The Lakeside Surgery

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 inspection, we rated this key question as good. At this assessment, the rating has changed to requires improvement.

Staff understood the need to reduce health inequalities, providing flexible care through accessible cervical screening and longer appointments where needed. The practice said they worked within the Primary Care Network (PCN) and contributed to local service developments. However, performance in relation to access was below expected levels when compared with other local practices, indicating that improvements were needed to ensure patients could access care in a timely way.

Information on how to raise a complaint was available to patients. However complaints we reviewed were not consistently managed and analysed to support learning and improvement. Overall, while some systems and processes were in place to respond to patient feedback, these were not effective, and further improvements were required to ensure a consistently high standard of care and patient experience.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider demonstrated a person-centred approach to the delivery of care once patients were able to access the service. Feedback from patients indicated that clinicians took time to listen, involved people in decisions about their care and treatment, and provided appropriate support for people with complex and long-term conditions. Patients also described GPs, nurses and pharmacists as caring, compassionate and responsive to their individual needs.

However, patients did not consistently experience person-centred care throughout their journey with the practice. Difficulties accessing appointments, limited continuity with a preferred GP for some patients and communication being relayed through administrative staff meant some people felt their individual needs and preferences were not always recognised or responded to in a timely way.

The provider offered a broad range of services and worked collaboratively with health and social care professionals to support coordinated care. Feedback received directly from patients demonstrated positive experiences of services for long-term conditions, cancer care, mental health and pharmacy support, together with access to appropriate external services. The National GP Patient Survey showed that 90% of respondents had confidence and trust in the healthcare professional they saw or spoke to, compared to the local result of 93% and the national result of 93%. In addition, 83% said their needs were met during their last appointment, compared to the local result of 91% and the national result of 90%.

The provider had arrangements in place to communicate information to patients using a range of methods, including text messaging, telephone contact, the NHS App and online services. Patients told us clinicians explained diagnoses, investigations and treatment options clearly and involved them in decisions about their care. 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%. In addition, 87% of respondents said the healthcare professional had all the information they needed about them during their last appointment, compared to the local result of 93% and the national result of 92%. However, communication arrangements were not consistently effective outside of consultations. Feedback from patients identified delays in receiving information about test results, referrals, medication queries and hospital correspondence. Some patients told us they needed to contact the practice on multiple occasions to obtain updates, while others reported information being relayed through administrative staff rather than directly by a clinician. We also identified examples where patients became aware of errors or outstanding actions through the NHS App before being contacted by the practice. These findings were reflected in the National GP Patient Survey, where 57% of respondents described their experience of contacting the practice as good, compared to the local result of 73% and the national result of 73%. In addition, 55% of respondents described their overall experience of the practice as good, compared to the local result of 78% and the national result of 77%. 

Patients consistently described clinicians as compassionate, professional and attentive, and told us they felt listened to during consultations. Feedback highlighted positive experiences of GP, nursing and pharmacy staff, particularly in the management of long-term conditions, cancer care, mental health and complex health needs. 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%. In addition, 90% of respondents had confidence and trust in the healthcare professional they saw or spoke to, compared to the local result of 96% and the national result of 95%.

However, patients did not always feel involved throughout their care journey. Feedback identified poor communication about referrals, test results and follow-up, with some patients having to chase information or repeat their medical history when seeing different clinicians. Some patients also reported information being relayed through administrative staff rather than directly by clinicians, which reduced confidence in communication and continuity of care.

The practice operated a total triage model using a clinical triage system to assess and direct patients according to clinical need. Leaders told us this enabled patients to access the most appropriate clinician and, during our assessment, we observed patients being directed appropriately. The provider offered a range of appointment types, online services and telephone access to support patients.However, patients did not consistently experience equitable access to care. Feedback identified significant difficulties accessing appointments, with patients reporting that the online appointment system reached capacity shortly after opening, long telephone waiting times and limited access to routine appointments. Patients also described barriers for working people, carers and those unable to access the system at 8am. This was reflected in the National GP Patient Survey, where only 23% of respondents found it easy to get through to the practice by phone, compared to the local result of 57% and the national result of 57%. In addition, 33% found the practice website easy to use, compared to the local result of 81% and the national result of 79%. Only 31% of patients found it easy to use the NHS App to contact the practice, compared to the local result of 60% and the national result of 60% and 34% reported a good experience of making an appointment, compared to the local result of 56% and the national result of 56%.

The provider demonstrated an awareness of the needs of different patient groups and had arrangements in place to support equitable care. This included maintaining a learning disability register, providing shared care for patients prescribed ADHD medicines, which leaders told us was not offered by other practices within the PCN, and working with the multidisciplinary team to support patients with mental health needs and long-term conditions. The National GP Patient Survey showed that 83% of respondents said their needs were met during their last appointment, compared to the local result of 89% and the national result of 89%. Patient feedback consistently demonstrated that the quality of clinical care was good once patients had accessed the service.

The provider had arrangements to support people to plan for their future health and care needs. Patients with long-term conditions, frailty and complex needs were reviewed, and clinicians worked with other services to support ongoing care where appropriate.

However, records did not consistently demonstrate that future care planning was appropriately documented. We identified examples where DNACPR decisions were not supported by appropriate documentation to demonstrate that decisions had been made and recorded in line with national guidance. These findings meant the provider could not demonstrate that future care planning was consistently documented to support safe, person-centred care.