Alston 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 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 Outstanding.

This service scored 89 (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 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 local people and the community. It was clear that the practice strove to be a key part of the local community.

All staff had contributed to the development of the practice vision and strategy, which was kept under review. This was done in collaboration with the partner practices under the provider, Cumbria Health.

We spoke with members of the PPG (Patient Participation Group) who told us how they were involved in shaping the future direction of the practice and had a strong voice in scoping the direction of the provider going forward. Examples that we heard about included the PPG participating in the development of workload agreements for staff and supporting the practice manager with fund raising for the social hub.

Staff and leaders had a good understanding of the challenges faced by their patient population, around health inequalities and strove to ensure that local services continued to meet patient demand. They shared evidence of numerous quality improvement projects with us which aimed to reduce health inequalities.

Staff and leaders actively monitored and anticipated current and future risks to delivering the strategy, including relevant local factors. The practice leaders had reviewed the demographics and social makeup of the patient population and went to lengths to recruit patients to research trials to help combat specific ailments, including respiratory disease. There was an ongoing trial which 17 practice patients were part of.

Equality, diversity and human rights approaches were embedded in the organisation and understood by all staff.

The service had exceptionally inclusive leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. This included acknowledging when things hadn’t gone right and looking to work collaboratively to put things right.

Staff told us leaders in the practice were approachable and responded to any concerns raised. Staff told us leaders modelled the values of the practice. For example, the lead GP would complete out of hours visits to families of patients receiving palliative care in the local community to provide reassurance; exemplifying the family feel to the practice, and the value they placed on support and kindness.

We saw the leadership team worked with other practices under the provider (Cumbria Health) proactively and in pursuit of patient care and were engaged in the development of support services within the local area. We saw evidence of leaders cross-skilling to support staff where required. For example, the practice manager had undertaken appropriate training for the dispensary and would support with the administrative team answering patient calls. Leaders were willing to listen to feedback from all staff members.

We saw evidence of leadership meetings that discussed a range of topics including developing a standardised audit cycle and shared template to improve consistency and evidence for clinical leads both for the practice and the wider Cumbria Health teams. Improvement plans were constantly looking to modernise access to general practice and align services more closely with patient needs through a data-driven approach. Leaders at the practice felt invested in this approach and the work they did was evidence of that approach.

Practice staff knew patients and their needs very well on an individual level. This was shown in high levels of patient satisfaction in respect of how they could access the service, despite considerable health and socio-economic challenges within the local area.

Leaders have access to high-quality resources, support and development in their role, linked with the provider. We saw examples of staff being offered leadership courses and digital/AI training for leaders. With the aims of increasing staff flexibility within roles, being able to cover for each other and reflecting on how digitisation can be put into effective use to benefit of patients.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The practice had established Freedom to Speak up arrangements with Cumbria health and other external agencies. Staff were aware of how to raise concerns. Staff stated they felt comfortable speaking up if they had concerns and would be listened to by leaders.

Managers encouraged staff to raise concerns when things went wrong. Staff felt there was an open culture and that safety was a top priority.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Policies and procedures to promote diversity and equality were in place. We saw senior leaders had addressed concerns related to discrimination. 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 within framework set by the provider, Cumbria Health. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate including secondary and community services.

The provider had processes for staff to report incidents, near misses and safety events. These would be reported internally the practice and shared with the wider linked practices under the Cumbria Health Ltd umbrella, as the provider which has overall responsibility for the practices. Discussions would be had between staff, clinical staff and leaders; with appropriate actions taken, reviews and changes made if necessary.

Leaders and managers supported staff, and staff were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. The provider had established governance processes that were appropriate for their service. Staff could access all required policies and procedures in multiple formats. 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. Staff took patient confidentiality and information security seriously.

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. They worked with linked practices under the Cumbria Health umbrella and within their primary care network, sharing best practice and engaging in clinical discussions. Leaders at the practice carried out mock inspections of linked practices – analysing and sharing best practice. There was also clear evidence of clinical leaders at the practice sharing learning with other clinicians within the Cumbria Health network. They did this to share knowledge and best practice and, in an attempt, to improve patient care and experience.

