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

This means we looked for evidence the service understood the needs of the people and communities they served and put them at the centre of how care was planned and delivered. We looked for evidence This means we looked for evidence the service understood the needs of the people and communities they served and put them at the centre of how care was planned and delivered. We looked for evidencepeople accessed the care and treatment they needed when they needed it.

At our last inspection we rated this key question Inadequate.
At this inspection, the rating has changed to Good.

This is because:

• Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were recorded in line with legislation.

• The practice provided a range of different appointment types. Since our last inspection, the provider had employed specialist clinicians, with whom patients were offered longer appointments.

• Feedback from care homes the practice supported was more positive than at our last inspection. However, support for care homes could be improved, including considering whether virtual ward rounds meet the needs of residents living with Dementia.

• Whilst the practice had moved to a new ‘Total Triage’ system and the provider told us access to appointments had improved, staff and patients told us appointments were not always available.

• The findings of the 2025 GP Patient Survey showed significantly fewer people were positive about accessing the service than the local and national averages. The survey also showed that although people said they felt the healthcare professional they saw was very good or fairly good at treating them with care and concern, people’s overall experiences of the practice were below the local and national averages.

• Whilst the practice’s complaint response letters were sent in a timely way, offered an apology when it was appropriate, and contained information about what the person could do if they were not satisfied with the response, the practice could make it easier for people to make a complaint and clearer how someone could make a complaint.
 

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The findings of the 2025 GP Patient Survey showed fewer people, 44% of people who responded to the survey, were positive about their overall experience of the practice than the local average (67%) and national average (75%).

However, other findings from the survey were more in line with local and national averages:

• 82% said during their last appointment they had confidence and trust in the healthcare professional they saw or spoke to, compared with the local average of 90% and the national average of 93%.

• 76% said during their last appointment the healthcare professional was very good or fairly good at listening to them, compared with the local average of 83% and the national average of 87%.

Results from the NHS Friends and Family Test showed more people were positive about their experiences of using the service since our last inspection. Data is collected monthly. Between 66% and 82% of people who completed the survey responded positively. Whilst these were below the average for England, they showed an improvement since our last inspection of the practice.
Results also showed fewer people responded negatively about their overall experience of the practice since our last inspection. Between 9% and 17% of people completing the survey responded negatively. Although these were above the average for England, they showed a sustained improvement for the practice since our last inspection.

Feedback from people who had used the service and provided feedback online or to CQC was mixed. Some said they felt staff did not listen and staff did not investigate or address their concerns.

The practice supported residents living in 3 local care homes. Each care home was supported by a named doctor, who carried out virtual ‘ward rounds’ weekly and would visit the care home when it was needed.

Feedback from care home staff was largely positive. However, some said that communication with the practice and the timeliness of the practice’s response, for example in response to requests for medicines to make sure residents had the medicines they needed when they needed them, were areas the services were improving together.
 

The provider was registered as a data controller with the Information Commissioner’s Office.

Information was displayed in the waiting areas and was available on the practice’s website advising people how their information was stored and managed.

Where training records were available, these showed staff had completed training in information governance.

There were posters displayed informing people that interpreter services were available for people who did not speak English as their first language, including sign language. It was easy for people who did not speak English as their first language to translate signing-in screens into other languages.
 

Information about how to complain was available in the practice’s waiting areas. Information about how to give feedback or complain was also available on the practice’s website, including the practice’s Complaints Policy and what people could expect.

However, the website had not been updated with the practice’s new Complaints Policy, dated December 2025. This policy did not reference the practice’s complaints leaflet, which was available on the practice’s website.

People could share their thoughts with the practice by completing an online Feedback Form, the NHS Friends and Family Test, or by posting a suggestion into the ‘Patient Suggestion Box’ in the reception area.

However, although the new policy defined a complaint as “an expression of dissatisfaction requiring a response, whether verbal or written about the services provided by the practice or the actions of its staff”, the practice accepted formal complaints only by letter or filling in a ‘complaint form’. These needed to be posted or hand-delivered to the practice. The practice did not accept complaints made verbally or by online feedback forms, and accepted complaints by email only in exceptional circumstances.

At both sites, information about the practice’s Patient Participation Group (PPG) was displayed in the waiting areas. This included posters with ‘QR codes’ for people to post their feedback.

Also displayed were ‘You asked, We listened, We did’ boards.

The practice had a system for recording and responding to complaints.

We looked at some of these complaints and found the practice had responded to them in a timely way, offered an apology when it was appropriate and contained information about what the person could do if they were not satisfied with the response.

However, complaint responses did not always address all of the concerns raised.

People who provided feedback to CQC told us they felt the practice was slow to manage their complaint or that their complaint had got ‘lost’.
 

Patients registered with the practice could access support from advanced care practitioners, a clinical pharmacy team, doctors, healthcare assistants, paramedics, a phlebotomist, a physiotherapist, practice nurses, and nurses with specialist knowledge in assessing and treating children, diabetes, heart disease, and respiratory conditions.

