Cleveland Clinic London Hospital

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

Managers and leaders were caring and compassionate and had the skills and abilities to run the service. Managers were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. The service had a vision and strategy for what it wanted to achieve and plans to achieve it developed collaboratively with the team. Managers monitored action plans to deliver the strategy. The senior team promoted a positive culture that supported and valued staff. Staff felt respected and supported and were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear. Governance processes were highly effective and facilitated collaborative working and encouraged and rewarded innovation. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss, and learn from the performance of the service. There were appropriate systems to manage performance effectively. Risk management systems were well developed and multidisciplinary.

This service scored 86 (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 mission and vision that applied to all services focused on the quality of healthcare, underpinned by research and the education of staff. Teamwork, integrity, innovation, and inclusion formed part of the provider’s values. GPs focused on quality and safety through effective interactions, regular team decision-making, and a rolling programme of audits. Some GPs maintained practice in the NHS and shared national updates with the wider team under agreement with NHS England.

GPs met with nurses before the start of service and visited the provider’s booking call centre frequently. Supplemented with a weekly staff huddle and monthly team meeting, the structure enabled GPs to maintain consistent communication with each other and the wider team.

GPs carried out quarterly multidisciplinary audit reviews and worked with colleagues in a diverse range of teams such as safeguarding, marketing, and philanthropy to identify good practice and opportunities for improvement. The team worked closely with global concierge colleagues who helped coordinate management and transfer of care internationally.

GPs valued the team’s mix of private and NHS positions and recognised the strengths this added to the service. For example, the team’s principles and values were guided by those of the NHS and enhanced by their commitment to this provider’s mission and patients.

The director of quality, safety, and patient experience led a monthly leadership round across all departments. Senior staff chose a provider value and visited each department to ask staff and patients how their experiences reflected the value. They recorded responses digitally in real time and analysed the responses collaboratively, with a focus on qualitative, narrative information.

We joined a leadership round in the GP service that focused on the ‘integrity’ value. The process involved examples of engagement such as non-clinical senior leaders meeting GPs, nurses, and patients to discuss their experiences.

The director of quality, safety, and patient safety worked closely with the primary care clinical lead and the chief of operations to provide oversight and leadership. The chief executive officer met daily with the senior team to review challenges and performance.

Clinical services were organised into institutes, each led by a clinical chairperson and institute managers, with oversight and support from the head of clinical operations and the chief of staff. GP services were part of the general practice institute, and the chairperson was a practising GP. They worked with institute managers to support the delivery of the service.

GPs had leadership development opportunities that included formal education and coaching led by a dedicated mentor from the senior leadership team.

Leaders, and the provider more broadly, had a focus on inclusivity, staff wellbeing, and continuous development. The senior team used evidence from international research to act on feedback and create a positive workplace. They linked this with care and demonstrated how motivated, empowered staff drove high standards of patient outcomes.

We spoke with 5 GPs and 6 nurses who regularly supported the primary care service. In each case staff said they were happy with line management arrangements and leadership. They had regular 1-to-1 meetings and described the supervision and appraisal processes as useful. Permanent staff set their own annual goals and reviewed progress during the year. GPs who also worked for NHS services completed their appraisals in their substantive practice and integrated goals with their work in this location.

Senior staff carried out periodic ‘listening tours’ in which GPs and nurses were invited to spend time ad-hoc with managers, either individually or in groups. The tours were focused on improving engagement and facilitating open and honest communication across all levels of staff.

The provider and primary care institute fostered a positive culture where people felt they could speak up and that their voice would be heard.The senior team ensured each member of staff had a voice in the organisation and had the support to take ownership of their work and decisions. For example, the service encouraged staff to propose improvements and research to one of the councils that worked across departments. Where staff provided feedback to the leadership team, managers responded meaningfully.

A dedicated multidisciplinary freedom to speak up (FTSU) team supported staff across the department. Clinical and non-clinical staff worked in the team in addition to their substantive role and met weekly to discuss issues and concerns raised by staff to achieve the fundamental goal of resolving problems. The team worked to increase awareness amongst staff and the profile of the service, such as through speak up events. The team aligned itself with the provider’s culture of learning, development, and no blame when things went wrong, and worked collaboratively with human resources (HR) colleagues to ensure support was embedded. They included medical students in the FTSU induction, which helped to build understanding of the principles of speaking up.

The FTSU team reported themes and trends to the executive team, including directly to the chief executive officer. Senior primary care staff we spoke with recognised the importance of the team’s work and supported departmental colleagues to address issues.

Guardians carried out walk arounds of each department to maintain a visible, supportive presence and empower staff to reach out to them if they needed help.

