The Sidings 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 care; supported learning and innovation; and promoted an open, fair culture.

At our previous inspection in 2024 we found concerns related to the governance, management and sustainability at The Sidings Medical Practice. Following the inspection initial improvement were made but these were not monitored by the provider or sustained.

At our visit in February 2025 Leaders and staff did not have a shared vision and culture was poor. Staff did not feel supported or listened to. Leaders were not visible, knowledgeable or supportive. Staff felt unable to give feedback for fear of bullying or harassment. The service did not have clear responsibilities, roles, systems of accountability and good governance. Learning was not seen as a priority and changes to improve care not identified consistently.

At our second visit in April 2025 we saw evidence that changes had been made to leadership, governance, accountability systems processes which had led to improvements in culture, shared vision and learning at the practice.

Whilst improvements were seen at our second visit, due to the lack of sustained improvement following our last inspection we could not be assured that these improvements would be maintained. Therefore, the sustainability and the impact of these changes could not yet be assessed.

At our last inspection, we rated this key question as inadequate

At this assessment, the rating has remained the same

The service was in breach of legal regulations relating to safe care and treatment and governance.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At our visit in February 2025 staff told us culture within the practice was poor with support and wellbeing, openness, and honesty not perceived as a priority by the local management team. Staff had not been involved with developing or improving the shared direction of the practice. This had led to them becoming disengaged and a lack of trust had developed.

Staff told us they felt undervalued, they told us they had not been given appropriate time off to attend and recover from medical appointments, annual leave was not authorised in a timely manner and sometimes not at all. Staff were expected to work extra hours without pay and were not all able to take the time back with rotas not released in a timely way to allow staff to plan their home life with work commitments. Protected training time was removed, staff were expected to complete tasks they were not trained to do, staff felt they were not listened to and were unable to challenge decisions or raise concerns. Complaints and incidents were not manged in line with policy and potentially unprocessed paperwork appears to have been hidden.

At our visit in April 2025 the SLT had implemented changes and practice staff told us the culture and relationships were now improving. Staff told us they now felt they would be supported if they requested assistance, rotas were released and annual leave was authorised in a timely manner, protected training time had been reinstated and they were no longer expected to work extra hours without pay.

The provider was now developing a vision, strategy and culture for the future of their service. Staff had been more involved in decisions taken and changes required to improve patient care and staff wellbeing. Staff confidence and trust in the management team was improving and this was evidenced through a recent in house staff survey.

People, partners and communities had not always been engaged with, or their needs understood to help develop the vision, values and strategy. Work was ongoing with key stakeholders and other providers of care who use the service to understand their requirements to improve patient care delivery.

Leaders had recently liaised with the PPG at the practice and the relationship between them was improving to enhance their understanding of peoples’ needs.

The provider was aware of some risks to delivering the strategy due to the recruitment of new staff. Processes to support the development of the local leadership team have been reviewed and strengthened. The revised quality dashboard reported at the provider board meeting monthly monitors progress against delivery of the strategy and relevant local plans.

Whilst improvements in shared direction and culture were seen at our second visit, due to the lack of sustained improvement following our last inspection we could not be assured that these improvements would be maintained. Therefore, the sustainability and the impact of these changes could not yet be assessed.

At our inspection in February 2025 we found the service lacked effective local leadership and senior leaders were not visible. The provider had not identified or acted to address issues escalated by staff related to concerns about the local leadership at the practice.

We identified local leaders had introduced changes to the way staff worked at the practice without consultation which the provider was not aware of. For example:

the removal of protected time for staff training. This led to staff being unable to complete the providers expected mandatory training.

Administration staff had been allocated tasks they were not appropriately trained, skilled or supported to complete by the local management team. For example, they routinely carried out clinical triage and were asked downgrade clinical tasks. This led to increased risk to patients.

Staff told us local managers had stored paper work in a locked cupboard and in a remote area of the building and they were not aware if this had been reviewed or processed.

Changes were made to the way FP10 paper prescriptions were managed which was not in line with legal requirements.

Staff concerns about the changes and their impact were not taken into account.

Following our visit in February 2025 the provider commissioned an independent investigation into the leadership and management of The Sidings Medical Practice following concerns identified during our assessment visit. Implementation of the findings has commenced and is ongoing.

At our visit in April 2025 the provider had undertaken a significant amount of work which was ongoing to develop local knowledge, experience and credibility to understand the requirements to improve safety and culture.

