We carried out an announced comprehensive inspection at Lawns Medical Practice on 16 January 2019 as part of our inspection programme. The practice was previously inspected in November 2014 and rated as good overall and outstanding for providing caring services.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected,
• information from our ongoing monitoring of data about services and,
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw one area of outstanding practice

• The practice identified an increase in requests for home visits for patients who would normally be seen by community specialists as a result of a reduction in community nursing resources. In response, the practice secured funding to appoint an outreach nurse to work with patients in the community, to visit the frail and elderly and those at risk of emergency hospital admission. Outreach nurse visits covered health and social needs with a comprehensive questionnaire designed by the practice and appropriate referrals to social services, occupational health and physiotherapy services and dementia support organisations. The practice told us they had seen a reduction in emergency hospital admissions, prescribing costs and pathology costs during the same period the outreach nurse has been in post. The practice also identified an overall reduction in the numbers of home visit requests and an increase in the number of home visits completed by the outreach nurse, increasing GP resource availability.

Whilst we found no breaches of regulations, the provider should:

• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Embed the reviewed process for maintaining blank prescription stationery security in line with national guidelines.
• Review the process for seeking and recording consent in line with national guidelines.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Our key findings were as follows:

• The practice was safe, well led, effective caring and responsive. Staff recognised and understood the needs of patients and tailored access to care and treatments to meet these needs. The practice was working in partnership with other health and social care services to deliver individualised care.
• The practice provided a safe service in an environment which was well managed and risks to staff and patients were identified and minimised.
• Staff were trained and supported to deliver high quality patient care and treatment and to improve outcomes and experiences for patients.
• The practice had analysed the needs of patients with long term cardiac and vascular conditions and had developed a scheme to deliver care to them in the most practical and convenient way for patients. The practice offered nurse led clinics for patients with conditions such as diabetes, heart failure and hypertension. These clinics were available on Mondays, Tuesdays, Wednesdays and Fridays each week and up to 16 patients were reviewed each week. The nurses liaised with GPs to review each patient’s medical records and test results before appointments to determine if any changes to treatment or medicines would be appropriate. This helped to reduce the number of appointments patients needed to attend and ensured the best outcome for each patient. Late afternoon appointments were available for patients if required.

We saw areas of outstanding practice including:

• The practice understood the needs of the population groups it served and took these needs into account. Appointments for older patients and those living in the more rural areas, people who have mobility problems and others who this would benefit were offered to co-incide with the timings of the local bus services to help patients access the practice more easily.
• The practice recognised the needs of patients who were voluntary carers for others. One member of staff took the lead on overseeing the support provided to carers. In 2011 a carer’s support group was set up and meetings were held at the practice. Staff invited carers to attend and guest speakers were invited to give talks and provide advice on issues such as bereavement, power of attorney and health matters. The meetings also provided opportunities for befriending and emotional support.

• The practice had an identified member of staff who acted as a lead for supporting patients who were carers for others. In 2011 a carer’s support group was set up and monthly meetings were held at the practice. All known patients who were carers were contacted and reminded of these meetings. Guest speakers were invited to give talks on a range of topics such as bereavement, power of attorney and health related matters including preventing and managing pressure sores. The meetings also provided opportunities for befriending and emotional support.

• The practice had reviewed its systems for reviewing the needs of patients with one or more long term condition and had implemented long term clinics for patients with cardiac conditions. These clinics allowed patients to attend one extended appointment for their reviews. The effectiveness of these clinics was audited and the practice reported that by combining patient reviews they had identified an additional 8% of patients who would benefit from statin medicines to reduce their blood cholesterol levels.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice