Dr Alva & Partners Also known as Houghton Regis Medical Centre

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

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 Good.

At this inspection, the rating has changed to Inadequate.

This is because the service did not always make sure people’s care and treatment was effective and in line with up-to-date evidence-based best practice.

The practice had not met national targets for the numbers of patients being screened for the risk of cervical cancer nor for the numbers of children having immunisations against various infectious diseases. The practice did not always complete recommended health checks with patients.

Not all clinicians were aware of their responsibilities around consent and the Mental Capacity Act. Systems for checking and recording when patients had arrangements in place for others to make decisions on their behalf were not effective. Staff acting as chaperones did not follow procedures set out in national standards.

However, the practice supported carers and promoted national programmes to help people improve their health, such as stopping smoking, getting fit and improving mental wellbeing.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

28% of patients registered with the practice had 1 or more long-term conditions, such as asthma, chronic kidney disease (CKD), diabetes or hypothyroidism.

However, the practice had not always identified and taken action when test results indicated a possible missed diagnosis.

This included 128 patients whose test results suggested they had CKD. We looked at the records for a sample of these patients and found the practice had not identified the possible missed diagnosis. There was no evidence some of the patients had been informed of the diagnosis, and offered appropriate medicines, further investigations and monitoring to help protect against further damage to the kidneys.

The practice did not always work in line with current evidence-based best practice. For example, our clinical searches showed the practice did not 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.

The practice did not always prescribe medicines in line with national guidance. For example, our searches of the clinical records system found patients who were prescribed certain medicines who had not been prescribed an additional medicine to help protect the stomach from bleeding, in line with national recommendations.

Although the GP partners and practice manager met weekly, the practice did not routinely hold other meetings that other practice staff could attend, for example to share and discuss clinical guidelines to help staff keep up-to-date.

Various clinical staff gave examples of when they would refer patients to other services. However, some of these staff told us they did not follow-up referrals they had made, and that it was the doctors’ responsibility to monitor the progress of referrals, respond to reports and letters from other services, and to take follow-up actions when needed.

Whilst individual staff shared information with other staff and services on a case-by-case basis, these discussions did not always involve all relevant teams and professionals. The practice did not have systems for the routine and planned sharing of information with other staff and organisations to help make sure patients received coordinated and safe care and treatment.

The practice told us that until June 2024 they attended meetings with other teams and services, such as community nursing teams, hospital consultants, specialist nurses and social workers to discuss and coordinate care for patients who had more complex needs and to help reduce avoidable hospital admissions. Although the practice told us these meetings had been beneficial for patients, the meetings had stopped.

Since June 2024, the practice had attempted to start monthly meetings with a palliative care nurse to discuss and coordinate care for patients nearing the end of life. However, evidence showed only one meeting had been successfully held by the time of this inspection.

The practice did not always monitor and review patients who had long-term conditions in line with national guidance, to make sure their health and medicines needs were being met.

Searches of the practice’s clinical records system showed the most recent test results for 14% of patients who had diabetes indicated their diabetes could be better controlled. These patients were at higher risk of developing complications because of their diabetes. For some patients, the practice had not acted on the most recent test results, taken between October 2023 and July 2024, and which were significantly outside the expected range.

Searches of the practice’s clinical records system showed 11% of the patients who were prescribed medicine for hypothyroidism were not up-to-date with the required monitoring. We looked at the records for a sample of these patients. We found medicines reviews had not been completed in the last year and monitoring was significantly overdue for all of the patients whose records we looked at, by up to 4 years. This meant one could not know if these patients’ long-term condition was managed as well as possible and the dose of medicine prescribed for them was safe and effective.

Some staff shared with us examples of when they had referred patients to a social prescriber. For example, to support a patient with diabetes to eat well, for housing and emotional support, including for those who may be lonely.

The practice supported national priorities and initiatives, for example the practice’s website had information for those wishing to stop smoking and about ‘getting fit for free’.

The website also had information about ‘winter health’ and ‘summer health’, to help keep people safe and to help them to manage common conditions.

Information was available on the practice’s website, including about local community groups and local and national services offering support, for example about autism; mental health; drug and alcohol problems; bereavement; children’s health, pregnancy and maternity care; and diabetes. There was a section on the website with information for young people.

