Archived: The Lawn Medical Centre

Updated 12 December 2017

The provider delivers all regulated activities from:

Lawn Medical Centre

Guildford Avenue,

Swindon,

Wiltshire

SN3 1JL

Website: www.lawnmedicalcentre.co.uk

Lawn Medical Centre is located in the south east of Swindon in Wiltshire. The practice has occupied its current, purpose-built facility since 2004 and is arranged over two floors. There are four GP consulting rooms and two treatment rooms on the ground floor; and nurses’, management, meeting and training rooms on the first floor.

The practice has around 7,300 registered patients from an area immediately surrounding the practice and areas across Swindon. The practice age distribution is broadly in line with the national average, with most patients being of working age or older.

Lawn Medical Centre is a training facility for GPs and currently has an F2 (medical practitioner in the final year of their postgraduate medical training programme), and an ST3 (in the first year of general practice speciality training) at the practice.

The practice has a General Medical Services contract with NHS England to deliver primary care services to local communities. Services include acute treatment, chronic disease management, antenatal care and child health, cervical cytology and minor surgery. There are three GP partners and one salaried GP who are part of the practice team. The nursing team of four includes two nurses who are qualified in non-medical prescribing and diabetes care, and is completed by a Health Care Assistant (HCA). In addition to the practice manager there are nine administrative and reception staff who support the day-to-day running of the practice.

91% of the practice population describes itself as white British, and around 9% as having a Black, Asian and Minority Ethnic (BAME) background. A measure of deprivation in the local area recorded a score of 8, on a scale of 1-10. A higher score indicates a less deprived area. (Note that the circumstances and lifestyles of the people living in an area affect its deprivation score. Not everyone living in a deprived area is deprived and not all deprived people live in deprived areas).

Lawn Medical Centre is open from 8.30am to 6pm, Monday to Friday, and the practice will take calls during these times. On-call cover is provided by the surgery between 8am and 8.30am, and between 6pm and 6.30pm. Routine GP appointments are generally available from 8.30am to 11am and from 2.30pm to 5.30pm, Monday to Friday. For three weeks per month, the practice provides extended hours appointments from 7am to 8am on Monday and Wednesday mornings, with a GP and nurse or HCA. On the fourth week the practice is also open on Saturday from 8.30am to 11.30am. All extended hours appointments can be pre-booked up to four weeks in advance.

The practice has opted out of providing Out-Of-Hours services to its own patients. Outside of normal practice hours, patients can access NHS 111 and an Out-Of-Hours GP service is available. Information about the Out-Of-Hours service was available on the practice website, on the front door, in the patient registration pack, and as an answerphone message. 

Updated 12 December 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. Previous inspection October 2014 – Good across all domains

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Lawn Medical Centre on 1 November 2017, as part of our inspection programme.

At this inspection we found:

• The practice had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• 97% of patients who responded to the NHS national survey said the GP gave them enough time compared with the Clinical Commissioning Group (CCG) average of 84% and national average of 86%.
• The patient participation group (PPG) was well engaged and represented a diverse range of ages and backgrounds. The PPG liaised closely with a Community Navigator, employed by Swindon Borough Council, to support people who attended their GP surgery but did not necessarily require medical care. Patients were supported with issues such as social isolation and coping with caring responsibilities, and were connected to services and groups that could help improve their wellbeing and meet their wider needs. The PPG suggestions for changes to the practice management team had been acted upon and the group had raised awareness to patients about practice services generally.

• Staff had lead roles that improved outcomes for patients such as a carers’ lead.
• 93% of patients who responded to the national GP survey said they could get through easily to the practice by phone (CCG average 69%, national average 71%).
• 91% of patients who responded said their last appointment was convenient (CCG average 76%, national average 81%).
• Daily GP triaging of patient calls reduced the number of unnecessary appointments booked and therefore enabled the greater available of on-the-day appointments. We saw documentary evidence that the number of calls triaged in one month, that did not lead to a visit to the practice, home visit or referral to another service, led to on-the-day appointments.
• There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. Lawn Medical Centre identified patients at risk of developing diabetes who were not on the diabetes register, and implemented changes that could help to delay or prevent the progression of this health condition. Changes offered to patients included lifestyle interventions and annual blood testing. The practice routinely referred patients to the DESMOND service. DESMOND is the name for a group of self-management education modules, toolkits and care pathways for people with, or at risk of developing, Type II diabetes. In the last 12 months, the practice had 36 patients with a new diagnosis of diabetes, all of whom were referred to the DESMOND service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2015

The practice is rated as good for the population group of people with long term conditions. Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed longer appointments and home visits were available. All these patients had a named GP and structured annual reviews to check their health and medication needs were met. For those people with the most complex needs the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 31 March 2015

The practice is rated as good for the population group of families, children and young people. Systems were in place for identifying and following-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. Patients told us and we saw evidence that children and young people were treated in an age appropriate way and recognised as individuals. Appointments were available outside of school hours and the premises was suitable for children and babies. We were provided with good examples of joint working with midwives.

Updated 31 March 2015

The practice is rated as good for the care of older people. Nationally reported data for 2013 showed the practice had good outcomes for conditions commonly found amongst older people. The practice offered personalised care to meet the needs of the older people in its population. There were enhanced services for patients over the age of 75 with regard to unplanned admissions. All patients eligible for this service had detailed care plan in place and the practice demonstrated they met their needs. The practice was responsive to the needs of older people, including offering home visits and rapid access appointments for those who needed it and home visits.

Updated 31 March 2015

The practice is rated as good for the population group of the working age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered so they were accessible, flexible and offered continuity of care. The practice offered online services as well as a full range of health promotion and screening which reflected the needs for this age group. 

Updated 31 March 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). Patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice had in place advance care planning for patients with dementia.

The practice sign-posted patients experiencing poor mental health to various support groups and third sector organisations. The practice had a system in place to follow up patients who had attended accident and emergency where there may have been mental health needs.

Updated 31 March 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances which included those with learning disabilities. The practice had carried out annual health checks for people with learning disabilities and 90% of these patients had received a follow-up. The practice offered longer appointments for people with learning disabilities.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector 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 and out of hours.