Background to this inspection
Updated
10 March 2016
Langdon Hills Medical Centre provides primary care services to a population of approximately 7311 patients in the Basildon area. The surgery is close to Laindon town centre and can be accessed by bus. The premises are purpose built and the practice are planning to extend the building to improve services. The practice holds a General Medical Services (GMS) contract. There is parking for the disabled at the front of the building and translation services are available for those patients whose first language is not English.
The surgery has two female GPs, two male GPs and one practice nurse. There is also a practice manager and deputy and administration and reception staff
The practice population is slightly higher than the national average for younger people and children under four years, and for those of working age and those recently retired. It is slightly lower for older people aged over 75 years. Economic deprivation levels affecting children, older people and unemployment are lower than the practice average across England. Life expectancy for men and women are similar to the national averages. The practice patient list is similar to the national average for long standing health conditions and lower disability allowance claimants. The number of care home patients is comparable to national averages.
The surgery is open every day of the working week from 8.30am until 6.45pm. with no closures during the day. Telephone access is available from 8am. They offer both face-to-face and telephone appointments and aspire to offer a same day appointment for any patients wishing to see a GP. Patients also have access to advice on line and any queries submitted are dealt with on the day received by the practice.
In September 2015 Langdon Hills Medical Centre joined forces with twelve other local practices to form BB Healthcare federation . The hub offers routine appointments for patients who have difficulty attending during normal surgery times at alternating surgeries. The hub offers appointments at the following times:
- Monday to Friday from 6.30pm to 8pm and Saturdays and Sundays from 8am to 8pm. This service includes Bank Holidays including Christmas Day and New Year’s Day.
Emergency appointments are available throughout the day. The practice has opted out of providing GP out of hour’s services. Unscheduled out-of-hours care is provided by the NHS 111 service and patients who contact the surgery outside of opening hours are provided with information on how to contact the service. The out of hour’s provision is provided by IC24 and commissioned by Basildon and Brentwood CCG. This information is also available on their own and the NHS choices website
Updated
10 March 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Langdon Hills Medical Centre on 26 January 2016. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
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Patients were protected from abuse and avoidable harm as staff were confident to report serious incidents, whistle blow or challenge if they suspected poor practice.
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Risks to patients were assessed and well managed. Information about safety was monitored, appropriately reviewed and addressed. Learning from incidents was cascaded to staff.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. There were timely multi-disciplinary team discussions to ensure patients’ care and treatment was coordinated and the expected outcomes were achieved.
- Langdon Hills Medical Centre is a teaching practice and clinical staff and doctors were supported to participate in training and development which would enable them to deliver good effective quality care.
- Patients said they were treated with compassion and dignity 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.
- Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
- The premises were purpose built and maintained to an acceptable standard throughout the clinical areas. Access for disabled people was in place including parking for the disabled and washroom facilities.
- The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
- There was a clear leadership structure. Staff were appropriately qualified and competent to carry out their roles safely and effectively in line with best practice. Staff received satisfactory supervision and appraisal and were supported to undertake their continual professional development.
- Staff were involved in the vision of the practice and an effective communications structure was in place to keep them informed about issues.
The areas where the provider should make improvement are:
- The provider should develop systems to manage the safe storage and security of prescription pads in the clinical areas to ensure safe prescription practices at all times.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
10 March 2016
The practice is rated as good for the care of people with long-term conditions.
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All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
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The practice performance for the management of patients with long term conditions was similar to or higher than other GP practices nationally.
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The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority and referred to the community matron to support them at home to reduce the risk of readmission to hospital.
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Referrals for people diagnosed with a long term condition followed the care pathway appropriately.
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The practice performance for the management of people with diabetes was comparable to other practices and additional community clinics were provided at the medical centre to improve access for patients.
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Longer appointments and home visits were available when needed.
Families, children and young people
Updated
10 March 2016
The practice is rated as good for the care of families, children and young people.
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Minor surgery was available in the practice including removal of skin lesions, joint injections and aspirations. Contraception services including coil insertions and implants were provided on site so that patients’ needs were responded to in a timely manner.
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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 a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
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Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
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Appointments were available outside of school hours and the premises were adequate for children and babies. The waiting room was suitable and child friendly.
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The practice provided full paediatric services including child development checks. We saw positive examples of joint working with midwives and health visitors. In-house weekly midwifery services, post-natal and baby checks were available to monitor the development of babies and the health of new mothers. There was an emphasis on providing support to mothers and babies when they needed it including encouraging breastfeeding.
Updated
10 March 2016
The practice is rated as good for the care of older people.
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The practice offered responsive, proactive, personalised care to meet the needs of the older people in its population. Nationally reported data showed that outcomes for patients were comparable for conditions commonly found in older people.
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Home visits and urgent appointments were available for those patients with enhanced needs.
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A register of older people who needed extra support was in place. The percentage of people aged 65 or over who received a seasonal flu vaccination was comparable with the CCG and national averages.
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GPs worked with local multidisciplinary teams to reduce the number of unplanned hospital admissions for patients at risk, including those with dementia and those receiving end of life palliative care.
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A community matron worked with the surgery to oversee the care plans of older people discharged from hospital, making sure the patient (and/or their carer) was informed of changes to their care and treatment. Weekly GP ward rounds were in place for residents at a local care home to support patients and encourage health promotion.
Working age people (including those recently retired and students)
Updated
10 March 2016
The practice is rated as good for the care of working-age people (including those recently retired and students).
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The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
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Extended surgery hours were available during the week, at weekends and GP cover was in place for
Bank Holidays including Christmas Day and New Year’s Day.
People experiencing poor mental health (including people with dementia)
Updated
10 March 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
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The number of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months was 88%. Which was comparable to the national average.
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There was evidence of shared communication between the multi-disciplinary services that the practice used when referring patients for mental health assessments. Care plans were in place for those patients suffering with dementia, poor mental health and palliative care.
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The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Systems were in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
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Staff had received training and had a good understanding of how to support patients with mental health needs and dementia.
People whose circumstances may make them vulnerable
Updated
10 March 2016
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
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The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people to ensure that patients whose circumstances made them vulnerable were supported holistically.
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Patients who were at a higher risk of unplanned hospital admissions were supported and treated in their home.
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The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice promoted annual health checks for patients with learning disabilities.
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The practice carried out home visits to undertake health reviews as needed. The practice offered longer appointments for patients with a learning disability and worked with multi-disciplinary teams in the case management of vulnerable people.
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The practice informed vulnerable patients about how to access various support groups and voluntary organisations. 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 in normal working hours and out of hours.