Millbarn Medical Centre

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 practice leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

Leaders had established an inclusive, positive, learning and improvement culture and were driving improvements in outcomes for people who accessed services at Millbarn Medical Centre and wider communities.

There were consistent examples of how an inclusive supportive and collaborative leadership approach had driven improvements in safety, sustainability and care integration. This enhanced the ability to meet people's needs and address inequalities for people who used services.

Governance and management systems enabled leaders to identify and act on information about risks performance and outcomes.

Leaders drove continuous efforts to maintain and improve ways of working, including staff and people's experiences, to proactively mitigate risk and improve care delivery.

Leaders recognised their role as drivers of a strong safety culture, and this was visible within the practice and throughout the inspection. Staff feedback during the inspection was positive with staff stating there was a supportive team-based culture and all staff we spoke to were passionate about delivering high quality service.

This is the first inspection for this practice since its registration with CQC. This key question has been rated as OUTSTANDING.

This service scored 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a clear shared direction, mission statement, strategy and culture. This approach was based on transparency, equity, equality and human rights, and underpinned by a commitment to diversity, inclusion and meaningful engagement. Leaders demonstrated a deep understanding of the challenges people faced, as well as the evolving needs of patients, staff) and the wider community.

The practice mission statement was: “Caring for our community”. The mission statement was supported by 11 separate strands, referred to internally as the collective vision which were joined by 5 practice values: Caring, Accountable, Fair, Professional and Evolving.

All staff told us they had contributed to the development of the vision and strategy, prior to the relocation to the new premises, at all stages throughout the relocation and now in the day-to-day delivery of services. Leaders demonstrated how the practice direction had adapted to external changes within the community, the local health economy and changes within the wider NHS. Furthermore, leaders said they relished any forthcoming changes or challenges and saw these as opportunities to work with partner agencies to find workable solutions.

The direction of the practice was under constant review and updates shared with staff. Leaders highlighted the importance of reviewing the plan as changes continued within primary care, the NHS and the local communities. The direction of the practice had several focus areas included the NHS 10-Year plan and further collaborative working with the local Primary Care Network (PCN), Integrated Care Board (ICB) and Integrated Neighbourhood Teams (INT). All staff we spoke to demonstrated a consistent ethos and acknowledged that the general practice of today, would not be the general practice of tomorrow. This demonstrated a shared strategic understanding and acceptance that continuous evolution was both essential and inevitable.

The findings from our inspection, growth in patient list size (21% increase in 3 years) and repeated high levels of patient and staff feedback indicated the practice was delivering their vision and the culture was embedded. The direction of the practice was under constant review and shared with staff. Leaders highlighted the importance of reviewing the plan as changes continued within primary care, the NHS and the local communities.

Throughout the inspection, staff spoke positively about working at the practice and demonstrated how they implemented the values into everyday life within the practice. Staff feedback, both verbal and written demonstrated that they understood their contribution to achieving the practice vision.

Staff highlighted the culture within the practice had positively impacted patient experience, this was reflected in patient feedback including the increased scores captured within the recent national GP patient survey.

The practice 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. Leaders had the skills, knowledge, passion, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

It was evident that patients were at the heart of everything the practice did and leaders demonstrated compassion and the importance of staff wellbeing to support them in maintaining good outcomes for patients.

We saw the leadership team worked with other practices in the wider health system and were engaged in the development of primary care services within the local area. This was evident in the pilot work the practice had completed and in which it continued to be involved, for example the fragility project. We saw examples where the practice shared their learning, experiences and solutions with other practices to reduce the likelihood and impact of similar events occurring.

All leaders were knowledgeable about 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 Buckinghamshire community. This was evidenced through their patient segmentation analysis and health inequality work alongside information and feedback collected as part of this inspection.

Staff we spoke with told us the leaders modelled the practice values and there was an “open door” culture were GP partners and leaders were always visible, responsive and available to provide support.

Leaders invested (both 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.

To support an inclusive team within a new large building, leaders had established new ways of working to retain the ‘small practice energy’. For example, the introduction of co-ordinated coffee/tea breaks, designated areas within the new building and further channels of staff communication, for both professional and social purposes.

