Larksfield Surgery Medical Partnership

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Compassionate, inclusive, and effective leadership was not evident at all levels. The practice was not led in a way that supported the delivery of high quality care, learning and innovation. Processes for managing risks, issues, and performance were not always effective. We have told the provider they must take actions to establish effective systems and processes and operate them effectively to ensure good governance and compliance.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff we spoke with understood equality, diversity, and human rights. Feedback from a variety of clinical and non-clinical staff referred to how they worked together as a team. Staff told us they strived to provide safe, high-quality, and compassionate care for patients. However, they also described feeling tired, stressed, unappreciated and morale was generally low. Staff also felt they were not always supported to be able to provide the quality of care they desired for their patients.

While the provider talked about a vision and plan for the future of the practice, staff were not aware of these and stated they had not been involved in the planning or development of them. They also said not all the partners were visible and did not always respond to suggestions and concerns about the running of the practice and ideas for improvements that could be made.

Staff said that while they felt well supported by their line managers, including the practice manager, there was not a compassionate, inclusive, and effective leadership at provider level. They also referred to leaders knowledge about issues and priorities for the quality of services been delivered. For example, staff told us that not all partners knew who they were as individuals and their personal circumstances. Staff commented that the practice was not run in a way that embraced each member of staffs’ interests and expertise, or fully appreciated how their professions could support patients in a primary care setting. Additionally, they told us the provider was not always supportive of their professional development, with some staff referring to inequity in working arrangements.

Staff reported that there was an open and honest culture within the practice, and they felt able to raise concerns with their immediate management team. However, some staff were apathetic about raising concerns with leaders at the practice because they thought that their voice wouldn’t be heard, or their views would be dismissed.

The practice had access to a Freedom to Speak Up Guardian and some staff knew who to contact and would, should they wish to raise any concerns. However, not all staff were aware of Freedom to Speak Up Guardian arrangements or how to contact them, as a resource for staff to raise concerns or speak up when they feel that they cannot in other ways.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

A variety of staff, both clinical and non-clinical, told us they did not have sufficient time to complete tasks required of them, for example to complete audits, infection prevention and control measures and administrative tasks. Non-clinical staff told us the arrangements agreed to help them balance telephone calls into the practice and their well-being were not achievable. Not all staff were aware of practice policies and how to access them.

The provider could not always account for the actions, behaviours, and performance of staff. For example, the competency of clinical staff who were not doctors but who were able to prescribe medicines and did so safely and effectively. The provider did not show there was due oversight of risks affecting the practice. For example, to make sure staff were up to date with required training, there was suitable staffing at both practice’s sites to meet demands, and to act on issues identified in infection prevention and control audits. Additionally, the practice's governance systems were not always effective. For example, to identify when emergency medicines and equipment needed replacing or to act on recordings of the temperatures of the vaccine fridges to make sure the medicines stored in them were safe and effective to use. Leaders did not demonstrate they had plans for the future of the practice that took into consideration challenges to quality and sustainability. For example, plans leaders had to manage backlogs in administrative tasks whilst also managing work coming into and leaving the practice and plans for changing the staff mix in the practice.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The practice did not have an embedded focus on continuous learning, innovation, and improvement. For example, in their feedback, staff referred to not having sufficient time to complete training the practice deemed essential, with some staff carrying out such learning, in their own time. They also told us that the provider did not always support their professional development and did not see innovation and improvement as a priority. Staff felt well supported by their line managers, including the practice manager who encouraged them to speak up with ideas for improvement and innovation. However, they didn’t think that leaders spent time to listen and engage with them and there was a lack of trust between leadership and staff. Leaders informed us that they were planning to start regular educational meetings for clinical staff, once there were more regular clinicians in post, where they could present and discuss cases, clinical updates, and guidance. They were also hoping for the Primary Care Network (PCN) to initiate education sessions.

Larksfield Surgery Medical Partnership is an Armed Forces veteran friendly accredited GP practice. It can provide Basic Life Support training to external parties. The practice also shared with us an overview of quality assurance and improvement activities undertaken for the period 2023/2024. This included, a General Practice Improvement Plan (GPIP) under the module of effective processes which referred to areas that needed improvement, around patient access and the development of knowledge and skills for non-clinical staff. However, the practice did not review the effectiveness of changes made as part of the GPIP or in response to significant events or complaints to further develop and improve the experiences for patients and staff. Additionally, there was no embedded quality improvement programme, including audits for monitoring and improving outcomes for patients with long-term conditions or prescribed certain medicines. The practice did not always use data to monitor and improve performance and hold management to account, for example data around access.