Larksfield Surgery Medical Partnership

On this page

• 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

Patients’ needs were not always assessed, and care and treatment were not always delivered in line with current legislation, standards and evidence-based guidance supported by pathways and tools. We have told the provider they must take actions to provide effective care and treatment.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received some positive feedback from patients in respect of their experiences with clinicians meeting their needs, in the Give Feedback on Care we received from people who use the service for this assessment. These referred to those patients who said that once you were able to get an appointment, the care and treatment they had was good. However, other patients were less positive about their experiences of the appointment and felt they had been dismissed or not listened to by the clinician or that they were not given sufficient information about their health. Some people also said that they were not confident their immediate needs were appropriately assessed and fully understood. For example, patients told us they had been offered telephone or online appointments to assess their individual needs such as breathing problems, when their needs could not be effectively assessed without having had a physical examination.

Clinical staff told us that for the patients they saw, an assessment of their needs was provided, including clinical needs and mental and physical wellbeing. Patients were also given information about what they should do if their condition worsened. The practice had now moved to an online triage system. However, some staff told us that this was not working effectively. For example, the practice was not always able to offer patients appointments with a clinician who would be most suitable to meet their needs. During the inspection, we found that the practice did not prioritise care for the most clinically vulnerable patients, to ensure that the appointments available were given to the patients most appropriate for them. Our searches showed patients’ immediate and ongoing needs were not always fully assessed. Most of the patients registered with the practice who had asthma had been prescribed reliever inhalers appropriately. However, we looked at the records for 4 of the other 20 patients who had been issued a high number of reliever inhalers in the last year which could suggest the person’s asthma could be better controlled. We found the reliever inhalers had been issued on repeat prescriptions for 3 of these 4 patients, reviews of their asthma and medicines completed in the last year were not always effective or of a good quality, for example, they did not include a change of the person’s preventative medicines to help improve control of their asthma. In response to our feedback, leaders told us about actions they had taken to review patients’ records and systems, including a protocol for asthma inhalers on repeat prescriptions.

We also identified from our searches on the practice’s clinical system and review of a selection of patients records that patients presenting with symptoms which could indicate serious illness were not always followed up in a timely and appropriate way. For example, the practice did not always identify when a patient’s test results indicated they had an undiagnosed condition, such as diabetes. Our searches identified 26 patients as having a potential missed diagnosis of diabetes. We looked at the records for 4 of these patients and found that 2 of these patients had diabetes but they had not been informed or offered advice, medicines, screening, and other treatments to help limit any harm. The practice had not coded these 2 patients as having diabetes on the system, which meant there was a risk they would not be invited for regular reviews of their condition, to help make sure their condition was managed as well as possible.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

The practice supported patients to be involved in monitoring and managing their own health. For example: the practice loaned blood pressure monitoring machines so patients could check their own blood pressure at home. Patients could provide information about long-term conditions through forms on the practice’s website. Information about support available and self-help advice was available on the practice’s website and in the waiting areas at both sites. Patients could discretely pick up a testing kit for Chlamydia. During our searches on the practice’s clinical system, we reviewed a selection of the records of patients, we also looked at the records for 4 patients for whom the practice had recorded had had a review of their care plan. The care plan reviews we looked at were of good quality, however, for 2 of the patients the care plans had last been reviewed more than a year ago. For one of the patients the practice had recorded had had a review of their care plan, there was no evidence in the patient’s records a review had been completed with the patient. During the inspection, leaders told us about actions they had taken to review patients’ records and systems around care plans.

Some responses from the Give Feedback on Care we received from people who use the service for this assessment, highlighted how the monitoring of their care, treatment and their outcomes was not effective. For example, patients told us that when they tried to book an appointment or when the practice had contacted them to arrange an appointment, for reviews of their long-term conditions, such as asthma or diabetes, there were no appointments available. So, their reviews were not monitored in a timely manner, as they needed to wait for an appointment to be available. These concerns were exacerbated with wider issues around access and being unable to contact the practice and the inaccessibility of the online triage system. Similar concerns had been raised by patients through the practice’s patient participation group (PPG).

Staff involved in arranging or completing reviews with patients of their long-term conditions, such as asthma and diabetes, also told us about their frustrations of not having enough staff to provide these appointments and of clinics being cancelled when appointments were not available. This also included cervical cancer screening clinics. The latest available information from the UKHSA showed that, on 30 June 2023, 79% of people registered with the practice who were who were eligible for a cervical smear test had been screened. This was slightly below the national target of 80%. At the time of this inspection, the practice was running a waiting list for patients for cervical cancer screening testing and planned to run some clinics on Saturday mornings to help clear the waiting list.

During our searches on the practice’s clinical system, we reviewed a selection of the records of patients with long term conditions to ensure the required assessments and reviews were taking place. We looked at patients with asthma who had had 2 or more courses of rescue steroids in the last 12 months. The search identified 68 patients, with 2,350 patients on the asthma register. We looked at the records for 4 of these patients. We found 3 of these patients had not been followed-up in line with national guidance and did not always have the recommended reviews of their asthma and medicines. At the time of our site visit, the practice could only offer patients a telephone appointment for a review of their asthma, which meant the review may not be as effective as it could be. Another search reviewed the monitoring of patients with severe chronic kidney disease (CKD), stages 4 and 5. The search identified 33 patients who were coded as having this diagnosis, with 17 patients noted as not having had the necessary blood test monitoring in the last 9 months. We looked at the records for 4 of these patients. While these showed patients with severe CKD were usually managed by a hospital specialist, some of the required monitoring could be improved, including of blood pressure and a specific calculation made from looking at blood test results. These are important to identify any deterioration in the patient's condition and to make sure advice is sought from the patient's hospital specialist in a timely way. We also looked at how the practice monitored patients with hypothyroidism. The search identified 653 patients as having this diagnosis, of whom, 5 were overdue blood test monitoring. We looked at the records for 4 of these patients. We found 3 of the patients had not been followed-up in line with national guidance and did not always have the recommended reviews of their hypothyroidism, monitoring blood tests and medicines.

Another search looked at the recording of patients diagnosed with diabetes. Our search identified that of 1,043 patients with diabetes, 176 had high blood sugar levels at their last blood test. We then reviewed a random sample of 4 of these patients’ records and saw that 2 patients were monitored by secondary care and another patient was monitored appropriately, by the practice. However, we found that for 1 patient, they had not been followed-up in line with national guidance and had not the recommended reviews of their diabetes, monitoring blood tests and medicines. Additionally, during our searches we noted that the routine monitoring of care and treatment for people with long term conditions was not effective. So, while some patients had had appropriate monitoring, many of these were because they were monitored under secondary care. Patients exclusively managed by the practice seemed to have variable monitoring and only some patients appeared to be chased for their monitoring. During the inspection, leaders told us about actions they had taken to review patients’ records and systems, with regards to the monitoring of the care and treatment of people with long term conditions. The practice shared with us an overview of clinical audits that had been undertaken for the period 2023/2024. This included the monitoring of patients who were prescribed medicines, such as, Lithium and an assessment of the effectiveness of the cervical screening process at the practice. However, the practice did not have an embedded programme of quality improvement activity in place, including audits to routinely review the effectiveness and appropriateness of the care and treatment provided.

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). DNACPR decisions were made in line with relevant legislation and were appropriate.