Leander Family Practice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.
Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs.
One clinical search identified 22 patients that had been prescribed a medicine for a long-term condition, we sampled 5 records, all 5 records showed that patients had not always had the required monitoring and had not received medication reviews, we did not see evidence that monitoring has been checked prior to clinician issuing the last prescription.
We identified 20 patients with having a potential missed diagnosis. We reviewed a sample of 5 patients, and none of them had been informed and none had been coded as having the condition on the practice information system. This meant these patients would not receive the necessary reviews and monitoring.
Following our site visit, the provider reviewed all the patients we identified concerns with, contacted the patients and submitted an action plan showing how they were going to address the issues found during our inspection. The practice also submitted an updated medicine prescribing policy.
Data from the 2025 National GP patient survey found 88% of patients felt their needs were met during their last GP appointment (in comparison to the local 91% and national 90% averages) and 91% felt the healthcare professional they saw had all the information they needed about them during their last GP appointment (local average 93%, national 92%). There were systems and processes in place to identify patient’s needs and preferences.
Reception staff were aware of the needs of the local community. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.
The practice had a social prescriber who attended the practice twice a week.
 

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.
Systems were in place to ensure staff were up to date with evidence-based guidance and legislation.
 

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.
 

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support, live healthier lives, or where possible, reduce their future needs for care and support.
Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.
The National GP Patient Survey carried out from January to March 2025 had 640 surveys sent out and 117 responses were returned which equalled a 18% completion rate. Data from the 2025 National GP Patient Survey showed that 67% of people completing the survey felt they received enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. This was comparable to the local average of 70% and national average 69%. In addition, 75% of patients said the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment this was comparable to the local 76% and national 74% results.
 

The practice had not met national targets for screening and immunisations but was performing similarly to local averages. At the time of our assessment, the latest published information from the UK Health Security Agency (UKHSA) showed that the practice did not meet the World Health Organisation target of 95% as 5 out of 5 childhood indicators were below 85% for the number of children immunised against various infectious childhood diseases.
When we raised this with the practice, they explained that they actively encouraged patients to attend the practice, they have a monthly meeting with the Integrated Care Board (ICB), and they work with health visitors. They use codes as soon as a patient is pregnant and follow patients throughout the pregnancy journey, once the baby is born, they send a congratulation letter and book an appointment with the GP. They told us they encouraged patients to speak with the nurse and they signpost patients, they also have dedicated appointment slots just for immunisations.
 

The service always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.
The service told people about their rights around consent and respected these when delivering person-centred care and treatment.
Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.

We reviewed 2 records of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and found decisions were appropriate and were made in line with relevant legislation.