Parkwood Surgery

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

We looked for evidence that the service met people’s needs, and that staff treated people equally and without discrimination. We found the service was not consistently responsive to people’s needs. Patients experienced significant difficulties accessing care, including long telephone waits and online systems closing early. Appointments were often unavailable even when clinically advised and some people queued in person, disadvantaging vulnerable groups.

The triage systems did not reliably prioritise urgent need and continuity of care was poor, with frequent use of locums and delayed follow up of results, referrals and correspondence. Communication was inconsistent and complaints were not always managed effectively. Although access improvements were introduced after assessment, these were not yet embedded or consistently effective.

As a result, the service has been rated inadequate for providing responsive services.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found due to the staffing and leadership issues at the practice, the service provided did not make sure people were consistently at the centre of their care and treatment choices, and they did not always work in partnership with people to decide how to respond to any relevant changes in their needs. We received mostly negative feedback from patients regarding receiving care tailored to their needs and centred around them as the patient. We saw examples of where patient’s mental health had deteriorated and when they were in crisis, there was no support for them to access the service.

Our review of clinical records showed there was inadequate management and oversight of patients' health needs. For example, long-term conditions were not always being monitored due to gaps in systems and processes to recall patients in line with guidance. There were also delays in all aspects of patient care, such as blood test monitoring not having been carried out for years and a lack of medicines reviews, which had a significant and negative impact on person-centred care and treatment.

Patients told us they were very unhappy with the care provision. For example, 1 parent reported that despite their child’s persistent respiratory symptoms and repeated attendances, the practice had not undertaken appropriate clinical investigations or established a management plan, nor had they proactively explored or addressed the underlying cause of these ongoing symptoms.

Complaints received by CQC showed patients were leaving the practice to register at other GP practices. Data showed a 4% reduction in the practice’s patient list size over 12 months. This reduction occurred during a period in which the practice also received significant negative feedback from patients about access and care.

Significant operational issues at the practice meant leaders did not maintain an adequate understanding of the diverse needs of their local population. This led to fragmented and inflexible service delivery, with care pathways lacking co-ordination, partnership and failing to support continuity for people using the service.

The practice supported 3 care homes. Although care home staff reported some improvement, they continued to raise concerns about delays in registering new residents. These delays meant some people were not added to the practice register in a timely manner, which resulted in late access to prescribed medicines and an increased reliance on urgent care services.

Local pharmacies had identified a backlog in prescription handling, and we also received concerns that prescriptions issued by allied health professionals were not being signed and were left waiting, this included antibiotic prescriptions. This backlog went back as far as 2024.

People using the service reported poor continuity of care, stating they were frequently booked with a specific clinician such as a paediatric specialist, only to find on the day that the appointment had been switched to a different or unfamiliar doctor. They described routinely seeing different locum clinicians at each visit, leading to inconsistent assessments, lack of follow up and a sense that no one clinician maintained oversight of their care. Other patients described longstanding difficulties accessing appropriate care, leading them to seek private treatment due to frustration with the service and others described being in distress when their mental health concerns were dismissed.

During our April 2025 assessment, we saw limited evidence of effective partnership working or coordinated systems to ensure information was acted on in a timely way.

Essential clinical information was not being processed promptly, which resulted in missed or delayed follow up. For example, a vulnerable patient requiring enteral tube feeding did not receive prescribed nutrition for 2 days because a prescription request had not been actioned. This represented a significant gap in continuity of care. While we found no evidence of significant harm in this case, the practice subsequently amended its processes to ensure urgent prescriptions were reviewed and signed by the duty GP without delay.

Following the inspection, the practice told us a suggestion box was put in the reception for patients to give feedback and the website was updated to inform patients about the changes in the surgery.

Our assessment in April 2025 identified serious deficiencies in the practice’s ability to provide accurate and timely information to patients and staff.

We found patients had access to information in different languages via their practice website, including a language translate option and access to interpreter services, including British Sign Language. Patients were advised to contact the practice prior to their appointment so they could arrange to have a BSL interpreter when required. However, when we looked at accessibility arrangements for individuals, we saw there was no hearing loop in the practice at the time of assessment.

We identified concerns regarding communication about prescriptions, where patients were not informed of medication refusals and only became aware through the NHS app. Up to 20 of the 50 patient complaints sent to the practice and submitted on assessment were information related complaints. Patients reported difficulties obtaining hospital documentation, stating that staff often advised documents were unavailable without checking. Reception staff were described as providing inconsistent information and patients felt their online notes were not reviewed prior to their consultations.

We received feedback from patients who reported significant concerns about timely access to essential clinical information. One patient explained that a private consultant had written to the practice regarding ongoing health issues; however, when they contacted the practice, staff were unaware of this correspondence because it had not been added to their medical record.

