Lister Medical Centre

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We rated the provider as good for caring services because the 2024 National GP Patient Survey showed the overall experience of their appointment had risen by 4%. There had been a 5% increase in patients feeling healthcare professionals treated them with care. An increase of 4% was positively noted for people feeling listened too. Involving people in their care had positively rose by 7% and confidence and trust in a healthcare professional had increased by 12%. This demonstrated the providers ability to improve caring.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We reviewed different sources of feedback ranging from NHS national GP patient surveys, feedback and complaints sent to CQC as well as to the practice, online patient complaints and patient interviews on inspection. Prior to the inspection, we received patient feedback, 2 of which were positive and only related to staff attitude. One patient told us the administration and medical staff at the practice had been understanding and patient through their illness. Unverified online reviews gave mixed feedback regarding staff attitude with some reporting some reception staff were rude, defensive and unhelpful, as well as not showing compassion for patients mental health, whilst others said staff attitude was hit and miss, whilst positive feedback received in 2023 praised clinicians and some staff for listening to them, as well as showing kindness and compassion. The January to April 2023 national GP patient survey results available at the time of inspection showed 73% of patients said the last time they had a general practice appointment, the healthcare professional was good or very good at listening to them; however, this was lower than the local average of 83% and national averages of 85%. Although the practice was tending a negative variation in this indicator, performance in this area had improved from 69% in the 2022 results. 91% of patients stated that during their last GP appointment they had confidence and trust in the healthcare professional they saw or spoke to and this was in line with the local average of 91% and national average of 93%. This data had also improved from 80% in the 2022 survey results.

We gathered all staff views as part of our inspection. Some staff told us the practice had a very friendly atmosphere, with everyone willing to work hard for one another, whilst putting patients first. Leadership told us there had been a lot of personnel changes as a result of feedback. The current staff team told us that they felt a positive and embedded kindness and caring workforce. Where there had previously been staffing concerns of caring responses lacking, these had been acknowledged and addressed. The provider had listened to peoples feedback and was in the process of implementing a ticket call system to support people with poor mobility. People could take a ticket and remain seated until their number was called to enable privacy and also support poor mobility. The practice told us where they had been made aware of poor staff attitudes, they had acted appropriately and taken the required disciplinary measures. Most of the non-clinical staff had received customer care training. Leaders worked with the local integrated care board patient experience team and their local MP to address any concerns or compliments raised. Positive experiences for people were one of the core values the provider had developed and putting people first was their priority. The practice were realistic to understand although they could never meet all patient satisfaction, they felt the changes implemented had made the maximum impact positively and remained clinically safe to provide services. The provider told us staff had confidentiality clauses in their contracts of employment and signed a confidentiality agreement and expected to adhere to the Confidentiality: NHS Code of Practice 2003.

When we carried out our onsite visit, we observed staff treating patients with kindness. We also observed the difficulties reception staff had in being able to book appointments for patients without redirecting them to the practice website to complete the online form had an impact on them, as they felt helpless to assist patients. We observed the practice premises to be large enough to facilitate private conversations. A confidentiality policy was in place and staff had signed confidentiality agreements.

Some patients did not always feel they were treated as individuals. One patient reported they were not always in control of planning their care due to the GP not communicating with them. One patient reported the GPs had left them in limbo with a serious health condition, for over 3 months with no communication whatsoever in relation to required medicine changes. Despite receiving assurances that something would be done and they would be contacted, they heard nothing from the practice and no progress was made. This had an impact on the patient's confidence which deteriorated when their condition worsened and caused them to not want to leave the house or socialise with anyone, leaving them feeling isolated. We also received feedback that some elderly patients registered with the practice who could not access the practice online system were also unable to access the practice via other means. We looked at NHS reviews and saw patient feedback relating to lack of care when patient presented with low mood. Some positive feedback sent to CQC said patients felt they received excellent treatment from the practice. We also reviewed 8 compliments sent on the practice website and patients complimented staff on being kind and supportive and working together with them to create a care plan. The patient said they were given time, listened to and understood what they needed to do.

Leaders told us positive experiences for people were one of the core values the provider had developed and putting people first was their priority. Staff told us since November 2023, they implemented a total triage service where the patient completes a link with their request. They told us patients who were not able to go online could ask reception staff to complete the online form on their behalf.

There was a mission statement in place that stated, 'Care is our core business and the care we deliver helps the individual person and improves the health of the whole community. People receiving care expect it to be right for them, consistently, throughout every stage of their life. We have teams of both clinical and nonclinical staff who look after our different groups of patients from birth to end of life'. However, significant access difficulties experienced by patients meant that the practice were not consistent in adhering to this statement. People’s communication needs were not always met to enable them to engage in their care, treatment and support to maximise their experience and outcomes because despite their policy to allow reception staff to complete patient online request forms, the issues surrounding poor access into the service had an impact on patients having their individual needs met. Patient feedback sent to CQC reported that patients who tried to ask reception staff for help to use the online system were often told they could not help them. For example, an elderly patient could not access the practice when family members tried to book online and when they went to the practice to seek assistance at the reception desk, they were told the same and could not access appointments. There was no assurance of how elderly patients needs were considered in relation to access.

