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

This means we looked for evidence the practice was led effectively and in a way that was inclusive, supported improvement and innovation and made sure patients received care that was safe and effective.

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

This is because:

• Some staff felt leaders were not visible or approachable, did not involve them in the planning for the future of the practice, did not take time to listen to and understand their concerns or ideas or act on them, and did not act with openness and transparency.

• Not all staff felt able to raise concerns with leaders, and the practice’s arrangements for supporting staff to speak up needed strengthening.

• Some staff reported a perceived inequity in how leaders and managers supported staff wellbeing, professional development, and career progression.

• Some staff in lead roles or with additional responsibilities had not had suitable training to help them to carry out the roles and tasks safely and effectively.

• There was ineffective oversight of the day-to-day running of the practice. The practice did not have effective governance and assurance systems in place. This meant risks were not identified and managed or addressed.

• Leaders did not always respond to challenges affecting the service effectively.

However, since our last inspection, the practice had taken steps to improve engagement with the Patient Participation Group (PPG) and local community.

The service was in breach of the legal regulation in relation to good governance of the service. We have told the provider they must take actions to establish effective systems and processes and operate them effectively to ensure the service provided a consistently safe and effective service.
 

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.

Leaders told us about their vision for the future of the practice.

Following the inspection, the practice shared with us a succession plan. However, this did not match the vision, 5 year focus, future and succession the practice presented at the time of the inspection in January 2026.

Most staff, both clinical and non-clinical, told us they had not been involved in the planning or development of the vision and plans for the future of the practice. Some staff who provided feedback for this inspection told us they felt they either didn’t know if there was clear vision for the future of the practice or did not feel there was one.
 

Leaders were aware of some of the challenges affecting the service, such as the limited space available, improvement works that were needed to make the branch site safer, and low staff morale and tensions in working relationships between some staff members. However, the provider had not always taken steps to address them safely and effectively.

Only 38% of staff who provided feedback for this inspection told us they felt leaders listened to or acted on their views and feedback.

Some staff also told us they did not feel supported by some members of the management team and that communication with some leaders could be better.

Of the staff members who provided feedback for this inspection, about 50% told us they did not feel leaders were visible or approachable and about 60% told us they felt leaders and managers were not open and transparent.

Some people who provided feedback to CQC told us leaders were not available and did not call them back when this had been agreed.
 

The provider shared with us a Whistleblowing (Freedom to Speak Up) Policy.

This included details for a Freedom to Speak Up service that worked outside the practice with whom staff could raise concerns if they felt they needed external support or advice to raise concerns, or speak up.

However, not all staff were aware of the practice’s whistleblowing or Freedom to Speak Up policies or processes, or where they could find information about them.

Some staff also told us they did not feel able to raise concerns with practice leaders.
 

A mixture of male and female clinical staff worked at the practice and staff members were from a variety of different nationalities and backgrounds.

Not all staff felt there was an inclusive and fair culture in the practice. For example, some staff told us they felt not all staff were given the same opportunities for professional development and career progression.

Several staff used words such as ‘favouritism’ when describing the culture in the practice. Some staff said they felt leaders ‘protected’ certain members of staff, and only certain staff were involved in, or were kept up-to-date with, decisions about the practice.

Some staff told us they felt there was inequity in how staff were treated. For example, some staff told us that although they had seen leaders offer support to others, they felt they had not been offered support in the same way. Some staff told us the practice had supported them to work flexibly to help them balance work with other responsibilities, such as caring responsibilities, whereas other staff told us the provider had not supported them in the same way when they felt they needed it.

Some staff described inequity in how they felt work was allocated in the practice. Some staff members were supported to work from home. However, other staff saw this as inequitable, particularly when they felt not enough appointments were available, regularly shortened their appointment times to fit in more patients, or felt they had been asked to see more than the recommended number of patients a day and in less time.

Some staff described their working environment as ‘challenging’, and ‘unsupportive’.

Staff also shared with us they felt some leaders labelled staff who raised concerns as ‘trouble-makers’, and avoided them.

We found there had been a high turnover of staff since our last inspection in 2024. Some staff told us they felt this was because of what they described a poor culture within the practice.
 

The GP partners and practice manager met weekly to discuss matters relating to the running of the practice. In addition, the various department leads met every 2 weeks and practice meetings were held monthly. However, not all staff attended meetings, for example because they were on days when they did not work at the practice. Some staff told us they did not feel team meetings were helpful and said they sometimes felt uncomfortable going to them.