Other patients raised concerns about delays in communicating invalid test results; for example, a patient submitted two samples requested by a GP to rule out a serious condition. Although the surgery received the results weeks prior, no contact was made to advise that both samples were inconclusive due to being submitted in incorrect containers. The patient, who had a progressive condition was unable to obtain results by telephone and was required by the practice to queue outside before 8am to secure an appointment a week later. The failure to review the results promptly and communicate with the patient and proactively request repeat samples created delays in care and caused significant distress. No alerts were placed on the patient’s record to indicate that repeat specimens were required and this raised concerns about timely communication of information to patients.

Following the assessment, all clinical and reception staff were reminded to inform patients in advance if their appointment would be with a non-GP clinician and whilst not all cases required a GP review, clear communication was essential.

Evidence did not demonstrate that leaders took patient complaints seriously. The assessment found that the service lacked accessible channels for feedback and complaints. We received a significant number of concerns from patients who reported difficulties in submitting concerns, noting that online or email options were unavailable and complaints had to be made in person by requesting the complaints email address from reception which created barriers particularly for working-aged people. Patients felt the practice was making it very difficult to contact them.

Several patients also reported frustration with the complaints process, stating that their concerns were not acknowledged and responses felt dismissive. When they did submit formal complaints, the practice failed to acknowledge the distress experienced by patients. During our assessment, patients told us they did not feel listened to and some escalated their complaints to external bodies such as their Member of Parliament (MP) and the Herts and the integrated care board.

The practice reported 50 submitted complaints since January 2024, while CQC received 78 concerns from people. We found the record incomplete and potentially inaccurate, as at least 17 complaints, some dating back to August 2024 lacked documented actions, and patients told us that their written complaints to the practice in December 2024 were eventually closed due to no reply. We also saw complaints were not managed in line with the practice’s policy. Their complaints policy stated that complaints would be acknowledged within 3 working days; however, we found a significant length of time was left between submission and acknowledgement; for example, 1 complaint submitted January 2024 was not acknowledged until February 2025 and the GPs spoke to the patient in March and a child’s complaint raised in January 2025 was not acknowledged by the practice.

Complaints did not lead to improvement. The provider failed to implement the promised double checking process for clinical letters and our assessment in April 2025 showed there was still no evidence of action as patients continued to face delays in referrals and hospital correspondence due to ongoing backlogs.

Not all staff were aware of improvements made as a result of patient complaints. Staff also felt patients were not always listened to and identified that sometimes conditions they thought were urgent had been turned away by the GPs. For example, 1 patient felt that their immediate health concern had been overlooked and that the complaints process was insensitive and dismissive. When they raised their concerns, they felt their complaint was handled poorly by the practice. Instead of acknowledging the distressing experience they had described, the response they received simply advised them again to seek help from emergency or urgent care services.

The service did not make sure that people could access the care, support and treatment they needed when they needed it. They had failed to meet their contractual enhanced services and extended hours targets and as a result, they were unable to meet the needs of their patient population.

People felt there was a failure in their triage system and they were consistently unable to secure an appointment to speak to a clinician of their choice. This also had an impact on the choices available to them for their care and treatment reviews. Some patients told us they were not left with an alternative or choice when it came to their appointments.

Access to appointments at the practice was significantly limited. Staff expressed concern that the appointment system restricted their ability to help patients. We received concerns that their e-consult (where patients can book appointments and make requests online) was closed early every day, sometimes within half an hour of opening, due to clinical staffing issues, leaving patients with no alternative but to queue or call repeatedly, often unsuccessfully. This resulted in patients having to contact NHS 111, or attend urgent care services, putting additional strain on the administrative team who were often unable to allocate appointments to patients signposted back to the surgery. Appointments were released daily at 8am but were often fully booked within approximately 16 minutes. This was consistent with patient feedback. Many patients stated they were advised to attend the practice in person and queue from 8am, which was not feasible for everyone. This led to long queues outside the practice early in the mornings and created barriers to care for vulnerable groups and working-age adults and school aged children.

Patients also told us the practice kept changing the way patients booked appointments and this was not clearly communicated. This negatively impacted patients’ health and wellbeing. For example, multiple complaints highlighted that the online triage system was frequently turned off, leaving patients with no alternative but to queue or call repeatedly, often unsuccessfully. Some patients reported taking annual leave or multiple days off work just to secure an appointment, describing the system as not viable as a service for patients.

There was a process for managing urgent appointment requests for vulnerable patients, including children under 5 and those with complex needs. Five urgent slots were available each morning and afternoon. When these were full, reception staff escalated cases to the duty doctor via instant message for a decision. We found that responses varied as some GPs accommodated additional patients, while others declined. We also found this appointment system did not adequately safeguard vulnerable groups and required urgent review.

Concerns were raised that on multiple occasions, young children requiring urgent care were not seen and turned away by the GPs because they presented late in the day. During our inspection, we observed instances where children under 5 years of age, at risk of rapid deterioration were turned away at reception due to a lack of available appointments, without escalation to a GP. Similarly, elderly patients with complex health needs often faced significant delays in accessing care, leaving some without essential medical support. Their appointment system failed to safeguard vulnerable patients, including children, elderly individuals and those with complex health needs. Following the assessment, the practice introduced measures to guarantee same-day appointments for children under 5 years of age and adults over 80 years, with contingency slots available to accommodate urgent needs.