Feedback from patients and staff regarding the leaders within the practice, was consistently extremely positive.

The practice fostered a positive culture where people felt they could speak up and their voice would be heard. Leaders actively promoted staff empowerment to drive improvement. They encouraged staff to raise concerns and promote the value of doing so. Staff were confident that their voices were heard.

There were systems in place to support staff to whistle blow or to speak with a Freedom to Speak Up Guardian if they had any concerns. Staff were aware of how to whistle blow and who the Freedom to Speak Up Guardian was and what their role was in supporting staff. The practice had established Freedom to Speak up arrangements with the ICB.

The practice valued diversity in their workforce. Practice staff were predominately part time. Staff reported despite various work patterns there was an inclusive and fair culture which had improved equality and equity for them. This included those with additional caring responsibilities and for those staff who had returned to work following absence.

Leaders had implemented fair and transparent systems to ensure all staff had access to development opportunities, regardless of their role or background. Staff consistently reported there was zero tolerance for discrimination and that they felt treated fairly. Policies and procedures to promote diversity and equality were in place.

Staff had completed equality, diversity and inclusion training and provided examples of tackling inequalities during the inspection.

Adjustments had been made to ensure all staff were valued, for example we saw adjustments to support disabled staff were in place.

The practice had clear responsibilities, roles, systems of accountability and good governance. Lead roles were shared across the 4 GP partners to ensure shared accountability and resilience. Assigned workstreams were used to manage and deliver high-quality, sustainable care, treatment and support. They always act on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Governance was extremely well-embedded into the running of the practice. Information about risk and performance was shared proactively and there were robust systems for capturing data. These systems demonstrated the ability to provide excellent quality information for relevant data or submission requirements such as declarations to stakeholders and commissioners and also as part of this inspection.

Staff told us, the governance systems within the practice not only encouraged learning and development but were effective in increasing production and positive outcomes for the patients and the whole community. We noted positively that systems were in place to routinely manage and act on performance data in a range of areas including urgent treatment presentations, patient feedback and ongoing analyses of online consultations.

The provider used a variety of data, this included historic, seasonal, live and forecasted data to govern performance and quality. This was shared and discussed during protected learning time (PLT) with all staff. Topics included incidents, near misses, patient feedback, complaints and compliments, inherent risks, patient care and treatment, and best practice. Some sessions included an external speaker to inform, share experiences, or present learning the practice could use to improve outcomes.

A regular suite of searches of the clinical record system were run to identify and govern patient needs and ensure these were being met and our review of clinical records showed that this was effective. Staff told us and the evidence we reviewed, indicated the searches were completed routinely and not just in readiness for the CQC inspection.

Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. Leaders had established governance processes that were appropriate for their practice in a shared occupancy building. Staff could access all required policies and procedures. 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.

There was a comprehensive programme of clinical audits with clear oversight to monitor and track audit cycles, results and outcomes. These were monitored effectively and repeated in a timely manner and the results were shared with the relevant members of staff and partner agencies, including health and community services and the ICB for ongoing shared learning and improvement.

The practice used Artificial Intelligence (AI) tools in the delivery of care and treatment. A GP partner led on this workstream and governed the practice’s use of different AI tools used. This was in accordance with the NHS Digital clinical risk management standards, the Digital Technology Assessment Criteria and other digital and information security standards.

When considering service developments or changes, the impact on quality and sustainability was assessed. This included working with the developers and co-located GP practices to make adjustments, including environmental sustainability adjustments when moving to the new building in 2022. The aim of this was to reduce the environmental impact of the healthcare activity.

The practice clearly understood and carried out their duty to collaborate and work in partnership with other services and the local community, this was reflected within the practice’s mission statement which was: “Caring for our community”.

We saw the practice shared information and learning with partners and collaborated for improvement. This included work with a local care home, practices further afield and local Beaconsfield and Buckinghamshire charities.

We also saw examples where the practice worked with member practices within the PCN; sharing earning, experiences and solutions with the practices, so as to reduce the likelihood and impact of similar events occurring.

Examples of this partnership work with the PCN included a variety of pilots and projects and also the recognition as an approved PCN learning environment, supporting workforce education, development and sustainability across the system.

