Larkside Practice

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs, and that staff treated people equally and without discrimination. 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 equity in access and equity in experiences and outcomes. For example, data from the 2024 GP Patient Survey showed the practice performed below the local and national averages for the percentage of people who find it easy to get through to this GP practice by phone, using their website and the NHS App. Some people struggled to make appointments via the online booking system, including older people, people with hearing impairments, those who were less confident with technology and working individuals. We also found that the practice generally delivered person centred care, recognised the importance of flexibility and informed choice and continuity of care. Patients were provided with appropriate information and listened to and involved in their care, treatment, support and planning for the future.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While we did not receive specific examples from patients about the provision of person-centred care, most feedback from people who use the service regarding interactions with clinical staff was positive. One person explained the impact this had had on them how it had made them feel like they mattered.

Care home representatives were positive in their feedback around the delivery of person-centred care for residents.

Staff we spoke with shared examples of how they made sure people were at the centre of their care and treatment choices and in partnership with them, decide how to respond to any relevant changes in their needs.

As part of our inspection, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. We reviewed a sample of care plans for people with a learning disability and found them to be of a good standard.

While the practice recognised the importance of flexibility, informed choice and continuity of care, leaders recognised challenges the practice had with the delivery of continuity of care for patients. For example, a total triage model of care for patients did not always allow for patients’ follow-ups with the same clinician. Staff we spoke with told us that patients could pre-book appointments and clinicians could book in patients for a follow-up appointment with them or another suitable member of staff, when appropriate.

Reference to continuity of care was noted in the feedback from people who use the service. Some people shared that they were able to see the same GP consistently (contributing to a positive experience), while others reported difficulties in booking appointments with the same GP. Additionally, a few people expressed frustration with a lack of availability of face-to-face appointments. One individual shared that this seemed “almost impossible” to access since the pandemic. However, a few people reported being offered both face-to-face and telephone appointments, after using the online system. Moreover, it appeared that some people were able to phone and make an appointment, while others were directed to use the online system, leading to differing experiences and frustrations and raising questions about the consistency of how appointments are offered and accessed.

We saw the practice worked in partnership with other services to meet the needs of its patient population. For example, care home representatives told us staff would arrange face-to-face consultations for residents, either at the practice or at home, if requested.

People received care and treatment from services that understand the diverse health and social care needs of their local communities. For example, the practice adjusted the delivery of its services to meet the needs of people with a learning disability by allocating longer appointments for annual health checks.

Most feedback from people who used the service around the provision of information was positive, with a few negative responses.

Staff told us that the practice had access to interpreter services, and these were booked for patients when needed.

Leaders told us that they were an international team, speaking 8 languages in addition to English including, German, Spanish, Urdu and languages spoken in Nigeria.

However, according to the information on staff mandatory training that was set and shared by the practice, 19 staff members (clinical and non-clinical) were not up to date with their training in relation to information governance and the General Data Protection Regulation (GDPR). The practice had recognised the completion of staff mandatory training generally, as an area for improvement.

The practice complied with the Accessible Information Standard (AIS). For example, there was a hearing loop for people who are deaf or have difficulty hearing.

The provider was registered as a data controller with the Information Commissioner’s Office.

The practice had effective systems for storing and keeping confidential and sensitive personal information secure. The practice held and used this information in line with requirements and information security standards, including when held and used digitally. There was information on the practice’s website advising patients how their information was stored and managed.

During our site visit, we saw that leaflets and notices were available in the waiting area, advising patients on how to access support groups and organisations. A television screen also provided patients with information. Posters throughout the practice alerted patients to chaperone arrangements and requests. Telephone consultations and calls took place in appropriate environments to ensure confidentiality.

The practice’s website also provided information to patients, including the roles of the various professionals who patients may see at the practice.

 

Most feedback from people who use the service with regards to how staff listened to and involved them was positive, with a few negative responses. This included discussions between clinicians and patients around test results.

We noted that 90% of the people who responded to the 2024 GP Patient Survey said during their last appointment they were involved as much as they wanted to be in decisions about their care and treatment. While 82% said the healthcare professional was good at listening to the patient. These were generally in line with local and national averages.

Staff were aware of the practice’s complaints procedure and said they would advise people how they could make a complaint if the person wished to.

People could provide feedback and complain online, by email, letter or verbally. People were also encouraged to give feedback online, through the NHS Friends and Family Test. The practice’s complaints procedure leaflet was available on the practice’s website and onsite.

