Cuckoo Lane 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 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. We assessed all of the quality statements from this key question. At our last assessment we rated this key question as outstanding. At this assessment the rating has changed to good.

This service scored 79 (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 had a clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. Leadership was strong, visible and deeply embedded across all areas of the service. They had contributed to a number of projects to reduce health inequalities for the local population. Patients were placed at the centre of decision-making processes, which facilitated the delivery of optimal treatment options.

Staff and patients contributed to the development of the service and strategy, “your health, our concern and your responsibility”. Leaders actively reinforced the mission and vision across all aspects of the service, ensuring staff and patients understood how they contributed to delivering quality personalised care. We saw the mission statement displayed in various areas such as on doors and on the notice board. Patient participation group members we spoke to spoke positively about the service and this being centred around patient care.

We reviewed staff feedback the practice collected. There was a positive and compassionate listening culture that focussed on learning and development. Staff and leaders spoke positively about the flat structure of the service. Staff also told us leaders valued and actively engaged staff in the direction and plans for the service. The service was aware of the projected increase in the local population and was working with partner agencies to address future challenges. For example, the service was in the process of recruiting an additional lead.

The service had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. There was a positive and compassionate listening culture that focussed on learning and development. Leaders had the skills, knowledge, experience and credibility to lead effectively.

Leaders led with integrity, openness and honesty. The leaders demonstrated they had created a strong staff culture through their leadership and invested (financially and with time) in learning and development for all staff and developed tools to assist staff to achieve best practice on a daily basis. The service approached patients with ideas to gauge interest; they were currently arranging a sound bath and gong session for young patients with anxiety and depression and regular drama workshop sessions for those with a learning disability. The service covered expenses for all these sessions for their patients within their own budgets.

Staff told us leaders were approachable and responded to any concerns raised. Leaders drove an awareness of positive accountability, support and sustainable improvement across the service. There was positive feedback about leaders in the practice from other healthcare professionals that worked in partnership with the service. Leaders engaged with patients, staff and external healthcare providers to gather feedback and they took meaningful action in response. Staff told us leaders modelled the values of the service and spoke to us passionately about how the leaders valued their contributions and listened and responded to feedback. We saw the service had a “glimpse of brilliance” notice board to celebrate staff achievements and a kudos card system for staff to praise each other.

Leaders were knowledgeable about the issues and priorities relating to the quality and future of services. They understood and were addressing local and national challenges within primary care, general practice, the future of the NHS and the Ealing community. This was evidenced through their work alongside information and feedback gathered as part of this inspection.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. They had established Freedom to Speak up arrangements both internally and with other practices in the primary care network. Staff were aware of how to raise concerns, and we saw examples where staff had used the arrangements in place to a positive effect.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who worked for them. We saw that the service had a diverse team and staff photographs were available on the noticeboard in the waiting area for those on duty.

Policies and procedures to promote diversity and equality were in place. We saw senior leaders had addressed concerns related to discrimination and the service offered work placements for refugee health professionals. Adjustments had been made to ensure all staff were valued, for example we saw adjustments to support disabled staff were in place.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. The service always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff.

The service had established governance processes that were appropriate for their service. They had multiple ongoing audit processes which demonstrated robust quality assurance and governance arrangements. Clinical audit and data driven monitoring was undertaken regularly including analyses of outcomes for patients. Designated leads were in place for the oversight of different health conditions. This distributed responsibility, enhanced the resilience and sustainability of governance within the service.

Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Staff took patient confidentiality and information security seriously. Managers met with staff regularly to complete appraisals and performance reviews. Induction processes were structured with ongoing supervision to support professional development. Staff could access all required policies and procedures. Staff were supported during twice daily huddles, that provided an informal opportunity for support, advice and guidance. Staff were recognised and thanked for their contribution. There were staff recognition schemes to identify and reward staff.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement. There was partnership working with the social prescribing service to encourage uptake of health promotion initiatives and the service held different sessions, for example they invited patients to participate in an exercise session in collaboration with stayactive4life. This focussed on exercises patients could carry out at home. Feedback following the session was positive overall.

The service worked with other practices within their primary care network and engaged with the wider community. They provided us examples of joint work undertaken such as with the North London health protection team to provide sessions on tuberculosis screening. Staff had made adjustments to improve coordination of their service with community healthcare providers, including through established meetings centred on the care of those at higher risk of hospital admission.

We saw the leadership team worked with the Primary Care Network (PCN) and were engaged in the development of primary care services within the local area. We saw the practice shared information and learning with partners and collaborated for improvement. This allowed for patients to receive seamless and coordinated joint care. There were examples of how partnership working had improved patient outcomes and how best practice had been shared across the wider organisation. The service offered specialist services for patients registered with neighbouring practices such as paediatric phlebotomy, diabetic clinic and insertion of ring pessaries.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. For example, the service team worked with an NHS improvement and transformation service Xytal to continue to evolve in the primary care setting. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. The service is a training practice for a variety of healthcare professionals including medical students, nurses and pharmacists. They actively contributed to safe, effective practice and research.

We saw evidence of a range of audits and quality improvement projects. Projects were designed to improve performance, outcomes and patient experience. Leaders showed strong commitment by regularly listening to patient and community feedback. They also invested significant time and resources to support staff.

The leaders told us they were part of a digital clinical safety pilot for ambient scribe and this assisted clinicians to generate clinical notes with patient consent. The service had a proactive approach to educating patients and committed to regular events that focussed on different patients’ needs which included:

• Improving online access for patients.
• Stress and anxiety in teenagers, 91% of patients reported they would recommend this event to others.
• Healthy eating and eating well on a budget, 32 patients attended this event.
• Staying well over winter.
• Support for carers, 15 patients joined this event and all attendees found this helpful.

Leaders and staff understood the importance of listening to the voice of people who use services and the local community. They incorporated these views to drive development, improvement, and innovation.