Some of these staff were employed by the Ivel Valley South Primary Care Network (PCN). The practice was 1 of the 3 practices in this PCN, working together to address local priorities in patient care. Other PCN staff who supported the practice included a GP assistant, a cancer care coordinator, a care home coordinator, child and adult wellbeing coaches, a learning disabilities care coordinator, and social prescribers.

The practice offered a range of appointment types including face-to-face, telephone, video call, online and home visits.

There was information in the practice and on the practice’s website to support people to understand how to access services. This included information about services provided by the practice including the practice’s opening times, GP extended access services and the roles of care navigators and first-contact physiotherapists. There was also information about self-referral to other NHS services, such as antenatal care; specialist services in mid-Bedfordshire such as dementia care; and promoting the NHS App.

When the practice was closed, patients were directed to access support, treatment and advice from the NHS 111 service or emergency services.

Since October 2025, the practice offered an online consultation service open between 8am and 6.30pm for people to submit non-urgent appointment requests, medicine queries, and administrative tasks, in line with requirements set out by the commissioners of the service, the Bedfordshire, Luton and Milton Keynes Integrated Care Board (BLMK ICB).

This meant people needed to complete an online form, called an ‘Accurx Total Triage Form’, to request some types of appointments, such as with a GP or for a minor illness.

Patients who could not fill in the online form themselves or did not have someone who could complete the form for them could telephone the practice, where a member of the reception team could complete a version of the form on the patient’s behalf.

All forms were reviewed and acted on by a doctor and reception staff.

The practice’s website directed patients who felt they needed help urgently the same day to telephone the practice rather than use this form.

There were ‘protected’ same day appointments with a doctor. However, the practice regularly signposted patients to other services once all these appointments had been taken.

Patients could book an appointment with a doctor up to 2 weeks ahead and with nursing team members up to 4 to 6 weeks ahead.

Leaders told us about data that showed improvements in access to appointments, such as more appointments being available and fewer people accessing other services such as A and E, urgent treatment centres and out-of-hours services. Leaders told us the practice was more in line with the other practices in the PCN. However, the impact of some of the actions the practice had taken were not yet reflected in other evidence available at the time of this inspection.

For example, the practice’s Patient Participation Group (PPG) had carried out a patient survey during the summer of 2025, before the changes since October 2025. The PPG had compared the responses with the findings from a similar survey carried out by the PPG in 2024. Although comparison between the surveys is limited because of differences in the survey approach, the analysis completed by the PPG showed patients continued to find booking appointments difficult, particularly if they wished to pre-book. However, the analysis also showed fewer people said they had needed to use alternative services because they could not get an appointment at the practice.

The results of the 2025 GP Patient Survey, also carried out before the changes made in October 2025, showed significantly fewer people were positive about access at the practice than the local and national averages. Of the people who responded to the survey:

• 17% were positive about how easy it was to contact the practice by telephone (compared with 53% nationally and 40% in the Bedfordshire, Luton and Milton Keynes (BLMK) area).

• 45% responded positively about their overall experiences of contacting the practice (compared with 70% nationally and 60% in the BLMK area).

The PPG told us they felt that feedback from patients since the launch of the new system was more positive.

Patients could ask for repeat prescriptions online, by filling out a ‘request form’ and posting it into the ‘prescription box’ at the practice or via the patient’s pharmacy. The practice did not accept repeat prescription requests by email. The practice also did not take repeat prescription requests over the telephone, in line with national recommendations.

The practice had a specific telephone line for professionals calling from care homes or other NHS services. However, we received feedback that sometimes it could take 15 to 20 minutes for a call to be answered, even if the person was first in the telephone queue, or the call was not answered at all.
 

The practice told us 65% of patients registered with the practice had signed up to online services.

There were posters displayed informing people that interpreter services were available for people who did not speak English as their first language, including sign language. It was easy for people who did not speak English as their first language to translate signing-in screens into other languages.

The practice complied with the Accessible Information Standard (AIS), a requirement for all providers of NHS care. The AIS applies to people who use a service, and their carers or parents, who have information or communication needs because of a disability, impairment, or sensory loss. For example, there was a hearing loop at both sites for people who are deaf or have difficulty hearing.

People who were or might be vulnerable could register with the practice, including those with no fixed abode such as people who were homeless, Travellers, and refugees.

At the practice’s main site, there were baby changing facilities. There was accessible parking and ramped access suitable for wheelchair users or those with scooters or prams. However, the access button at the main entrance was not working. Most clinical rooms were on the ground floor and there was lift access to the upper floor. There was a chair in the corridor near the clinical rooms furthest away from the waiting area for patients to recover, for example if they had become short of breath.

Although space at the branch site was limited, there was level access and the clinical rooms were all on the ground floor. However, in the car park, although there were marked disabled parking bays the ground was uneven, making it more difficult for people with mobility needs to access the service.
 

Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decisions we looked at during this inspection had been recorded in line with legislation.