Recruitment had been successful for some leadership posts but this was ongoing for some key positions. Leadership at the practice was supported by visiting members from the providers SLT and from other services within the providers portfolio. Training programmes and support to provide high-quality leaders have been developed or improved and are in the process of being introduced, this will continue once recruitment has been completed.

Changes in the providers approach have led to the start of open and honest relationship. Senior leaders were now more visible and have taken steps to ensure they always set examples of inclusive behaviours by listening to staff and responding to their increased understanding of staff needs. Staff told us they were starting to feel confident about the leadership team and they reported they would now approach leaders with issues, concerns and for support.

Whilst improvements in leadership were seen at our second visit, due to the lack of sustained improvement following our last inspection we could not be assured that these improvements would be maintained. Therefore, the sustainability and the impact of these changes could not yet be assessed.

At our visit in February 2025 a Freedom to Speak Up Guardian was in place supported by a policy and process. Staff told us they were not confident to use the process as when they had nothing had changed and feedback was not given. Some staff told us they were concerned about local leaders’ reactions if they escalated concerns.

At our visit in April 2025 the provider had changed the Freedom to Speak Up Guardian and staff told us they felt this change had been positive and was starting to improve staff confidence around raising concerns, honesty and transparency.

Staff were aware of who to approach if they needed to speak up and told us how they would now be able to appropriately escalate concerns to the provider if the local process in place was not working.

Staff and leaders now actively promoted staff empowerment to drive improvement. They encouraged staff to raise concerns and promote the value of doing so. A minority of staff were still not confident that their voices will be heard due to historic issues.

Improvements had been seen at the practice following recent changes. They had not been in place long enough to become embedded in normal practice and give all staff confidence in the system.

At our visit in February 2025 we did not see evidence of a culture which promoted workforce equality, diversity and inclusion in place.

Staff told us they had on occasions felt they had not been treated equally with some getting preferential treatment. They describe how they had felt bullied by local managers and not listened to by senior leaders when concerns were escalated and often didn’t get feedback.

At our visit in April 2025 leaders have implemented new systems to hear the voices of staff including those with protected equality characteristics and those who are excluded or marginalised, or who may be least heard within their service. An independent advisor attends the practice on a 3 monthly basis to carry out listening exercises with issues anonymised and reported back to the provider.

Staff told us they now believed they would be treated equally and told us reasonable adjustments and support had been given to staff when required for both professional and personal issues. They told us when they share concerns and ideas to drive positive change to shape services and create a more equitable and inclusive organisation, these are now being acted on and feedback was received.

Whilst improvement was reported and evidenced the changes made had not been in place for sufficient time to become embedded in normal practice and assess their impact.

At our previous inspection in 2024 we found concerns related to the governance, management and sustainability at The Sidings Medical Practice. Following the inspection initial improvements were made but these were not monitored by the provider or sustained.

At our first visit in February 2025 the service did not have clear responsibilities, roles, systems of accountability and good governance, management and sustainability.

We found the provider had lost oversight of the Governance and systems at the practice. They were unaware of the changes made by the onsite local leadership team identified during our assessment visit and the impact on care and staff wellbeing.

Performance, outcomes and risks were not clearly understood, monitored, managed consistently or effectively by the provider. They did not have an understanding of the delays in care, omissions in care, backlogs in correspondence, reviews and tasks, complaints and incident management, recruitment and retention, capacity and demand, safety issues and patient experience.

The providers corporate policies had not been personalised for the practice and lacked guidance to allow staff to undertake their roles and associated tasks safely. Changes had been implemented at a local level which were not supported by policy.

Governance systems and processes were reviewed by the provider following our assessment visit on 5 February 2025 and some changes were made immediately. Some responsibilities were immediately changed.

At our visit in April 2025 we saw evidence of further changes in the governance at both local and provider level. More changes were either ongoing or planned.

An improved governance assurance framework had been developed which identifies clear responsibilities, roles, reporting structures and systems of accountability.

Changes made to governance are ongoing and not all areas have been addressed at the time of our report. For example, key staff recruitment was ongoing, and governance responsibilities would need to be amended over time when posts were filled.

An improved quality dashboard has been developed which is reported at the providers board meeting on a monthly basis to monitor performance. The dashboard includes delays in care, any backlogs, complaints and incident management, recruitment and retention, capacity and demand, safety issues and patient experience. Required actions were identified and results of said actions monitored to check effectiveness and for any themes or reoccurrence of risks. We reviewed the dashboard over a 3 month period which showed improvements in all areas.

