Lawton House Surgery

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed all quality statements in this key question. Our rating for this key question is good overall. We found staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this. However, consent processes were not always effective.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs.

Staff and leaders were aware of the needs of the local community. Staff told us they checked people’s health, care, and wellbeing needs during health reviews.

The provider had systems and processes to keep clinicians up to date with current evidence-based practice. People’s immediate and ongoing needs were fully assessed. This included their clinical needs and their mental and physical wellbeing. Staff could add digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

People had no specific feedback on this area.

Staff and leaders were encouraged to learn about new and innovative approaches that evidence shows can improve the way their service delivers care.

The provider had systems to ensure staff were up to date with national legislation, evidence-based good practice and required standards. For example, the provider had a standing agenda item on the monthly meeting for National Institute for Health and Care Excellence (NICE) updates.

Representatives from the patient participation group (PPG) described their active roles in improving the service, such as conducting walk arounds and improving displays for patients.

Managers told us minutes of meetings were shared for staff who could not attend. However, not all staff felt they were kept up to date through meetings.

Partners had no specific feedback on this area.

The provider had processes in place, so information was shared between teams and services to ensure continuity of care, however there was no whole staff meeting. We asked for further clarification on how the practice ensured staff were communicated with effectively. Not all the meetings had standardised agendas. The development planning meetings had a standardised agenda which included learning from complaints and incidents, vulnerable patients, best practice/new guidance updates and practice news/updates. The practice employed four nurses at the time of inspection, however, there was no lead nurse at the practice.

People had no specific feedback on this area.

Staff identified patients who needed extra support and directed them to relevant services. This included patients in the last 12 months of their lives, patients at risk of developing a long-term condition and carers.

The practice had process in place to ensure that patients were told when they needed to seek further help and what to do if their condition deteriorated.

People told us they were able to get results to tests in a way that suited them as soon as they were available. People felt their health was monitored appropriately and explained to them.

Leaders and staff demonstrated a commitment to monitoring and improving outcomes for people who used the service. Our CQC GP specialist advisor reviewed two clinical audits the practice had completed and found both audits had been completed appropriately.

As part of the inspection a number of set clinical record searches were undertaken by a CQC GP specialist advisor remotely. The results from the searches demonstrated there were mostly effective processes in place to monitor people’s care and treatment. This meant that continuous improvements were made to people’s care and treatment.

The results from the clinical searches undertaken were mainly positive although some improvements were needed in order to effectively monitor and improve people’s outcomes. We found six patients who had potentially undiagnosed diabetes during our clinical searches. This meant the patients were at risk of not being monitored and treated and therefore at higher risk of complications. We reviewed five of these records in more detail. We told the practice this on the day of inspection. Following the inspection, the practice told us four patients were due to have tests repeated and they were non-diabetic currently. One patient was diagnosed, and an appointment booked for them to discuss this. There was not an effective system in place for monitoring hypothyroidism treatment. We found 15 patients with hypothyroidism who had potentially not had a thyroid function test for 18 months. We looked at five patient records in detail and found only two patients had been identified by the practice as overdue for monitoring. Following the remote inspection, the practice reviewed all the patients identified by the search and they told us two patients had the monitoring completed elsewhere and the results were normal, one patient had an appointment booked and they were awaiting responses for two patients.

People did not always receive information about care and treatment in a way they could understand and were not always given appropriate support and time to make decisions.

Staff told us they knew the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment.

There were systems and practices to ensure people understood the care and treatment being offered or recommended. However, we reviewed the consent forms used for children’s vaccinations, the form was incorrect, a standard pre-populated form was being used which was out of date.