • Staff questionnaires

Our findings

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 Inadequate overall

We found that:

  • The lack of leadership had failed to ensure safe and effective care and treatment was delivered to all patients.
  • The practice was unable to demonstrate that good systems and process were in place, and that they were regularly used to identify and mitigate risks. Any systems that were in place had not been monitored effectively to identify poor performance or service delivery to encourage improvement.
  • The practice performance in relation to patient feedback around access was poor and, in some domains, significantly below local and national averages. The practice was aware of this but had not been able to make sufficient changes to address the issues. Feedback from the Patient Participation Group (PPG) was negative in respect of engagement with the practice GP leaders.
  • We noted the practice had installed a new clinical system in November 2021, they told us this had been challenging and may have contributed to the inconsistency of data.
  • Although since our inspection July 2022 the practice have, with the support of the Integrated care Board (ICB) shared an action plan and have in areas made some improvements. These improvements need to be embedded and monitored to ensure they are safe and effective and will be sustained.

We found breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Whilst we found no breaches of regulations, the provider should:

  • Continue to encourage patients to attend for the national cancer screening programme.
  • The practice should embed the newly implemented systems to manage and monitor complaints and significant events. This should include improved ways of monitoring changes and sharing learning and outcomes with staff.
  • The practice should continue to identify ways to engage with the patient participation group (PPG) and patients to improve patient feedback, especially in relation to access to the practice.

I am placing this service in special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Following the inspection, a warning notice was issued under Section 28(3) of the Health and Social Care Act.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

25 July 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Long Melford Surgery on 9 January 2017. The overall rating for the practice was requires improvement, with requires improvement for providing safe and well led services and good for providing effective, caring and responsive services. The full comprehensive report on the 9 January 2017 inspection can be found by selecting the ‘all reports’ link for Long Melford Surgery on our website at www.cqc.org.uk.

We undertook a focused inspection on 25 July 2017 to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 9 January 2017. This report only covers our findings in relation to those requirements.

Overall the practice is now rated as good, and good for providing safe and well led services.

Our key findings from this inspection were as follows:

  • Dispensing errors were recorded and reviewed within the practice and errors which were deemed significant by the practice were raised as significant events and managed effectively.
  • Patient safety alerts were logged, shared, initial searches were completed and the changes effected.
  • All clinical staff and the dispensary delivery driver had a Disclosure and Barring Service (DBS) check. (DBS 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).
  • Risks to patients and staff were assessed and well managed, including those related to infection control. Safe practices were in place in relation to the cleaning of spilt body fluids and requests for home visits.
  • Staff sought patients’ consent to care and treatment in line with legislation and guidance and relevant information was available to staff which included The Mental Capacity Act (2005).
  • The practice had undertaken work to improve the identification of carers. The practice had identified 308 patients as carers (3.2% of the practice list). Suffolk Family Carers attended the practice on a monthly basis in order to support carers. Information was available in the waiting room for support groups and organisations aimed to help and advise carers.
  • An effective process was in place for the development, approval, sharing and review of policies and procedures.
  • There was an effective governance process in place to assure the practice that risks to patients and staff were identified, acted upon, monitored and reviewed. This included auditing minor surgery outcomes, complications and infection rates and staff training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

09/01/2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Long Melford Surgery on 9 January 2017. Overall the practice is rated as requires improvement.

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

  • There was an effective system in place for reporting, recording and learning from significant events. However, there was scope to ensure that all dispensing errors were investigated as significant events to minimise the chance of a similar error occurring again.
  • Health and safety risks to patients were assessed and managed. However, not all nursing staff had a Disclosure and Barring Service check.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment, although e-learning deemed mandatory by the practice had not been completed by the majority of staff.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Fortnightly multi disciplinary team meetings took place to discuss, review and plan ongoing care and support for older patients, including those who were vulnerable.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The majority of patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
  • The practice was well equipped to treat patients and meet their needs.
  • The practice ran weekly searches for prescriptions which were past their review date and gave these to the GPs to review so they could be proactive in resolving any issues that could arise.
  • All the staff we spoke with felt supported by management. The practice sought feedback from staff and patients, which it acted on.
  • Regular governance meetings were held, although some policies were overdue for review and audits to provide assurance that patients were safe were not proactively undertaken.

The areas where the provider must make improvements are:

  • Review the arrangements for the cleaning of body fluids by ensuring they meet the requirements as detailed in the Health and Social care Act (2008) Code of Practice for health and adult social care on the prevention and control of infections and related guidance.
  • Ensure that all nursing staff have a current Disclosure and Barring Service check.
  • Ensure there is an effective governance process in place to assure the practice that risks to patients and staff are identified, acted upon, monitored and reviewed. This includes auditing minor surgery outcomes, complications and infection rates.

The areas where the provider should make improvement are:

  • The practice should be able to provide evidence of actions taken in response to relevant alerts and updates issued from the Medicines and Healthcare products Agency (MHRA) and through the Central Alerting System (CAS).
  • Ensure that all dispensing errors identified are discussed within the practice and that all dispensary standard operating procedures (SOPs) are clear, detailed and reviewed and that staff sign up to, and date when they have read each SOP.
  • Ensure that staff complete e-learning and training deemed mandatory by the practice and that this is recorded effectively.
  • Ensure there are regular documented cleaning audits.
  • Continue to prioritise the identification of patients who are carers.
  • Ensure that policies and procedures are regularly reviewed, ratified and that all staff are aware of how to access them if needed.
  • Ensure that information on The Mental Capacity Act (2005) is available to staff.
  • Ensure that guidance is available for non-clinical staff when managing requests for home visits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice