Larksfield Surgery Medical Partnership

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• 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

This means we looked for evidence people had the best possible outcomes because their needs were assessed and care and treatment was provided in line with up-to-date best practice.

At our last inspection we rated this key question Requires Improvement.
At this inspection, the rating has stayed Requires Improvement.

This is because:
• Staff did not always work in line with current evidence-based best practice.
• The practice did not always identify when test results indicated a patient may have an undiagnosed long-term condition.
• The practice did not always support patients to live healthier lives, for example through effective medicines reviews.
• The practice had not met national targets for the numbers of patients being screened for the risk of cervical cancer and did not always complete recommended health checks with patients.

However, the practice:
• usually took steps to make sure patients who had long-term conditions were monitored and reviewed to make sure their health and medicines needs were being met
• supported carers
• had met most national targets for the numbers of children having immunisations against various infectious diseases.
 

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

27% of patients registered with the practice had 1 or more long-term conditions, such as asthma, chronic kidney disease (CKD), diabetes, or hypothyroidism.

The practice usually took steps to make sure patients who had long-term conditions were monitored and reviewed in line with national guidance, to make sure their health and medicines needs were being met. This included patients whose test results suggested their diabetes could be better controlled and were at a higher risk of developing complications because of their diabetes, and patients who were prescribed medicines to help make sure their hypothyroidism was managed as well as possible.

Our search of the clinical records system also showed the practice monitored patients who had more advanced CKD.

However, the practice did not always identify when test results indicated a patient may have an undiagnosed long-term condition. From the records we looked at for this inspection, the practice had not always informed the patient their test results indicated they had CKD. The practice had not always carried out further appropriate investigations or offered the patient the recommended treatment and ongoing reviews and monitoring to make sure the treatment was working as well as possible.
 

Staff did not always work in line with current evidence-based best practice. For example, the practice did not always prescribe medicines in line with national guidance. Our search of the clinical records system showed 95 older people who were prescribed certain medicines had not been prescribed an additional medicine in line with national recommendations.

Our clinical searches also showed the practice did not always follow-up patients after prescribing them medicines to treat a flare-up of asthma, to help prevent their asthma worsening and the risk of having a life-threatening asthma attack.

We looked at the records for 5 medicine reviews the practice had recorded within the 3 months leading up to this inspection. It was not clear if these 5 medicine reviews had been carried out by a person with the appropriate knowledge as all 5 records had been recorded by a member of administrative staff. It was not clear if all the medicines prescribed for the patient had been reviewed and any risks or areas where the patient’s health could be improved identified and addressed. These included checks to make sure any required monitoring was up-to-date and medicines were prescribed in line with current evidence-based best practice, including medicines less commonly prescribed and Controlled Drugs.

Staff referred patients to other services when it was appropriate.

Since the last inspection, the provider had employed specialist staff to support patients living with long-term conditions, including diabetes and heart disease. The diabetes specialist nurse held clinics at the practice once a month with a specialist nurse from the hospital. They explained how this continuity had helped patients feel more comfortable and confident in the care they received and helped to make sure patients did not need to repeat their stories.

Staff told us there were monthly clinical sharing meetings. Staff told us local palliative care nurses attended this meeting to discuss and coordinate care for patients nearing the end of life.
 

The practice supported national priorities and initiatives, for example the practice’s website had information for those wishing to stop smoking or lose weight.

The website also had information about local and national support services, for example about support for those living with long-term conditions such as diabetes and neurological conditions; autism; bereavement; maternity and child health; drug and alcohol use; mental health; and sexual health services.

There was a ‘patient pod’ where patients could take their own blood pressure.

Information was available in the waiting areas, including information to help support those affected by autism or attention deficit hyperactivity disorder (ADHD), and bereavement. There was also information about accessing other NHS services, such as for mental health support, and information about other services, including opening hours for a local pharmacy, eye care home visiting services, and private ear care services.

Although the practice did not provide a register of people who may need extra support, for example unpaid or family carers, the practice did have ‘Carer’s Champions’. Information to support carers was available on the practice’s website and in the waiting areas. An unpaid or family carer is anyone who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, mental health needs or drug or alcohol problem and cannot cope without their support. The care they give is unpaid. The practice asked patients newly registering with the practice if they were a carer or had a carer. For patients already registered with the practice, a form was available on the practice’s website for them to register as a carer.
 

The latest information from the UK Health Security Agency (UKHSA) showed the numbers of children aged 1 and 2 who had been vaccinated against various infectious diseases met the national target. The number of children aged 5 who had had 2 doses of immunisation for measles, mumps and rubella (MMR) was slightly below the national target of 90%, at 87%.

Patients aged between 40 and 74 are eligible for a NHS health check. The practice told us they had completed a health check with 8% of patients registered with the practice who could have one.

The practice offered patients with a learning disability a yearly health check. At the time of this assessment, the provider told us 44 (64%) of the 69 patients registered with the practice who had been recorded as having a learning disability had had a yearly review.

The practice displayed posters in the waiting areas promoting these health checks.

Cervical screening (a smear test) is one of the best ways to help protect against and prevent cervical cancer. The latest information from NHS England showed that on 30 June 2024, 77% of patients registered with the practice who were aged 25 to 49 and eligible for this screening had been screened adequately within the recommended time period of 3 years 6 months. 79% of patients registered with the practice who were aged 50 to 64 and eligible for this screening had been screened adequately within the recommended time period of 5 years 6 months. These were just below the national target of 80%.
 

We did not collect sufficient evidence at this inspection to score this quality statement.

Therefore, a score of 3 has been carried over from the previous assessment of the service.