A risk management framework had been developed with systems and processes in place to improve risk management. A Risk Register is now in place with an oversight group who will review and monitor risks with a predetermined high score. A corporate Risk and Compliance Manager has been appointed and training for local risk leads will be undertaken to improve understanding and management of risks.

Leaders have implemented a CWP to improve practice in a sustainable way leading to improved outcomes for people using services. The CWP includes action related to long term condition management, medicines management, management of safety alerts and missed diagnosis The CWP was in progress with some actions completed, some ongoing and some awaiting implementation at the time of our visit in April 2025.

The provider has begun to develop a core understanding of the actions, behaviours, and performance of staff by being visible, open and honest. Staff have told us this has improved the working relationships and meant that the majority of them are confident that any staff would be held to account in an appropriate manner if their actions or behaviours fell below the expected standards.

The provider was planning a review of policies to provide a local process maps for the practice in support of the policies in place.

Whilst improvements in governance were seen at our second visit, due to the lack of sustained improvement following our last inspection we could not be assured that these improvements would be maintained. Therefore, the sustainability and the impact of these changes could not yet be assessed.

At our first visit in February 2025 feedback from key stakeholders and other services using the practice in relationship to partnership working and community relations was not positive.

Representatives of other care providers we spoke to were not all positive about the practice staff, their responsiveness to requests and their knowledge of their patients.

We were told relationships with the local ICB and LMC were not always open, honest and effective to encourage partnership working.

Members of the PPG told us they had not been active as they had not felt listened too by the management.

The practice worked with other practices within their PCN to offer enhanced access appointments. However, staff had not always been encouraged and supported to attend PCN meetings or actively engage with the other services within the network.

At our visit in April 2025 we saw evidence of changes made to begin to improve the relationships with partner organisations and communities using the practice.

The provider had instigated dedicated meetings with one other care provider and a member of the local management team had met with representatives of other care homes to improve relationships and identify improvements that would lead to improved care delivery.

Members of the PPG told us they now felt the patient voice was listened to and the practice had started to act on feedback from the PPG to improve services.

Staff told us they now attend PCN meetings and were encouraged to engage with other practices to develop effective relationships

Relationships with the local ICB and LMC had improved and relationships were now described as collaborative with open communication.

Whilst improvements in partnership working and community relations were seen at our second visit, due to the lack of sustained improvement following our last inspection we could not be assured that these improvements would be maintained.

At our first visit in February 2025 there was limited evidence of continuous learning, innovation and improvement at the time of our assessment.

Incidents and complaints were not managed in line with the providers policy and learning was not identified consistently. Staff told us they were not always involved in the investigation and decisions relating to changes identified. The provider had made immediate changes, once they were aware of the issues to how complaints and incidents were managed, investigated and shared with staff.

Staff groups with the appropriate skills and knowledge told us they were not involved in the process to identify solutions to problems and the introduction of new ways of working. This meant changes often decided by a member of staff without any or appropriate clinical experience and understanding. This led to increased risks to patient care and staff ability to perform their roles safely.

Learning from partner organisations in relation to the needs of their service users was not always effective and we were told communication was poor with the practice staff. The PPG had not been assured the practice management and SLT had always effectively listened to their concerns. Collaboration with the other practice within the PCN was not seen as a priority, this led to missed opportunities for learning and innovation from a wider group.

Performance monitoring was poor at both local and provider level. The SLT had little understanding of the issues identified at our assessment and the information they did have was inaccurate and not always reviewed by the senior leaders. For example, complaints monitoring was not accurate and exit interviews were not reviewed to identify the reasons for increased staff turnover.

At our visit in April 2025 we saw changes had been made to the systems and processes to the way learning and improvements are manged.

Staff told us they were now appropriately involved in investigations and complaints. They were part of the investigation, solution identification and change process. We saw evidence that learning was shared effectively in staff meeting minutes.

Learning from partner organisations in relation to their needs to provide improvement is underway with meetings taking place or being planned. Relationships with other key stakeholders had improved with SLT members attending PPG meetings and staff actively engaging with the PCN.

Changes in governance at both local and provider level had occurred and information related to improvements and sustainability was now reviewed at the monthly meetings at local level and by the SLT via the improved dashboard.

Whilst improvements in the learning and innovation opportunities were seen at our second visit, due to the lack of sustained improvement following our last inspection we could not be assured that these improvements would be maintained.