Ling House Medical Centre

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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 from this key question and our rating is Good. Overall, we found the practice provided effective care and treatment for patients. A review of patient clinical records found that patients were safely managed by the practice. The practice was aware that there were areas of challenge with their childhood immunisation and cervical screening uptake. The practice was actively addressing this, and we saw they were involved in numerous women’s and child health initiatives to drive patient outcomes.

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.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns in this area.

The clinical and management team explained how patients requiring monitoring were supported and managed. This included inviting patients for annual health reviews and monitoring checks. Staff were trained to signpost patients to primary and voluntary care services to support them to access and receive appropriate care. The practice had a system to highlight any specific individual needs on their clinical system, such as the requirement for longer appointments or for a translator to be present.

As part of our assessment, a CQC GP specialist advisor (SpA) conducted a series of remote clinical searches of patient records to assess the practice’s procedures around the management of patients with long term conditions, which included asthma, chronic kidney disease, diabetes and hypothyroidism. We found good management of these patients and we saw effective annual reviews to check their health and medicines needs were being met. The practice had a high prevalence of patients with diabetes at 13% which was 3% higher than the local average and 5% higher than the England average. The practice had staff trained in the management of diabetes and held various health promotion sessions to support people with diabetes and pre-diabetes. The practice held registers for patients with a learning disability and provided annual health checks. There was register of those patients on end-of-life care who were regularly reviewed and supported to make informed decisions about their future.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns in this area.

Clinicians we spoke with told us a clinical decision support tool was integrated into their clinical system, which allowed easy access to the latest evidence-based guidance, resources and templates. We saw evidence from the clinical notes review that staff were managing patients in line with guidance, for example, The National Institute for Health and Care Excellence (NICE) guidelines. Staff told us they kept up-to-date with current evidence-based guidance through clinical meetings and in protected learning time. Staff told us peer reviews were undertaken which gave an opportunity for case-based discussions and a retrospective evaluation of clinical decision-making in patient care. Staff told us they felt supported in the clinical environment.

We saw the practice had systems and processes in place to keep clinical staff up-to-date with current evidence-based practice. Our review of the clinical searches of patient records showed that patients were being effectively and safely managed. Staff who were responsible for reviews of patients with long-term conditions had received specific training. The practice was a training practice for GPs and was proud of their strong emphasis on education and learning. We saw the practice monitored the use of evidence-based guidelines through consultation and prescribing audits.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns in this area.

Staff told us they worked closely with different teams and services to ensure patients received care in a coordinated manner. For example, they told us they worked closely with the mental health services Mind and GR8 Minds to support adults and children.

We spoke with the NHS West Yorkshire Integrated Care Board ahead of this assessment. From the feedback we received from them there was no indication of concern in this area.

We saw there were systems and processes in place to ensure care was delivered and reviewed in a coordinated way which included local care homes, people receiving end-of-life care and those with a learning disability. There were regular, documented multi-disciplinary team meetings. Information was shared with and received from out-of-hours services through their clinical system and there were systems in place to follow-up on information received.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns in this area.

Staff were committed to promoting and encouraging patients to live healthier lives. They told us they used consultations to opportunistically discuss health choices and provide supporting information. This included encouraging patients to attend health checks and reviews and signposting to support groups and self-help advice. Staff told us they supported national health priorities, initiatives and screening programmes to improve the population’s health, for example, stop smoking campaigns and breast and bowel screening.

The practice had nominated leads for dementia, frailty, learning disabilities and palliative care to support patients and staff. Patients had access to a social prescriber, which helped them improve their health, wellbeing and social welfare by connecting them to community services. We saw the practice website had links to health and wellbeing information. The practice included health events and promotion on noticeboards in their waiting area and in their quarterly patient newsletter. We saw that the summer newsletter had promoted cervical screening awareness week. The practice participated in the community pharmacy scheme which enabled staff to refer minor ailments to the local pharmacy.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns in this area.

Feedback from staff and leaders was positive about monitoring and improving patient outcomes. They told us they constantly looked at initiatives and interventions to tackle barriers to patient engagement with the cervical screening and childhood immunisation programmes. Staff shared with us educational and wellbeing events which had been arranged to promote women’s and child health in the local community.

There were patient registers in place for patients with a learning disability and those with long-term conditions. The practice had a systematic recall system in place to ensure patients were offered appropriate health assessments and checks. There was a system in place to actively follow up any reports of patients not attending for breast and bowel screening. We saw that the practice had a programme of quality improvement, including clinical and non-clinical audits, to drive improvements in care and treatment. Our review of patient clinical records showed the practice worked with patients to monitor and improve outcomes. To facilitate ease of booking cervical screening and childhood immunisation appointments, the practice used a text link to their appointment system.

The practice recognised cancer screening and childhood immunisations were a challenging area. We saw that their childhood immunisation and cervical screening uptake were below national targets. Validated data available at the time of our assessment for the period to June 2023 for cervical screening was 54%. Childhood immunisation uptake for the period to March 2023 for children aged 1, 2 and 5 years old ranged from 83% to 88%.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns in this area.

Clinicians understood the requirements of legislation and guidance around people’s consent to care and treatment, including the assessment of a person’s mental capacity to make a decision. When needed, clinicians supported patients and involved their families, carers and other professionals to make decisions in the person’s best interests, including decisions about Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR). Staff told us they had undertaken Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training. Staff were aware of the need to request consent to share records in line with General Data Protection Regulation (GDPR) principles.

There were appropriate consent policies and procedures in place. Carers and advocates were involved in consultation processes where required, and resources were used to support patient’s understanding of their treatment. We reviewed a patient record and saw evidence of the patient and their relatives being involved in end-of-life care discussions. We saw Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) care plans were used to record patient wishes regarding care and resuscitation. There was a formal consent form in place for procedures such as minor surgery.