The Lakeside Surgery

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our last inspection, we rated this key question as good. At this assessment, the rating has changed to requires improvement.

Staff we spoke with consistently described a caring and patient-centred approach to their work. They told us they felt supported by colleagues and managers and that consideration was given to their wellbeing.

We found evidence of a patient-centred culture, with staff demonstrating a commitment to providing compassionate care and supporting patients with dignity and respect. However, communication between teams and across the wider service was not always effective, which meant patients and staff did not consistently receive clear and consistent information.

Patient feedback was mixed. Some praised staff as caring and responsive, but direct CQC feedback highlighted negative experiences and inconsistent care quality.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they treated patients with kindness, empathy and compassion and described how they took time to listen to patients and involve them in discussions about their care and treatment. During the assessment we observed staff interacting with patients in a polite, respectful and caring manner. Reception staff were welcoming and helpful, and there was evidence that consultations were conducted in a way that maintained patients' dignity and privacy. Where a patient raised a concern regarding privacy, the practice responded promptly by addressing the issue.

Feedback from people using the service was mixed. Patients and local care home staff consistently spoke positively about the care, compassion and responsiveness of the permanent GPs, and members of the multidisciplinary team described the practice as approachable and supportive. However, some patients told us their experience varied when they were seen by locum GPs, and a small number of patients commented that the attitude of some reception staff could be abrupt or unfriendly.

National GP Patient Survey results relating to patients’ experiences were below local and national averages for a number of indicators. For example, 77% of respondents reported that they found the reception and administrative team helpful, compared with 86% locally and 85% nationally. Similarly, 80% of respondents said the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment, compared with 89% locally and 87% nationally. These results indicate that patients’ experiences of some aspects of care and service delivery were less positive than those reported elsewhere. Although feedback from patients was not consistently positive across all areas, the evidence we gathered through our observations, staff interviews and feedback from partner organisations demonstrated that people were generally treated with kindness, compassion and respect.

The provider recognised the importance of meeting the individual needs of people using the service and had arrangements in place to support some patient groups. Staff told us they considered patients' individual needs during consultations and there was evidence of support for people living with dementia where appropriate. The practice also had an Accessible Information Standard policy.

However, some arrangements to support patients with communication and accessibility needs required further development. For example, there was no hearing loop available, and we did not see examples of easy read information being readily available for patients, although staff told us information could be adapted if required.

Staff told us they worked in partnership with patients to help them make informed decisions about their care and treatment. Clinical staff described discussing treatment options with patients and involving family members or carers, where appropriate, to ensure people were supported to make decisions that reflected their preferences and individual circumstances. This was reflected in the National GP Patient Survey, where 89% of respondents said they were involved as much as they wanted to be in decisions about their care and treatment, compared to the local result of 93% and the national result of 92%.We saw evidence that patients were supported to access a range of services to help maintain their health and wellbeing, including social prescribing and referral to community services where appropriate. Staff demonstrated a good understanding of the wider support available to patients and described how they encouraged people to access services that promoted their independence and wellbeing.We were also told that patients who lacked capacity were supported through best interest decision-making, with family members and other professionals involved where appropriate. Overall, we found that staff were committed to promoting patients' choice, control and independence. However, although staff felt patients involved in decisions about their care, National GP Patient Survey results were below local and national averages, with 89% of respondents saying they were involved as much as they wanted to be in decisions about their care and treatment, compared with the ICS result of 93% and the national result of 92%. In addition, 83% felt their needs were met during their last general practice appointment compared with 91% in the ICS and 90% locally. This indicated missed opportunities to further improve patients' experience of shared decision-making.

Staff told us they aimed to respond promptly to patients' needs and described how they prioritised people requiring urgent assessment or support. We found clinicians worked collaboratively with other health and care professionals, and feedback from local care homes was consistently positive about the responsiveness of the permanent GPs. Members of the wider multidisciplinary team also described the practice as approachable and supportive when responding to patients' needs.

Patients had access to a range of services to support their health and wellbeing, including social prescribing, and staff described how patients were directed to the most appropriate clinician or service based on their needs. However, patients were not always positive about their experience of this.

Feedback from patients was mixed. Whilst many patients spoke positively about the care they received when they were able to see one of the permanent GPs, some described difficulties accessing the practice and variable experiences when receiving care from locum GPs. The National GP Patient Survey supported these findings and highlighted concerns about patients' ability to access the practice. Only 23% of respondents found it easy to get through by phone, compared with 57% locally and nationally. Only 33% found it easy to contact the practice through its website, compared with 55% locally and 58% nationally, and 31% found it easy to contact the practice using the NHS App, compared with 53% locally and 54% nationally.

Staff told us they felt supported by their colleagues and leaders and described positive working relationships within the practice. They spoke positively about the culture of the team and told us they felt valued. Leaders had taken steps to recognise staff contributions, including arranging opportunities for team engagement outside of the workplace.

However, the provider had not established effective systems to support staff wellbeing and enable them to undertake their roles effectively. Staff consistently described workload pressures and told us there was insufficient administrative capacity to complete all required tasks. Although these concerns had been raised with leaders, there was limited evidence that sustainable action had been taken to address them.

Protected time for learning and development was not consistently available, and mandatory training had not been prioritised due to workload pressures. Staff welfare facilities were limited, with no dedicated area available for staff to take breaks away from their working environment.