When we reviewed patient experience using the the January to April 2023 national GP patient survey data, we found 89% of patients were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment and this was in line with the the local and national averages of 90%. This had improved from at the previous inspection where 81% of patients were involved in decisions about their care and treatment. Patients told us they did not feel in control of how they communicated with the practice, mostly due to access issues. One patient told us the practice check in system was not working and this was not isolated as the practice always experienced issues with their check in system and another patient told us their booking system was down half the time. People told us the website would pause taking requests often as soon as it opened at 8am due to capacity and patients were often left with no choice or control over their care as they were directed to NHS111 for 999 for non-emergency related issues such as when they were requesting medicines reviews.

The provider felt there was an increase in patient satisfaction since the new appointment system was implemented. They also told us people had access to activities in the local community to promote and support their independence, health and wellbeing; for example, they had access to community outreach such as, Streets to Homes for homeless patients, Open Road for Drug & Alcohol services, 'Place to be' for children with mental health needs and a service dedicated to mothers and children at risk of or suffering from domestic abuse. The practice told us they facilitated giving vaccines in their car park for patients who struggled to attend the practice due to sensory issues or people could sit and wait in their car for appointments and be called in when their appointment was scheduled.

We were not assured there was an increase in patient's satisfaction since the total triage system was implemented, or that the provider had sufficient insight into the significant difficulties patients were facing regarding how they were supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing. As well as the national GP patient survey, the provider utilised many forms of in house feedback that was collated and analysed monthly. These findings were then discussed within a clinical governance practice meeting and all proposed changes were shared with staff and the patient participation group before being discussed with senior leadership for approval. Streamlining processes to include patient voices were a priority for staff and gaining peoples feedback before the changes were made were positively spoken about by staff and patients.

National GP patient survey data for January to March 2023 showed 50% of people responded positively to the overall experience of their GP practice but lower than the local average of 66% and national average of 71%. Although performance for this indicator had improved from the 2022 data of 46%, the practice continued to tend towards a negative variation. We were given 40 mixed feedback responses from people who told us they could not always access care in a timely manner. People told us the practice did not always recognise their urgent needs as a result. For example, one patient told us the practice had failed to recognise their covid-19 and sepsis symptoms and the people told us they were often redirected to accident and emergency by reception staff for non-urgent conditions.

The provider was located in a deprived area of Hertfordshire and Essex integrated care board and the practice and stakeholders had recognised a need to support people with mental health conditions. Emergency patient support was available for rapid response. The duty or emergency doctor was available to triage, to deal with any immediate need in the practice or over the telephone from 7am to 6.30 pm and home visits were available for patients that required them. Access to a Rapid Intervention Service (RIS) car was utilised to visit patients at home who were unwell. This was used for prevention of an admission to hospital and also gave oversight of patients who may have needed to be taken to hospital. A ‘Virtual hospital’ service to support patients at home was also accessible. A ‘Falls car’ service could attended the homes of patients who had fallen and the service supported with immediate assistance or onward referrals as required. The provider told us homeless patients could register with the practice without proof of identification, or proof of address and they were supported by care co-ordinators and link workers to make referrals for them and social prescriber to support them with their medical and social needs.

Staff told us there were regular meetings which included staff feedback as an agenda item. When rolling out new changes at the practice, staff comments, ideas, thoughts and suggestions were noted and discussed. Leaders told us they engaged with staff and listened to their comments and thoughts. Concerns and compliments were also welcomed during staff meetings. Leaders told us there was an open door policy and staff had requested support such as bereavement and other life events, mentoring and coaching, phased return to work, adjustments to working hours and flexible working.

The practice told us they promoted staff wellbeing. They had an Employee Assistance programme for staff to access. We saw evidence where staff benefited from providing feedback. For example, the provider replaced old chairs in the PCN suite which were old, non-adjustable and worn out with new ones following staff feedback. A staff survey was carried out in October 2022 which was carried out by an external consultant. The results showed a positive increase to staff feeling listened to and the provider was working with an external company to conduct another staff survey. Staff who experienced difficult situations were given individualised de-brief sessions. For the past 2 years, the provider arranged afternoon tea at a nearby hotel to promote staff engagement. The practice organised festive treats for staff and organised an annual festive parties. Any compliments received were anonymously published on the practice website. Staff who went above and beyond were given thank you gifts to recognise their hard work.