Lapal Medical Practice

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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

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

This service scored 67 (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 health, care, wellbeing and communication needs with them. However, some areas patients’ needs were not always met including those with diabetes.

The provider had systems to identify people with previously undiagnosed conditions. However, during our remote clinical review, we carried out a clinical search to identify people who had potentially been missed as having diabetes. The search identified potentially 25 people, and a review of 3 records identified two were likely missed diagnosis. Following the site visit the provider confirmed appropriate action had been taken.

Systems were in place to support mental health reviews, NHS health checks, immunisations, cervical screening, and the ongoing monitoring of individuals with long-term conditions. The practice’s cervical cancer screening was uptake of 76% was slightly below the target of 80%. The practice acknowledged this and was working to make improvement.

We spoke with the patient participation group (PPG) chair who was positive about people’s experience of the service. They stated that people felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. This was reflected in the national GP survey 2025 where 99% of practice respondents felt their needs were met during their last appointment.

Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. The practice staff including reception staff were aware of the large elderly patient demographics and their needs.

We found the provider held registers which were reviewed to prioritise care for their most clinically vulnerable patients. For example, we reviewed a sample of patients with a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) record to consider whether the DNACPR had been prepared and found this had been reviewed and agreed appropriately.

Most of the clinical records we saw demonstrated care was provided in line with current guidance, however we saw some areas where further improvements were required.

We reviewed the monitoring arrangements for patients prescribed direct oral anticoagulants (DOACs) and found that of 133 patients identified, 81 had not received the required clinical monitoring in line with national guidance. A sample of 3 patient records showed that 2 patients had overdue full blood counts, which may pose a low clinical risk, and one patient was overdue for all recommended monitoring, including blood tests, weight checks, and renal function assessment. Following the site visit, the provider had taken prompt action to improve monitoring processes. The provider told us they had contacted all the patients and going forward would ensure regular searches to identify any patients who need blood tests doing. This would be repeated every 4 weeks to check patients have attended for their blood tests.

The provider did not have effective systems in place to manage and respond to safety alerts. We identified historic alerts issued by theMedicines and Healthcare products Regulatory Agency (MHRA)that had not been appropriately actioned for patients prescribed citalopram,SGLT-2 inhibitors, andaldosterone.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We found systems were in place to share information about patients electronically with other services and the provider had a structured approach to meetings ensuring information was shared with the appropriate teams to maintain the care of patients in the community.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice 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 local primary care network (PCN) and had developed a positive working relationship with the patient participation group (PPG). The PPG representative considered the group were listened to and members could freely raise things in and outside of the meetings held.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

There were flags on patients records who were vulnerable and required ongoing monitoring and recalls in place to review patients and educate them to manage their health needs. There was regular engagement with community services and referral pathways in place. The practice website detailed information and links for health promotion, health conditions and common health questions. We were told by a GP partner that the practice was able to refer patients to the gym at a reduced price to manage weight and improve health.

Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities. Patients had access to a social prescriber via the primary care network (PCN) for emotional support and signposting to community groups and other agencies to improve their health and wellbeing. During our site visit we saw a range of health promotion information material was available within the waiting room and was also available on the provider website.

Results from the national patient survey results demonstrated that 77% of people had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses which was above the local ICB average of 64% and national average of 69%.

The practice monitored people’s care and treatment to continuously improve it. A review of the most recently published data showed the practice had had met the minimum based target of 90% in 3 of the 5 childhood immunisation indicators and 95% in 2 indicators. The World Health Organisation (WHO) recommends a rate of 95% for all routine childhood vaccinations. Those practices achieving this level are considered as performing for this indicator and are an example of good practice.

A review of the most recently published data showed the practices cervical screening uptake was just below the national target of 80%. The number of women in aged 25-49 who had an adequate screening test within the last 3.5 years was 76%. The number of women aged 50-65 who had an adequate screening test within the last 5.5 years was 78%.

The practice had an established programme of clinical and non-clinical audits aimed at driving continuous improvement in patient care and operational efficiency. This included audits of asthma, medicines management and prescribing practices. For example, the practice carried out an audit on benzodiazepines, which are used to treat anxiety and pain but can be addictive. The audit found 31 patients had received 10 or more prescriptions, slightly fewer than the 36 identified the previous year. Of these, 29 had already had a structured medication review, and their risk of dependency was recorded. The remaining two patients were contacted and scheduled for a review to ensure safe use of the medication. Other audits included UTI audit, high pain audit as well as audit of women on sodium valproate. Where relevant patients were monitored and identified learning shared with wider team.

The practice had also initiated further audits following our remote clinical search findings on monitoring of patients prescribed direct oral anticoagulants (DOACs).

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. There were policies and procedures in place such as mental capacity and best interest meeting. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. The provider carried out minor surgery and written consent was sought before undertaking any procedure. Staff had completed training in the Mental Capacity Act and consent.

The national GP patient survey demonstrated that 95% of patients were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. This was higher than the local average of 90% and the national average of 91%.