Dr Alva & Partners Also known as Houghton Regis Medical Centre

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

This means we looked for evidence the service understood the needs of the people and communities they served and put them at the centre of how care was planned and delivered. We looked for evidence people accessed the care and treatment they needed when they needed it.

At our last inspection we rated this key question Good.

At this inspection, the rating has changed to Requires Improvement.

This is because the practice did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decisions were not always recorded in line with legislation or reviewed when appropriate.

However, generally, people could access services, although the provider had missed opportunities to respond to patient feedback and data to improve access to the services the practice provided. The results of the 2024 GP Patient Survey showed fewer were positive about access at the practice than the local and national averages.

Although the provider had not always developed the service in a way that reflected the needs of the local population, the practice was accessible for those with a wide range of needs.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The findings of the 2024 GP Patient Survey showed people’s experiences of the practice were in line with, or slightly better than, local and national averages. Of the people who responded to the survey:

• 75% responded positively to the overall experience of their GP practice

• 86% said during their last appointment the healthcare professional was very good or fairly good at listening to them.

• 83% said during their last appointment the healthcare professional was very good or fairly good at treating them with care and concern.

• 88% said during their last appointment they had confidence and trust in the healthcare professional they saw or spoke to.

Some people described staff as professional, thorough, proactive, knowledgeable and helpful.

However, other people who used the service told us they did not feel clinicians treated them in a way that considered their individual circumstances. People told us they did not feel clinicians took time to understand their concerns or investigate the causes of their symptoms. Other patients felt there was a lack of support and interest from staff and that some clinical staff could show more empathy, professionalism and understanding.

Staff recognised the diverse health and care needs of the practice population.

The practice supported residents living in 2 local care homes. Each care home was supported by a named doctor, who visited every 1 or 2 weeks. The practice offered visits to the care homes between these ward rounds when needed for specific residents.

A practice nurse told us about monthly clinics they held at the practice during which they saw patients jointly with a specialist nurse. They explained how this continuity had helped patients feel more comfortable and confident in the care they received.

The practice complied with the Accessible Information Standard (AIS), a requirement for all providers of NHS care. The AIS applies to people who use a service, and their carers or parents, who have information or communication needs because of a disability, impairment or sensory loss. For example, there was a hearing loop for people who are deaf or have difficulty hearing.

The provider was registered as a data controller with the Information Commissioner’s Office.

Information was available on the practice’s website and there was a recorded message advising patients how their information was stored and managed when they telephoned the practice.

The practice did not provide evidence any clinical staff, including the practice’s lead for information governance, had completed any training in information governance. Although 12 of the 15 non-clinical members of staff at the practice had completed training in various specific aspects of data management and protection, the practice shared with us evidence only one member of non-clinical staff had completed training covering more aspects of information governance relevant to a GP practice.

Some people who used the service told us the practice were dismissive and defensive when concerns had been raised with them.

Information about how to complain was available in the practice’s waiting area and on the practice’s website. However, this lacked detail about the practice’s complaints policy and procedures and what people could expect.

Leaders told us people could make a complaint to the practice by letter or email, using online feedback forms or by collecting a complaint form from reception. However, practice staff were not clear about the practice’s complaints procedures, including how people could make a complaint.

The practice’s website said people could share their thoughts with the practice by completing an online Feedback Form. People were also invited to share their suggestions to improve how the practice operates or manages its services by completing an online NHS Friends and Family Test Feedback Form. However, these forms were not available.

Posters with a link to the NHS Friends and Family test were displayed in the practice’s waiting area.

There was a ‘Patient Suggestion Box’ placed near the reception desk in the practice.

Whilst there was a system for recording and responding to complaints, this did not function effectively. The practice had recorded on a spreadsheet 9 complaints in the 18 months leading up to this inspection. However, we also saw records for 13 further complaints the practice had received in the last 18 months that had not been recorded on the spreadsheet.

Although the practice responded to complaints in a timely manner, responses were not always apologetic when relevant or contained information about what the person could do if they were not satisfied with the response.

The practice often responded to complaints verbally, addressing the person’s immediate concern. However, this meant the practice did not investigate complaints thoroughly to identify and act on all possible learning from them to help prevent recurrences. For example, leaders were aware of several complaints to the practice from people who had not been able to access an appointment. Although leaders telephoned these patients and offered them appointments, the practice had not taken actions to try to improve people’s experiences of the practice’s appointments system. Staff told us people complained to them about the practice’s appointments system.

The practice had specific telephone lines for people to speak with a secretary, prescription clerk or the Patient Liaison Officer, or for test results or general enquiries. This meant people telephoning the practice to speak to these staff did not wait so long to do so, and people telephoning the practice to book an appointment did not wait so long for their call to be answered.

