Larksfield Surgery Medical Partnership

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

The practice did not organise and deliver services to meet patients’ needs. We have told the provider they must take actions to establish effective systems and processes and operate them effectively to ensure patients have access to services that meet their needs.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were a small number of comments in the Give Feedback on Care we received from people who use the service for this assessment stating that once you were able to get an appointment, the care and treatment received was good. However, some people referred to receiving care that they felt was not person-centred. For example, carers of young patients were not always involved in planning and making shared decisions about their children’s care and treatment, so that it was centred around them and their needs. Other patients referred to not receiving the most appropriate care and treatment, as the service did not always make reasonable adjustments, as systems in place were not flexible. For example, hospital letters had to be submitted electronically. Such concerns had also been raised by patients through the practice’s patient participation group (PPG).

Some staff had an interest in supporting those experiencing domestic abuse. They gave an example of how they had supported people with a positive outcome. Other staff told us about how they communicated with Deaf patients according to their preferences, such as, writing things down for them and providing information about appointments, via emails. However, a variety of clinical and non-clinical staff gave us examples on how they were often not able to make the reasonable adjustments identified because of inflexible systems, limited appointment availability or staff capacity. For example, people who could not use online services.

Leaders told us the practice could not offer patients continuity of care, at the time of this inspection. This included offering patients follow-up appointments with the same clinician. The practice could also not offer patients appointments with the same clinician for the oversight of their long-term conditions. Additionally, leaders said that they did not have the capacity to use information about the needs of the local population to adapt services offered by the practice to meet these needs.

Feedback from partner organisations included difficulties accessing appointments, concerns about how the practice processed referrals and worked with other services to ensure patients’ care and treatment was joined-up.

Therefore, the importance of flexibility, choice and continuity of care was not reflected in the services provided due to the systems and processes the practice had in place and the limited appointments available.

The practice had effective systems for storing and keeping confidential and sensitive personal information secure, for example patient’s current and historic medical records. There was information in the practice and on their website advising patients how their information was used. However, the practice had recorded 3 significant events involving data breaches in the year leading up to this inspection. Although the practice had managed these appropriately, informing the Data Protection Officer and the patients involved, not all staff had completed the required training in Information Governance or were up to date with this training.

Some responses from the Give Feedback on Care we received from people who use the service for this assessment, stated that while they felt that they could make a complaint or provide feedback, they did not believe that the practice would take on board their views and experiences. Others told us they had not raised concerns because they didn’t think they would be dealt with appropriately.

During the inspection, we found that staff were aware on how to signpost patients to information on how to make a complaint, raise concerns or provide feedback. Leaders told us that they had streamlined the complaints process, due to the volume of complaints they had been receiving, with 57 complaints received in the year leading up to our inspection. They also shared with us examples of communications they had distributed to patients, such as, a letter that was sent out in December 2023 with an update of changes at the practice. The practice had been developing the Patient Participation Group (PPG), with the appointment of a chair for the group. The PPG was working on a patient survey to collect the views and experiences of patients which included their opinions of the practice’s online triage system.

Information about how to complain was also available on the practice’s website and on posters throughout the buildings. However, while there was a system for recording complaints and complainants were usually responded to appropriately, the provider did not always act on the learning from them.

Data from the GP patient survey 2023 showed the practice was significantly below the local and national averages for patient satisfaction in respect of access. This included how easy it was to get through to someone at the practice on the phone. A cloud based telephony system to improve telephone access for patients was scheduled to be installed, shortly after this inspection. The most significant concern raised by people who use the service in their responses from the Give Feedback on Care we received for this assessment was the inability to access the practice. The two main barriers were a lack of available appointments and booking processes which patients found were obstructive and inefficient. Patients had also raised concerns in this area through the practice’s patient participation group (PPG).

Although the practice offered a range of appointment types, including 15 minutes face-to-face, telephone and home visits, availability was limited, and the practice did not offer patients timely access to appointments and treatment. At the time of our site visit, there was limited access to ‘routine’, or ‘non-urgent’, appointments. Patients needed to wait 10 working days for the next routine appointment to see a GP and 19 working days for an appointment for their child to have immunisations. There were no appointments available for cervical smears, and we did not see staff directing patients to other nearby services offering extended access appointments.

The practice’s systems meant staff were unable to prioritise patients with the most urgent needs. Patients were signposted to other services, such as NHS 111, out-of-hours and walk-in services, because no appointments were available at the practice. The practice employed a variety of staff, including Advanced Nurse Practitioners, GPs, Health Care Assistants, Nurses, and Paramedics. However, patients were routinely given appointments with staff who may not be able to fully address their needs because there were no appointments with a more suitable clinician. For example, if the patient needed a certain test or medicine. All appointments needed to be requested using the practice’s online triage system. However, this system was closed by the practice once the number of requests submitted had reached a certain number. The provider told us this was to help the practice manage the demand on the service. However, this meant there was no way for patients to access appointments once the system was closed for the day, with insufficient provision to meet the demand and needs of patients. Additionally, this resulted in the practice not always removing barriers and supporting all to access services.

Several people who provided Give Feedback on Care we received for this assessment were negative about how the practice did not always tailor the care, support, and treatment to meet individual needs. For example, the inflexibility of the practice’s system to book an appointment or consideration for people who cannot travel to other services for appointments. Similar concerns had also been raised by patients through the practice’s patient participation group (PPG).

We did not see evidence of active discrimination towards patients or staff during this inspection. Although staff at Arlesey Medical Centre told us about how they had made adjustments to help a patient with reduced mobility, the practice did not have the capacity at the time of this inspection to make adjustments for other individuals to help make sure all people using the service were supported to overcome barriers and access services. For example, the practice did not act on feedback from people using the service to minimise the length of time people waited for care, treatment, or advice, or to support individuals to access services where reasonable adjustments had been identified to help them to do so. For example, to help patients who did not have access to online services or who would find using online services difficult. Additionally, some staff were not aware that they could complete an online form on a patient’s behalf if it was needed.

According to information that was shared by the practice, not all staff had completed training in Equality and Diversity. During the site visit, we noted that the facilities and premises at Larksfield Medical Centre were appropriate for the services being delivered. However, we found that the Arlesey Medical Centre site was poorly signed, the car park had an uneven surface, and there were limited toilet facilities for patients with restricted mobility or for baby changing. We saw that a hearing loop was fitted at both sites.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.