LADMS GP Enhanced Access Service - Skegness and District Hospital

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 had not inspected this service before. At this assessment we rated this key question as Good. This meant people’s outcomes were good, and people’s feedback confirmed this.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their healthcare, wellbeing, and communication needs with them.

Reception staff were aware of the needs of the local community. Digital flags within the care records system were used to highlight any specific individual needs, such as the requirement for a translator to be present.

Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support people’s wider health and wellbeing. Staff could refer people with social needs, such as those experiencing social isolation, housing difficulties, and homelessness to a social prescriber or well-being coach.

Learning disability and autism training had been completed by 91% of the staff employed either through locum agencies or directly employed by LADMS for the provision of enhanced access services.

The practice had considered the Accessible Information Standards and made adaptations in line with this. For example, ramps and level access for people and parking for disabled people.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People were involved in decisions about their care, including what was important and mattered to them, for example, prescribing of medication or referral to other services.

Staff had access to local and national guidelines which could be accessed easily through online platforms with links to guidance also available through their clinical system. Staff we spoke with told us they used local and national guidelines and kept up to date through training and updates were circulated within the practice.

Clinical audits were conducted to ensure care was delivered in line with legislation and recommended guidelines. For example, the service carried out an audit for the prescribing of erythromycin for adults who had a penicillin allergy and had presented at the enhanced access hubs. The audit reviewed the prescribing to ensure that it aligned with antibiotic prescribing guidelines, which were evidenced to be mostly satisfactory. As a result of the audit, it was agreed that an educational workshop would be held to include feedback mechanisms for treatment failures and enhancing the recording of prescribing within the medical record.

The service worked well across teams and services to support people. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The service worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. People had access to services provided by the primary care network (PCN), including physiotherapy and social prescribers. Mutual support and learning were shared across the PCN.

Referrals and transfers to other services were undertaken in a timely way. The provider had identified the need for an administrator to liaise with other health care providers, including secondary care, during the normal working hours, and not during the time the extended hours was operating.

Referrals to other services were audited, for example, when people were referred for suspected cancers. The LADMS administration team regularly checked referrals were correctly processed.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. The service opportunistically provided advice to people regarding weight management, exercise and smoking cessation.

The service also referred people to the social prescriber for support with weight, exercise and smoking cessation advice.

The service also recognised the need to ensure that their staff lived healthier lives and supported staff with flexible working to improve their work life balance.

The service did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves

We were provided with “LADMS Operational Catch-up” meeting minutes. Action notes from these minutes indicated that several systems and processes had not been embedded and significant work was identified following the announcement of CQC’s onsite assessment. For example, the need to undertake and complete medication audits for non-medical prescribers.

The service had carried out monthly audits of clinical prescribing, record keeping for locum doctors and nurse practitioners to monitor and improve care for the periods between January 2023 and October 2025. One review had been carried out during April 2026 which also included the appropriateness of prescribing erythromycin for people who had an allergy to penicillin. However, due to staff turnover, the service had not maintained monthly audits to review effectiveness of prescribing and record keeping.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent. Consent training had been completed by 92% of the staff employed either through locum agencies or directly employed by LADMS for the provision of enhanced access services.

The staff had good knowledge of gaining and assessing consent options allowing the delivery of person-centred care and treatment which was in the person’s best interest. This included young people and people who did not have capacity to consent to care and treatment.

The service provided a comprehensive consent guidance document for staff to reference.