Larkside Practice

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

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same. This is because while we found areas for improvement in the quality statements for assessing needs, delivering evidence base care and monitoring and improving outcomes; For example, systems were not always effective for the assessment and monitoring of patients with long term conditions and patients with missed diagnosis of conditions, as per guidance; we also saw that generally staff worked effectively across teams and services to support people. Additionally, patients were supported to lead healthier lives; and the practice obtained consent to care and treatment, in line with guidance.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most feedback from people who use the service with regards to the assessment of their needs was positive, with a few negative responses.

As part of our inspection, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. The records of patients with long term conditions were reviewed to ensure the required monitoring was taking place.

These searches of the practice’s clinical records system included patients with asthma who had had 2 or more courses of rescue steroids in the last 12 months (excluding patients who have been prescribed regular steroids for other purposes). Another search reviewed the monitoring of patients with chronic kidney disease (CKD): stages 4 and 5. We also looked at the monitoring of patients with hypothyroidism, with a further search involving patients with diabetes who’s latest HbA1c was >75mmol/l.

We found that not all of patients with long-term conditions had the appropriate monitoring and reviews, in line with national guidance, to check their health and medicines needs were being met. Systems to identify these patients and make sure they were offered the appropriate investigations, treatment and monitoring were not always effective.

As part of our series of patient clinical record searches, patients with missed diagnosis of conditions were also reviewed to ensure the required assessments and reviews were taking place.

We looked at patients with a potential missed diagnosis of diabetes and found that they were not always followed up appropriately. Systems to identify these patients and make sure they were offered the appropriate investigations, treatment and monitoring were not always effective.

During the inspection, the practice took action to review and contact patients identified through our patient clinical record searches and provided assurances of action plans and future assessment and monitoring of patients with long term conditions and patients with missed diagnosis of conditions.

We did not receive specific examples from people about the planning and delivery of evidence-based care and treatment.

Staff had access to evidenced-based guidance, such as those from the National Institute for Health and Care Excellence (NICE) and used these to support the delivery of care and treatment and audits.

The practice had systems and processes to ensure that staff were up to date with national legislation, evidence-based good practice and required standards. For example, clinical staff we spoke with told us that regular meetings were held among clinicians to discuss cases, new guidelines and share learning. This feedback was reiterated by clinical staff in their questionnaires, including the development of working relations with other agencies to support patient’s care and treatment. For example, seeking guidance from tissue viability nurses on wound care and dressing options. The practice also facilitated multi-disciplinary clinical meetings which involved clinicians from other health services. Additionally, the practice made use of clinical system templates to support the management of patient care and treatment.

As part of our inspection, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. Findings from our searches of the practice’s clinical records system indicated that not all patients received care that was in line with national guidance. Examples of these findings have been highlighted in other parts of this report, such as under the key question safe and corresponding quality statement: medicines optimisation.

When we highlighted these concerns, the practice took action to review and contact patients. They also provided assurances that systems were in place to ensure staff remained up to date with evidence-based guidance and legislation.

Most feedback from people who use the service with regards to how staff, teams and services worked together was positive, with a few negative responses regarding follow ups and referrals to specialists.

The GP Patient Survey is an independent national survey that tells us how people feel about their GP practice.

We noted that 89% of the people who responded to the 2024 GP Patient Survey said during their last appointment, the healthcare professional had all the information they needed about the patient. This was in line with local and national averages.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support.

Staff we spoke with told us that they worked in partnership with other services to meet the needs of the patient population. For example, clinicians were aware of community health care services and referred house bound patients to appropriate provision, such as, arranging for blood to be taken at home.

Positive feedback from the 2 care homes under the care of the practice, highlighted the development of good working relations with residents and care home staff. They said that the practice responded to queries they raised by telephone or email and that responses to medicines management issues were well coordinated and quickly resolved.

Practice staff attended monthly meetings with other teams and services to discuss and coordinate care for patients who have more complex needs.

There were appropriate referral pathways to make sure that patients’ needs were addressed.

We did not receive specific examples from patients about how the practice supported them to live healthier lives.

The practice supported national priorities and initiatives to improve population health. For example, patients had access to a smoking cessation advisor. Support from Health and Wellbeing Coaches and a Social Prescriber were also available for patients registered with Larkside Practice.

The practice also encouraged and supported patients to be involved in monitoring, managing and improving their own health. For example, patients had access to an automated height, weight and onsite BP machine.

Staff we spoke with told us that they supported patients when they identified risks to their health. For example, referring patients with long term conditions, such as asthma or diabetes, to other colleagues or agencies.

Information about conditions and lifestyle advice were available in the practice’s patient waiting area.

At the time of this inspection, the practice had 221 unpaid or family carers on their register. This was about 2.2% of the patients registered with the practice. A carers registration form was available on the practice’s website. Leaders told us that the practice did not have an assigned carers champion. They had identified this as an area for improvement and were considering ways in which they could encourage patients to register as carers and in running carers groups with their Primary Care Network (PCN) colleagues.

Processes to support bereaved patients had been streamlined by the practice, so that all death administration and liaison with relatives was coordinated, appropriately and sensitively.

We did not receive specific examples from patients about how the practice monitored and improved outcomes.

Leaders told us that 25 out of 45 people with a learning disability registered with the practice, had had an annual health check.

Patients aged 75 and over are also eligible for an NHS health check. Health checks for this population of patients were carried out by the practice under long term health care and not recorded as NHS health checks. For patients aged between 40 and 74 who are also eligible for an NHS health check, the practice had carried out 198 of the 1,737 (11%) patients registered in this age group. Leaders told us that health checks had been identified as an area for improvement. They told us the practice had fallen behind in this area due to changes to Primary Care Network (PCN) staffing arrangements. A PCN care coordinator was scheduled to start working with the practice in January 2025 and leaders were anticipating that this staff member would lead on this piece of work.

The latest information from the UK Health Security Agency (UKHSA) showed the practice had not met all the national targets for the number of children immunised against various infectious childhood diseases. Additionally, the latest information from NHS Digital showed the practice had not met the national target for the number of persons attending for cervical cancer screening.

The practice monitored the numbers of children having the recommended childhood immunisations and the uptake of cervical screening, carried out reviews of practice performance against the Quality and Outcomes Framework (QOF), liaising with relevant agencies to improve the uptake of immunisations for children.

Staff we spoke with told us about procedures in place to encourage uptake of child immunisation and cervical screening. For example, there were follow up arrangements for patients who failed to attend appointments and flexibility for arranging appointments to meet individual need.

We did not receive any concerns from patients we had feedback from, regarding consent.

Care home representatives were positive in their feedback. They told us staff always spoke with the patient and their care home staff and considered the patients’ choices and decisions, including consent.

Staff told us they always obtained consent from patients or if appropriate their guardian and offered a chaperone where appropriate. This was recorded under the patient’s records on the clinical system.

Staff were also aware of the importance of making sure a patient had given their consent before sharing information with others and there was a system to record if the patient had given their consent.

There was information on the practice’s website about confidentiality and accessing patient health records, including requesting someone else’s information.