The practice worked with stakeholders to build a shared view of challenges and of the needs and growth of the population. The practice worked with a range of external partners, for example, other health and social care professionals, mental health services to support patients with a range of needs. There were many clear examples of how partnership working had improved patient outcomes and how best practice had been shared across the wider organisation.

As part of their PCN the practice had analysed their patient population group and identified patient groups that needed further support and developed PCN/neighbourhood level approaches to support the identified priorities. The PCN had recently been successful in a bid to be part of the first wave of the National Neighbourhood Health Implementation Programme (NNHIP). A programme focusing on tackling health inequalities via a large-scale change programme to accelerate neighbourhood health services across different communities by taking a ‘test, learn and grow approach’.

There were processes in place to work in partnership with key organisations and agencies to support the provision of care and joined up working. This included regular multi service pilot and project work. Staff also routinely referred people to services within the community such as the local health and wellbeing service to support them to live healthier lives.

In 2022, Millbarn Medical Centre relocated to purpose built modern premises. Prior to the relocation and move, the practice worked with patients, stakeholders, developers, the other co-located GP practice and the local community to ensure the new premises met the needs of the community. We saw, as an active member of the community, the practice worked with a local charity and helped design a tile mosaic which formed part of the Beaconsfield mosaic trail. Staff told us this was a fun activity to be part of, created a community spirit and also encouraged patients and others in the area to increase exercise and complete the trail by visiting the building where the mosaic was displayed.

The practice was supported by a Patient Participation Group (PPG). The PPG was made up of 7 core members who met regularly at the practice. We spoke with members of the PPG who were extremely positive about the practice. Both the PPG and the practice independently shared how they valued their collaborative partnership.

The practice had a strong focus on continuous learning, innovation and improvement across the organisation, the local system and wider health economy. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff at all levels actively contributed and embraced safe innovation, they described the practice as ‘forward thinking’.

Leaders embraced safe innovation and digital tools to improve efficiency. In line with best practice guidance, they had planned a staggered implementation of the applications to ensure that any problems could be resolved without having a negative impact on patient care.

They had commissioned and implemented an AI process to improve efficiency across various teams within the practice. This process was underpinned by the relevant safeguards to ensure safety and mitigate risk, and this included the relevant clinical risk assessment to comply with commissioner requirements. There was a human element involved in reviewing quality and safety, involving regular and frequent checks and recording any issues which could be addressed directly with the provider. Analysis had shown that there was a significant improvement in efficiency, meaning that staff time usually spent on this process could be diverted to other tasks.

Staff we spoke to, who used the new AI processes were complimentary of the new tools, advising the tools and processes helped them work more effectively and allowed for more time to spend with patients. Several members of staff highlighted the increased time they now had with patients correlated with improved patient satisfaction scores.

We saw evidence of a range of audits, pilots and quality improvement projects. Projects were designed to improved performance, outcomes, and patient experience. Leaders showed strong commitment by regularly listening to patient and community feedback, which directly influenced the design and assessment of new working practices. They also invested significant time and resources to support staff.

The practice had a quality improvement plan in place to help drive and sustain clinical outcomes, alongside maintain high levels of patient and staff satisfaction.

We saw evidence of a clear, systematic and proactive approach to seeking out and embedded new and sustainable models of care. Prior to any changes the practice used feedback from patients and staff alongside data and clinical safety information to ensure new ideas were suitable. For example, in 2021 the practice was an early adopter of online access and digital triage. The practice continually reviewed and had refined processes to ensure implementation was effective and met the changing needs of both patients and staff. The improvements in the efficiency of processes, high levels of satisfaction and staff morale indicated this approach was a success. Furthermore, given the practice’s use of new models of care, they had shared their work and achievements across the PCN, the local ICB and a neighbouring ICB. The practice had also recently started to mentor and support other practices to introduce these ways of working.

Millbarn Medical Centre is an approved training practice for both GP registrars (fully qualified doctors training to be a GP specialist). The practice is involved in the education and training of future healthcare professionals. Leaders and peers encouraged and supported staff to develop and encouraged career progression through the organisation and other services. This included clinical and non-clinical roles. Where clinicians had specific areas of clinical interest, they were afforded time and supported to upskill.