Staff provided us with examples of learning from patient feedback that had resulted in changes and improved care for others.

In the year leading up to this inspection, the practice had recorded 12 complaints. We looked at the records for 2 of these complaints and found the practice had handled them in a timely way and responded appropriately.

Leaders told us that complaints were discussed in practice meetings and learning was shared with staff when identified. However, some members of staff commented in their questionnaires that they had not been made aware of any complaints made regarding the practice.

Positive feedback was also collected by the practice, but some staff told us that it was not widely shared with the team. During the inspection, the practice shared with us their November 2024 staff newsletter which they had initiated to strengthen staff communications. It included a complaints, significant events, compliments and the learning points for the team section.

Feedback from people who used the service regarding accessing appointments was varied, regarding equity in access. People shared mixed experiences of using the online booking system, and the impact this had on accessing appointments. Some people told us that it had made it much easier for them to book them, while others reported that it had made it more difficult. The ability to secure appointments also greatly influenced people’s perceptions of the service.

Data from the 2024 GP Patient Survey showed the practice performed below the local and national averages for the percentage of people who find it easy to get through to this GP practice by phone (32%); using their website (35%); and using the NHS App (18%).

The practice was aware the results of the 2024 GP Patient Survey highlighted areas for improvement. Leaders told us that they had reviewed this data and compared it against other practices in their Primary Care Network (PCN) to find out whether they could learn from any practices which had achieved better results. These matters were scheduled to be discussed at the next practice team meeting in February 2025. However, the impact of some of the actions the practice had taken, and planned to take, were not yet known or reflected in validated evidence available at the time of this inspection.

The practice offered a range of appointment types including face-to-face, telephone and home visits with various clinicians. These included, doctors, an advanced nurse practitioner a healthcare assistant, a pharmacist, a physician associate and practice nurses. A GP offered minor surgical procedures.

Patients with the most urgent needs had their care and treatment prioritised. Both ‘urgent, or ‘same day’, and pre-bookable appointments were available.

When the practice was closed, patients were directed to access advice and support, from the NHS 111 service or emergency services.

While some people found the online booking system convenient and easy to use, many others struggled to make appointments, including older people, people with hearing impairments, those who were less confident with technology and working individuals.

Some of the common challenges reported by people included difficulty accessing the online system which included the potential for technical issues within the system, the system reaching capacity, and insufficient non-urgent appointments being offered after triage.

However, a few people told us that they were always able to obtain appointments for babies and young children, including disabled children.

Staff training records provided by the practice showed that 17 staff members were not up to date with their autism awareness training; and 11 staff members were not up to date with their equality and diversity training. This included both clinical and non-clinical staff. During the inspection, leaders told us that a training package to support autistic people and people with a learning disability had been recently introduced, with 3 clinical and 1 non-clinical staff members having completed the training to date. Additionally, they had recognised the completion of staff mandatory training generally, as an area for improvement.

Arrangements were in place for lesbian, gay, bisexual and trans (LGBT+) people so that they continued to receive appropriate health checks, and their preferred name was used. This included support from an LGBT+ practice champion.

We did not receive any feedback from people who use the service about planning for the future.

We reviewed 5 patients’ records where a DNACPR decision had been noted. Two of these had been completed by a Larkside Practice GP and had been recorded in line with national guidance. We also saw that where possible the patients’ views had been sought and respected and we saw that information had been shared with relevant agencies.

The other 3 DNACPR decisions had been carried out in a community or hospital setting and information about this decision had been recorded in patients’ records. However, a copy of the DNACPR decision was not available on these 3 patients’ records. During the inspection, leaders told us that they would be contacting these 3 patients and updating their records appropriately. They also provided assurances of an action plan and future monitoring of the recording and uploading of community or hospital based DNACPR decisions on patients' records.

Additionally, leaders shared with us a policy they had introduced to ensure that the practice’s register of patients receiving palliative care was updated appropriately and to improve shared care management, including ensuring all these patients had a DNACPR decision in place. They had shared this policy with community services colleagues and had listed it as an agenda item for their next clinical governance meeting. Leaders also provided us with the findings of an audit of the practice’s palliative care register, dated 27 December 2024 which included an action plan and ongoing monitoring. The practice also carried out reviews of the information held by the practice of house bound patients. This involved sending out a questionnaire to patients requesting an update of their details, including DNACPR decisions, if appropriate. The practice had completed a review of this population of patients in December 2023.