Not all staff knew where to find policies and guidance, and some staff told us they were unclear who they should speak to if they had a question or concern.

There were differences between both sites in how leaders supported staff. For example, although leaders told us they aimed to have the same information available for staff at both sites, information about safeguarding was displayed on noticeboards in all clinical rooms at the main site, however, this information was not displayed on the noticeboards at the branch site.

There were differences in how health and safety risks were identified and managed at both sites. For example, around fire safety.

Some staff told us they had protected time to carry out their additional responsibilities and training. However, other staff told us they did not have this protected time. There were gaps in some areas where regular checks were needed, for example in monitoring the availability of emergency medicines and equipment, and checks of the fire safety systems and water systems.

Staff with additional responsibilities or lead roles in the practice had not always had the additional training to help them understand how to do the tasks safely and effectively. This meant some risks had been missed, such as those relating to infection prevention and control (IPC) or accidental switching off of medicines fridges.

Leaders did not have effective oversight of the day-to-day running of the practice to be able to identify and respond to risks, such as those around the safe use of Patient Group Directions (PGDs) and the immunity status of staff to various infectious diseases.

Leaders did not have oversight of the training completed by staff, when updates were due or when there were gaps in training. There were no effective systems in place to make sure staff completed training when it was needed.

Systems were not in place for the provider to know all staff worked in line with the practice’s policies, national guidelines and within their competencies.

There were some assurance systems in place, however these did not work effectively for leaders to know the systems and processes in place worked effectively and as intended or expected. For example:

• The provider had not identified some of the recommendations in risk assessments and audits had not been acted on, such as responding to known risks highlighted in IPC audits.

• The provider had not been aware there were gaps in the monitoring of medicine fridge temperatures. Leaders responded to our feedback and told us about a new system they had introduced.

• Although there were ‘data loggers’ in the medicines fridges, the provider did not provide evidence these were used to help check the fridge temperatures displayed on the fridges and recorded by staff were accurate or to know medicines had been stored within the recommended temperature range when there were no records of fridge temperatures.

The practice had a Business Continuity Plan, dated December 2025. This outlined what staff should consider and what actions to take if there was a major incident or disruption to the service, such as a loss of computer or telephone systems, utilities, flooding, a pandemic, staff incapacity, or terrorist attack. The plan was specific to the practice and contained relevant contact details and completed risk assessments for a variety of situations.
 

There had been significant changes in the practice’s Patient Participation Group (PPG) since our last inspection.

The PPG met 4 times a year and was attended by practice staff.

The PPG and practice leaders told us they felt working relationships between the PPG and the practice were improving. They told us the practice and the PPG shared their plans for the future and had worked together to try to improve processes in the practice, such as processing correspondence. However, the practice did not share learning, such as changes made to the service in response to complaints or significant events.

The PPG told us they had supported health promotion events and supported the practice by encouraging patients who could have one to have a flu jab.

There were noticeboards in the waiting area at both sites with information about the PPG. Information included the role of the PPG, how to join the group, how to contact the PPG and how one could provide feedback about the practice. The PPG also shared information on these noticeboards, such as feedback from patient surveys, updates about work the PPG had done and was doing, and about changes to NHS GP services.

The practice also worked with other partners, such as the BLMK ICB, the commissioners of the service, to help identify how the practice could improve care for their patients living with long-term conditions.

Practice leaders told us about improved engagement with the local community, including with local councillors and Member of Parliament.
 

Leaders did not proactively identify and encourage learning, improvement, or innovation.

The practice did not show they always monitored their performance, including against other similar GP practices, to identify areas for improvement and share ideas.

Staff told us they were not supported to try new, innovative, or creative ways of working. Staff told us changes they had suggested were either not implemented or not implemented effectively to improve the quality and safety of the service.

Not all staff who provided feedback for this inspection knew of changes that had been made in the practice as a result of patient or staff feedback.

The practice’s PPG had carried out a patient survey during the summer of 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 findings suggest the practice had not always used the information effectively to make improvements in the service. The analysis completed by the PPG showed in both surveys, patients gave similar common suggestions for improvement, such as better communication with practice staff and better consistency and continuity of care.

However, the practice was involved in a new piece of work led by the ICB and the PCN to try to help improve care for Travellers.

Since 1 January 2026, the practice offered extended access appointments for some patients. Leaders planned to introduce more types of appointments over time. As the service had been introduced just before our inspection, it was too soon to know how this impacted on the care and treatment available for patients.

Practice leaders had an ambition for the practice to become a training practice for new GPs.