Iridium Medical Practice

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

We carried out an assessment of 7 quality statements under the Well-led key question.

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement.

Leaders and staff did not have a shared vision and culture based on listening, learning and trust. Leaders although visible, were not always supportive. Staff did not always feel supported to give feedback and did not always feel treated equally. Governance processes required improvement.

The service was in breach of legal regulation in relation to good governance.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a credible vision of designing shared outcomes across health and social care, focusing on person-centred care, improving population health and reducing health inequalities to provide best healthcare for the patients of East Birmingham. They had produced a 5-year plan that would help them achieve this vision. During the assessment we found evidence of the provider working with external organisations to reduce health inequalities for their patient population and the local area. All staff we spoke with shared this ambition to provide high quality care and told us they strove to achieve this. However, we found a workplace culture that lacked transparency, equity and engagement and did not enable or encourage staff to realise this vision. There had been significant changes in the leadership at the practice since October 2024. Unfortunately, the unexpected and challenging way these had occurred had impacted significantly on staff relationships. There was a noticeable division of feelings amongst the staff about the way they felt they were treated by leaders. Leaders told us they were not aware of the current culture and told us they would be taking action to ensure that all staff felt supported. Practice meetings were not taking place routinely and most staff that we spoke with felt they had not been kept informed about changes in leadership, leading to fears arising about their own future at the practice. We saw the provider had held meetings in December 2024 and January 2025 to update staff on leadership changes. The provider had reviewed governance structures and appointed new leads for areas such as safeguarding and complaints. However, during the assessment we found that relevant staff did not always have access to information that was required to effectively carry out these roles. The provider did not have effective recruitment and induction processes or systems that allowed effective oversight of ongoing checks including training.

The leadership team worked with other practices in the primary care network and were engaged in the development of primary care services within the local area.

However, leaders did not always lead effectively, or in line with their values of accountability and respect.

Staff feedback we received during the assessment was very mixed and often divided. All staff reported that clinical support was available when required. However, not all staff felt that leaders in the practice were approachable and did not feel they could raise concerns or if they did raise concerns, they were not confident their concerns would be responded to. Some staff reported feeling intimidated and fearing the repercussions if they did speak up. Staff told us about times when they had seen leaders behave in ways that did not demonstrate professionalism, respect or dignity, made staff feel undervalued and insecure about their position at the practice.

Some staff reported concerns that they were being asked to carry out duties that they were not suitably trained for, that did not align with the provider’s policies or that their workload was not manageable.

Staff feedback we received during the assessment was mixed. Staff were aware of who the freedom to speak up guardian (FTSU) was at the practice and within the PCN. However, not all staff felt able to speak up and raise concerns or felt confident they would be listened to without fear of repercussions. The culture of the practice did not encourage all staff to be open, honest and speak up readily, some staff felt confident to do so, others did not.

We saw that a new FTSU policy had been implemented in January 2025. The previous policy contained details of an independent person staff could contact, this had been removed from the new policy.

The provider told us any information disclosed to the FTSU was recorded and shared with relevant external organisations. However, the provider could not demonstrate how they used this information to make improvements.

The provider did not always work towards an inclusive and fair culture for people who worked for them. There was evidence of supporting staff to work flexibly from home. However, some staff said they felt under pressure to continue to work from home even when they were sick. Staff feedback was mixed and not all staff felt they had been treated equitably in relation to career progression or other opportunities to learn and develop. We found that not all staff had received annual appraisals and the provider could not demonstrate that regular formal clinical supervision and training was taking place for all staff, as required, at the time of the assessment.

Governance systems and processes required improvement. A new governance lead had been employed but was yet to start at the time of the assessment. Staff could not always access all required information. During the assessment, leaders were not able to provide evidence of risk assessments, audits and policies or complaint information whilst we were onsite and there were delays in the evidence being sent to CQC after the site visits. Processes for recording and managing incidents and complaints were not effective. We were told during the site visit there had been 35 complaints between December 2023 and December 2024. However, information sent to us after the site visit showed there had been 71 complaints. There was no comparison of incidents and complaints with previous years to see if learning was embedded and whether the actions taken had improved quality of services. There were processes in place to manage the premises however equipment re-testing at the branch site had not been done within required timeframes. Recruitment processes and processes to monitor ongoing checks, appraisals and training were not effective. There was no guidance within the governance policy for staff on the review process for policies, it was not always clear when some polices had been implemented (Prescribing policy). Version control was not used effectively and many policies had been updated and approved by the same person. The significant event policy and training policy did not give sufficient guidance to staff. We also found the provider did not have effective processes for patient specific directions, security of prescription stationery, management of MHRA alerts (ensuring that actions had been completed) and management of test results and correspondence. There was no process for checking that learning disability patients received an effective annual review.

The provider understood their duty to collaborate and work in partnership with other people and organisations to improve access to services and reduce health inequalities. Feedback from the patient participation group (PPG) was generally positive about the practice. However, feedback included that communication about meetings could be improved and this in turn would help to improve member attendance at meetings. The practice provided services to 3 local care homes. Staff we spoke with reported a good relationship with the GP. However, the provider did not meet with the care home staff to discuss and review arrangements and identify if any improvements were needed. The provider worked with other practices within their primary care network to offer extended access, and flu and covid vaccination programmes. Staff had improved coordination of their service with community healthcare services, through established weekly meetings centred on the care of those at higher risk of hospital admission.

We saw some evidence that the provider was working to improve and innovate. The provider used the health inequalities lead and social prescribers to encourage creative ways of improving outcomes and quality of life for patients.

The provider had acted to improve access and had received positive feedback from external organisations on their efforts and the systems they had implemented.

The provider worked with the patient participation group (PPG) to improve patient satisfaction.

The practice worked with the local community healthcare trust to deliver weekly clinics for complex vulnerable patients. The provider told us through these clinics, staff were able to support patients better and had reduced the number of GP appointments needed and hospital admissions.

The provider shared examples of quality improvement projects and audits they had carried out to improve care and treatment. However, we also found that opportunities to learn were not fully embraced, the culture of the practice did not encourage sharing of ideas. Not all staff felt safe to put forward and test out new ways of working.

The service did not always focus on continuous learning and improvement across the organisation.

There was not effective audit and oversight of non-medical prescriber’s records. Staff told us they did not receive regular feedback on their prescribing decisions.

Systems to manage complaints and significant events were not effective, learning was not embedded and the provider could not demonstrate that actions taken in the past had been effective.