The provider valued diversity in the workforce and facilitated an inclusive and fair culture by improving equality and equity for everyone.

GPs had equal and equitable access to continuing professional development opportunities as a primary care department and alongside colleagues elsewhere in the hospital.

Diversity and inclusion were embedded across all aspects of the service, including in new staff onboarding, training, and governance systems. This worked well amongst the GP team as they worked closely with nurses, consultants, and other specialists, which facilitated equitable working relationships.

The provider recognised the contribution non-clinical staff made to the service, such as receptionists, housekeepers, and security. They made sure all staff groups were included in diversity work.

Governance systems were integrated, with a committee responsible for coordinating compliance, quality assurance, and safety across outpatients. This system reflected the complex operating environment, in which multiple clinical specialties delivered care. In addition to internal quality assurance processes, the service reported to the Private Healthcare Information Network (PHIN) in line with national good practice.

Governance arrangements for doctors working under practising privileges ensured the provider always had assurance of training and appraisal completion. For example, training data and appraisals were often delayed for those working substantively in the NHS. The provider implemented interim measures supervised by the MEC in cases where delays were expected. This enabled the senior team to ensure patients were cared for by doctors up to date with training and supervision requirements.

The provider ensured consistency in clinical competencies between GPs through annual professional reviews (APRs). Each GP completed an APR with a senior member of the team regardless of their contract type. This was good practice because it meant GPs could work to their preferred contract and the provider had assurance of consistent standards of practice.

GPs who also worked in NHS services shared learning and changes to national guidance with the wider team. The provider had systems in place to integrate NHS guidance with internal practices to ensure patients received care based on the latest standards.

The primary care institute had a clear, persistent focus on quality improvement and the integration of GP-led care with other specialties to improve patient outcomes. When the provider introduced or changed policies, a member of the team reviewed this to identify how it would impact primary care. This approach led to improved practice, such as more frequent engagement with provider leadership and new documentation for the use of Controlled Drugs.

The service understood their duty to collaborate and work in partnership, which enabled services to work seamlessly for people. We share information and learning with partners and collaborate for improvement.

The provider was a non-profit organisation with a well-established focus on charity and community giving. GPs discussed this as a positive aspect of their work and provided examples of how they helped the local community beyond patients in their care. For example, GPs regularly volunteered their time in food banks and in a local homeless support service. This occurred during work time and the senior team provided protected time for such activities. Senior staff described a fundamental standard of the provider as making a difference in people’s lives. Incorporating staff and patients, this ethos was evident during our discussions with both groups, as part of a partnership approach to care and community.

GPs offered a women’s health service for patients at any stage of life. The team had established a partnership with a nearby private provider to supplement on-site services with specialist care available at short notice, such as bone density scans. Similar arrangements were in place for other needs relating to substance misuse and addiction, sexual health, and infertility.

The service had a wide range of corporate partnerships to provide wellness checks and health assessments for executive patients, sports professionals, and those with specific needs relating to their employment or travel patterns.

A significant proportion of GP time was spent with patients attending corporate wellness checks or care provided through their employer’s insurance. The team worked closely with global concierge colleagues to ensure the service met the needs of referrers and patients.

GPs worked with corporate referrers to enhance preventative medicine strategies, such as by supporting employers to adopt workplace wellness and health promotion programmes.

The provider held ‘Pathway to Excellence’ designation in recognition of continual organisational excellence. An international quality accreditation programme, staff had demonstrated quality in 88 standards of nursing care. Staff spoke positively of the programme and its impact on standards of practice and GPs said it enhanced the care they provided.

The GP team used an ‘innovations and interface’ programme to co-develop new clinical working practices with specialists in other departments. This was part of a strategy of continuous innovation and research and formed part of GP professional development. For example, the work led to GPs offering new long-term care for patients with a vitamin B12 deficiency.

GPs joined monthly lunchtime case discussions with multidisciplinary colleagues. Topics included difficult cases, national updates, and international health bulletins.

The primary care service, along with all other departments, used a 360-degree multidisciplinary feedback system to gather input from colleagues and patients. This reflected the wide range of CPD activities in the team and positive, constructive feedback. For example, colleagues noted the importance of the team’s work to assess and predict cardiac risks based on gender.

Quality and performance monitoring were closely linked with how GPs sought new opportunities for improved and innovative practice. For example, monthly data showed most patients referred to a specialist after seeing a GP needed cardiology or gastroenterology care. GPs established close working links with colleagues in these specialties through medical rounds to identify how to meet patient needs.

GPs continuously sought opportunities for innovation by exploring new treatments to improve patient experience and outcomes. For example, the team engaged with new international research on managing antibiotics amongst older people living with specific renal conditions.