Support from a Wellbeing Team was available for patients registered with the practice. This team supported people to access national and local services and activities to help with issues which are affecting their health and wellbeing, for example living with low mood or a long-term health condition, feeling stressed, or struggling with personal situations such as worries about money or housing problems.

The practice’s website also included information about a local charity offering social prescribing to help people make positive changes to take control of their health and wellbeing.

Information was available in the waiting areas in the practice, for example about diabetes, child health support and about a Young Person’s Wellbeing Navigator Service.

Posters informing adults about vaccinations available for them were displayed throughout the practice. The practice had also created an information folder for those making decisions about childhood immunisations. However, the practice did not promote the resource and had not kept the information in the folder up-to-date.

The practice identified people who may need extra support, for example unpaid or family carers. 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. About 220 unpaid or family carers were on the practice’s register, about 1.6% of the patients registered with the practice. 6 of these carers were ‘young carers’, meaning those under the age of 18.

Information for carers, and a form to register as a carer, was available on the practice’s website.

The practice had a ‘Carers Champion’ who helped support carers. For example, the Carers Champion provided information and could offer carers timely access to appointments with practice staff or make referrals to social prescribers. Carers were offered vaccinations, such as for flu, COVID-19 and pneumonia.

The latest information from the UK Health Security Agency (UKHSA) showed the practice was performing below the national targets for the number of children immunised against various infectious diseases. The national target is 95%. Data from the UKHSA showed:

• 88% of children aged 1 had completed a course of immunisation for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b (Hib) and Hepatitis B (Hep B).

• 89% of children aged 2 had received a booster immunisation for Pneumococcal infection (PCV booster).

• 90% of children aged 2 had received a booster immunisation for Haemophilus influenza type b (Hib) and Meningitis C (MenC).

• 89% of children aged 2 had had their first dose of immunisation for measles, mumps and rubella (MMR).

• 84% of children aged 5 had had 2 doses of immunisation for MMR.

Patients aged between 40 and 74 are eligible for a NHS health check. The practice told us they had completed a health check with 262 (10%) of the 2647 patients registered with the practice who could have one.

Patients aged 75 and over are also eligible for a NHS health check. The practice did not record how many patients had received one.

The practice offered patients with a learning disability a yearly health check.

Cervical screening (a smear test) is one of the best ways to help protect against and prevent cervical cancer. The latest information from NHS Digital showed that on 30 June 2023, 69% of patients registered with the practice who were eligible for this screening had been screened adequately within the recommended time period. This period is 3 years 6 months for people aged between 25 and 49, and of 5 years 6 months for people aged between 50 and 64. The national target is 80%. We saw the coverage of patients being screened had been consistently below this target since 2016.

The practice told us, at the time of this inspection, 71% of people aged between 25 and 49, and 80% of people aged between 50 and 64 who were eligible had been screened.

Staff had identified some reasons for the low uptake of smear tests. The practice sent reminders to patients, offered smear tests opportunistically, and there was information in the practice’s waiting area about smear tests.

Patients were advised chaperones were available. A chaperone is an impartial observer present during an examination or consultation when a patient may feel vulnerable, for example during an intimate examination. A chaperone acts to protect both patients and staff.

However, most staff members who gave us examples of when they had acted as chaperones did not describe following an appropriate procedure that was in line with national standards, such as standing the same side of any screens or curtains as the patient.

The practice did not provide evidence of Disclosure and Barring Service (DBS) checks for all staff who acted as chaperones. DBS checks identify whether a person has a criminal record or is on an official list of people that should not work in roles where they can have contact with children or adults that can be made vulnerable. These checks help to protect other staff and people using the service from abuse. DBS checks for staff who act as chaperones, are needed because of the nature of chaperoning duties. There were no alternative, clearly documented assessments of how risks would be managed when no DBS check was available for a member of staff.

Not all clinical staff knew their legal responsibilities with regards to caring for patients who may not have the mental capacity to make a particular decision, in line with the Mental Capacity Act.

Although staff told us they would only share information with a person, such as a family member, if there was a record of the patient’s consent, the practice did not have an effective system in place for verifying and recording any arrangements patients had in place allowing another person to make decisions on their behalf, such as a Power of Attorney.