The provider worked with local hospitals to try and offer treatments in the practice as much as possible before having to refer on. They did this recognising the location of the practice, the patient profile and local transport links. Patients, many of whom were elderly, lived around 28 miles from the local hospital. We heard from leaders’ examples where this had been done for cancer patients. Clinicians at the practice recognised there wasn’t a local urgent suspected cancer referral pathway. They worked with hospital teams, oncology and the ICB to raise this and support a targeted pathway to be developed. This will ensure all future patients that present with similar symptoms who meet the criteria for this pathway can access co-ordinated specialist assessments and investigations. This has been established and accessible for patients across Cumbria.

Staff had made adjustments to improve the coordination of their service with community healthcare services, including through the introduction of onsite podiatry and physiotherapy teams. The practice also worked in close collaboration with community midwifes and health visitors. District Nurses told us the practice was particularly good in communicating patients views and praised all aspects of the joint working they did.

The practice also worked with a third sector autism service called Triple A (Autism in Action) to help co-design services for autistic people; to improve access for these patients and for their experiences. This linked in with the practice proactively using available rooms on site and other reasonable adjustments. This engagement reflected the support and advice the practice offered to people with a learning disability and to patients living with autism. There are currently 14 learning disability patients registered with the practice and 21 patients registered with a clinical diagnosis of autism.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcomes and quality of life for people. Leaders and staff proactively drove contributions and engagement with effective practice and research to improve care quality. A recent example of this was the employment of a new practice nurse who was specialised in wound care. This had been an area the practice had identified to address following feedback and leaders worked to address this.

Practice leaders were able to provide examples of improvements that had been made as a direct result of feedback or incidents. An example of this work included where the clinicians reviewed all patients at the practice who were on private prescriptions for weight loss medication including mounjaro; cross checking against whether patients were taking oral contraceptives or on Hormone Replace Therapy (HRT) for those going through menopause. Action would be taken if this was the case (in the form of an HRT review being booked). As an additional safety net, a letter was sent out to all patients of childbearing age to warn them about the risks (even if not prescribed contraception/HRT). A practice protocol was set up, discussed in the Cumbria Health clinical leads meeting and the protocol was being rolled out across the providers linked practices. The implications of taking weight loss drugs and being on oral contraceptives or HRT are clinically clear in that they that they can reduce their effectiveness due to reduced absorption.

Leaders empower staff to share ideas and make changes. Staying on top of innovations and progressing new innovations is seen as integral to all staff roles. We saw examples of this where clinicians advocated for specific EMIS searches to be added to standard audit protocols particularly in regard to cancer patients. This increased flexibility in making sure no patients were missed, so they could be appropriately supported and plans put in place. This included further consultation and co-operation with secondary care providers. Leaders at the practice appreciated this approach. Other initiatives include leaders at the practice supporting GP trainees to conduct targeted projects such as asthma patients that are prescribed only salbutamol.

Leaders and staff proactively fostered a wide range of external networks, including by participating in research. They used these to identify and share improvements and innovations. The practice leaders actively engaged with NCIC (North Cumbria Integrated Care) and other networks in terms of research; constantly striving for better care, integrated systems and cooperation. The practice was a research practice and clinical leads worked closely with colleagues in NCIC to invite and enrol patients on innovative clinical studies. Examples of where patients from the practice participated in studies included 17 respiratory patients signing up to a study looking at ‘digital social intervention in patients with moderate to severe asthma’ and 5 patients joining a women’s health study looking at menopause management.

The practice has been working with the local Integrated Care Community (ICC) to look to set up a ‘staying steady falls clinic’ in Alston to begin to address a gap in provision for patients in Cumbria. The practice had developed assessment documents, protocols and other support for staff and this had been shared within the Primary Care Network (PCN).