However, people who used the service told us it was difficult to contact the practice and when they had successfully contacted the practice there were no appointments available for them.

The results of the 2024 GP Patient Survey showed fewer people were positive about access at the practice than the local and national averages. Of the people who responded to the survey:

• 29% were positive about how easy it was to contact the practice by telephone (compared with 50% nationally and 37% in the Bedfordshire, Luton and Milton Keynes (BLMK) area).

• 46% responded positively about their overall experiences of contacting the practice (compared with 67% nationally and 57% in the BLMK area).

At the time of our inspection, we saw timely appointments were available, with the practice’s doctors, healthcare assistants, nurse prescriber and practice nurses.

Patients registered with the practice could also access support from an advanced nurse practitioner and clinical pharmacists who were employed by the Titan Primary Care Network (PCN). The practice was a member of this network, which included 3 GP practices working together to address local priorities in patient care.

There was information in the surgery and on the practice’s website and a recorded message on the practice’s telephone system to support people to understand how to access services.

The practice offered face-to-face, telephone and online consultations. The practice offered home visits by a doctor or nurse prescriber.

Patients could book a ‘same day’ appointment by telephoning the practice. The practice released morning appointments at 8.05am and afternoon appointments at 12.30pm. All face-to-face appointments with a doctor were either for the same or next day. Patients told us about their frustrations of fitting in appointments around their other commitments, such as work and caring responsibilities, because the practice did not offer pre-bookable face-to-face appointments with doctors. However, patients could pre-book an appointment with a nurse up to 3 weeks in advance.

If no appointments were available in the practice, staff signposted patients to local urgent treatment or walk-in centres, pharmacies or the NHS 111 service.

When the practice was closed, patients were directed to access support, treatment and advice from the NHS 111 service or emergency services.

Patients could contact the practice using a recognised online system between 9.30am and 2.30pm for non-urgent queries.

Healthwatch Central Bedfordshire conducted an ‘Enter and View’ visit to the practice in January 2025. Healthwatch is the local, independent, consumer champion promoting choice and influencing the provision of high-quality services. It was created under the Health and Social Care Act to make sure the views and feedback from people who use services is considered. The Healthwatch report made several recommendations to support the practice to improve patient experiences, for example about access to appointments.

The practice supported more young people and fewer older people than the national average and the average for the BLMK area.

41% of patients registered with the practice had signed up to online services. Although the practice no longer allowed people to book appointments by visiting the reception desk, people could alternatively book appointments or contact the practice for other queries by telephone.

A number of patients registered with the practice did not speak English as their first language. When needed, the practice could offer longer appointments and use of a telephone-based interpreter service. Some staff members could speak other languages and could support discussions.

The practice also displayed some patient information leaflets in different languages and it was clear how to, and it was easy to, translate information on the practice’s website into a range of different languages relevant to the people using the service.

Staff described how they individually had made reasonable adjustments for patients when needed, for example allowing a patient to wait in a quieter corridor rather than the busy waiting area to be called into their appointment. Non-clinical staff told us they tried to book appointments that suited requests from individual patients, such as requests for appointments at certain times of the day.

Staff shared with us an example of offering longer appointments, appointments with the same clinicians so the patient knew what to expect, and appointments with a suitable British Sign Language translator with knowledge of translating medical language for a deaf patient. Appointments were arranged through the practice’s Patient Liaison Officer, who liaised with the patient’s keyworker.

Patients could ask for repeat prescriptions online or by filling out a ‘repeat prescriptions request form’ and taking it to the practice. The practice did not take repeat prescription requests over the telephone or by email.

There were baby changing facilities and ramped access suitable for those with wheelchairs, scooters or prams.

There was a bus stop and a public car park next to the practice which had disabled parking spaces.

The practice offered a range of appointment types including face-to-face, telephone, online and home visits.

People who were or might be vulnerable could register with the practice, including those with no fixed abode such as people who were homeless, Travellers, and refugees.

Some of the Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decisions we looked at during this inspection had not been recorded in line with relevant legislation.

This meant there was not always evidence these decisions had been made in line with legislation, and involved patients, and their relatives and carers.

When a decision about DNACPR had been made, a code was usually added to the patient’s record to alert staff.

Clinicians in the practice relied on these codes to identify patients for whom a decision about DNACPR had been made. However, clinicians were sometimes unable to find information on the clinical records system explaining the patient’s wishes and how the decision had been made, so they could be sure they acted in ways the patient wished.

We also saw doctors at the practice did not always review DNACPR decisions. For example, when decisions had been recorded and coded on the patient’s record by a different service.