National GP Patient Survey 2024 and 2025 showed only 45% of respondents rated their overall experience as good, compared to a local average of 75% and national average of 83%. Satisfaction with reception and administrative staff was 57%, significantly below the local average of 82%.

We were not assured of a safe escalation pathway for red flag symptoms or vulnerable groups as staff were often instructed to signpost patients to pharmacies, 111 or Accident and Emergency (AE) departments when no appointments were available, regardless of clinical need. This meant non-clinical staff were expected to ask patients for details of their symptoms without the training or ability to provide appropriate advice.

As a result, patients were routinely diverted to emergency and urgent care services due to lack of GP capacity, leading to the inappropriate use of AE and 111, delays in care and avoidable distress. This further increased clinical risk and contributed to poor patient experience, harm and loss of trust in the service. This was consistent with patient feedback. For example, an appointment for skin lesions was cancelled due to staff sickness but the surgery did not prioritise re-booking. This led to further delays and difficulty accessing care and the individual was ultimately seen via the Out of Hours service. Following further assessment activity in September 2025, the practice told us they introduced their new triage system introduced by the practice improved access, offering up to 60 patient slots per session but also increased clinical activity and administrative tasks. Patient online access was now open from 8am to 6.30pm without any restrictions.

Staff and leaders did not always listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this. There were no processes in place to prevent inequality in experience and outcomes; for example, there was no accessibility policy and no provisions for their blind or partially sighted patients when attending appointments and this was consistent with patient feedback on assessment.

Feedback provided by people using the service, both to the provider as well as to CQC, was predominantly negative. We were not assured that people were treated equally and without discrimination. Elderly patients with complex health needs were frequently unable to secure timely appointments and many lived without proper medical care or experienced extended delays, which placed their health at further risk.

Leaders did not proactively seek ways to address any barriers to improving people’s experience and work with local organisations, including within the voluntary sector, to address any local health inequalities. We were not assured the provider had effective processes to ensure people could safely register at the practice as we found a backlog in summarising new patient records dating back 1 year.

Treatment rooms were available on the ground floor and a ramp and automatic door had been fitted to the entrance.

The practice did not always recognise or respond to the individual needs of vulnerable groups, which created inequitable experiences and outcomes. For example, the practice reported having 530 registered carers, including 8 young carers. In September 2025, this had reduced to 469 carers, including 10 young carers. The practice was unable to provide a clear explanation for this change or evidence of any review or validation of the data. Carer information was published on the practice website alongside an online registration form.

However, accessibility remained a concern for carers, as some elderly patients without internet access were unaware of the service and therefore unable to register as carers. For example, 1 elderly carer told us they had not been offered support and were unaware of any services for carers. This meant they did not receive the guidance or signposting needed to help them manage their caring role. Training records showed only 2 staff had completed carer awareness training.

They did not involve people in decisions about their care as patients we spoke to with long-term conditions also told us they were not allowed to raise more than 1 issue during their appointments but had to request another appointment when accessing the service was already an issue. Patients also felt the practice did not help them use services. This left staff dealing with a system that resulted in a lot of frustration for patients and a lot of abuse from patients towards the staff

The practice maintained a register of 71 patients with a learning disability. Of these, 62 had received their annual health reviews, in line with national guidance. Designated staff were responsible for coordinating and monitoring these reviews to ensure timely completion and continuity of care.

People were not consistently supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. The practice told us that end of life care was discussed through regular, minuted multidisciplinary palliative care meetings involving all relevant clinical staff. They told us they maintained a palliative care register of 101 patients, with focused discussion on higher‑risk patients identified as amber or red, including new additions to the register. These meetings also provided an opportunity to review all recent deaths, reflect on what worked well and identify any learning to support improvement in end‑of‑life care and coordination.

However, we were not assured that patients consistently received appropriate support to manage end-of-life needs. This was inconsistent with feedback and our findings on assessment. We found a palliative care letter had not been actioned since November 2024 and we received concerns that palliative care meetings were not regularly attended by the practice and we did not see evidence of this on assessment. They oversaw 3 care homes but the GPs had not completed any capacity reviews.

We also received feedback in which a family member sought guidance from reception staff when a relative’s death was believed to be imminent. The family member was advised only to call an ambulance and was not offered any further information, support or signposting, indicating a lack of clear processes to support patients and families at the end of life.

We requested feedback from the 3 care homes looked after by the practice as part of the assessment. Feedback was mixed but mostly positive. It demonstrated that people at the end of life were treated with dignity and compassion and were supported in line with their individual needs. Medicines for symptom control, pain relief and palliative care were managed safely, provided in a timely manner and kept under regular GP review. Other care home staff raised concerns about end‑of‑life care, reporting delays in residents being reviewed by a GP. Reviews were often undertaken by a paramedic, who while described as respectful, was not able to make GP‑led decisions. This resulted in delays in prescribing end‑of‑life medicines and completing advance care planning, as decisions required escalation to a GP.