The Care Quality Commission
  • Doctor
  • GP practice

Lawrence House Surgery

Overall: Good read more about inspection ratings

107 Philip Lane, Tottenham, London, N15 4JR

Provided and run by:
Welbourne Medical Practice

All Inspections

17 November 2022

During an inspection looking at part of the service

We carried out an announced focused inspection at Lawrence House Surgery on 17 November 2022. Overall, the practice is rated as Good.

The ratings for each key question were rated as:

Safe - Good

Effective - Good

Caring - Not inspected, rating of Good carried forward from previous inspection

Responsive - Not inspected, rating of Good carried forward from previous inspection

Well-led - Good

Following our previous inspection on 19 December 2016, the practice was rated Good overall and for the key questions Effective, Caring, Responsive and Well-led. The practice was rated requires improvement for the key question Safe.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Lawrence House Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities. The focus of the inspection included:

  • Inspecting the Safe, Effective and Well-led key questions.
  • Following up on areas identified for improvement from previous inspections and remote monitoring activity.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

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 found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Staff interviewed describe a positive working environment and manager/staff relationships. Staff interviewed state they know who to report to if any concerns and staff are clear on roles/responsibilities within the team.
  • There is evidence of a strong focus on patient-centred care and innovation within the practice. For example, partners within the practice are well connected with local networks and share learning.
  • The practice has an effective system for monitoring staff training records and all staff files looked at had completed all mandatory training in the required time frames.
  • Staff spoken with felt supported within their roles and were given appropriate time to pursue additional learning and training.
  • Leaders within the practice showed awareness of current issues and had plans in place to address any identified concerns. For example, working on improving access and trialling use of a GP / other staff covering phone lines during early morning busy periods.
  • Patients received effective care and treatment that met their needs.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

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

  • Take action to ensure all patients with a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) order, and who and are deemed to lack mental capacity in relation to that decision, have a supporting formal capacity assessment available in their clinical record.
  • Implement a system to monitor the oxygen levels within the oxygen cylinders when completing checks on the emergency medicines supplies.
  • Review the disabled toilet facilities and the use of an emergency pull cord for patients.
  • Continue efforts to improve the uptake of childhood immunisations and cervical screening.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

4 October 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lawrence House Surgery on the 19 December 2016. The overall rating for the practice was Good. The full comprehensive report on the 19 December 2016 inspection can be found by selecting the ‘all reports’ link for Lawrence House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

  • The practice had a safe and effective system for taking action in relation to MHRA (Medicines and Healthcare products Regulatory Agency) updates. The practice took action where necessary to mitigate the risks to patient safety.

At our previous inspection on 19 December 2016, we rated the practice as requires improvement for providing safe services as the practice was not taking the relevant action following the receipt of MHRA updates, doing all that was reasonably practicable to mitigate the risks to patients. At this inspection we found arrangements for managing the receipt of all MHRA alerts including updates were robust and effective, therefore ensuring that patients who may be affected were appropriately identified, and assessed and treated appropriately in line with published guidelines. Consequently, the practice is rated as good for providing safe services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

19 December 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection Lawrence House Surgery on 19 December 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However, Medicines and Healthcare Regulatory Agency updates were not always acted upon and the necessary patient checks were not completed.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice, in conjunction with the patient participation group (PPG) set up education talks for patients and families. There was also annual open patient fun day, where patients were invited to attend the practice and participate in talks on health promotion. Last year’s patient fun day took place in June 2015.Patients were shown how to make simple healthy meals by staff for example a simple salad. There was also smoking cessation information and educational talks on sugars, mental health and nutrition. This year a fun day took place in August 2016, and there were demonstrations on resuscitation delivered by a paramedic as parents had asked for this and information was given on resuscitation and choking. The event was also open to patients and members of the public.

The areas where the provider must make improvements are:

  • Care and treatment must be provided in a safe way and the practice must take the relevant action following the receipt of MHRA updates, doing all that is reasonably practicable to mitigate any risks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice