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

At our previous inspection, we rated this key question as requires improvement. At this assessment, the rating remains the same. The service was in breach of legal regulation in relation to governance.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The organisation had a vision, strategy and culture which was based on equity, equality and human rights, diversity and inclusion, and engagement.

The leaders spoke positively about moving forward, their direction and culture and about making improvements to the practice. However, almost all of those completing the staff questionnaire said they did not contribute towards the development of the practice vision or strategy. From the feedback we received from staff, we had some concerns about staff engagement and culture of the organisation.

The practice mission statement and core values were included in the practice induction pack.

The service had an Equality and Equal Opportunities Policy.

The service had inclusive practice leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation.

Staff told us leaders in the practice were approachable and responded to any concerns raised. We saw they worked with other practices in the primary care network and were engaged in the development of primary care services within the local area.

Senior leaders had the skills, knowledge, and experience to lead effectively, however staff told us the communication at times was poor and staff did not feel involved in recent changes. Staff also reported that some senior leaders were only available remotely rather than in person which affected staff morale and team working.

During the assessment staff raised a concern that only some staff details had been provided to CQC when the staff survey was issued and reported there was an issue with this initially for the 2023 inspection also. This issue had been identified by the lead Inspector and raised with the provider. Further details were provided to CQC to ensure all staff were able to complete a survey.

The GP National Survey delivered some poor scores for initial patient access for the practice. They recognised this, and action was being taken to address this.

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

The practice had a whistleblowing policy with established Freedom to Speak up arrangements. The Freedom to Speak up Guardians were named managers either within the practice or within the wider organisation. There was also an external option listed in the employee handbook for staff to use. Feedback from staff indicated that not all of them were aware that the practice had a Freedom to Speak up Guardian. We saw an example where staff had used the arrangements in place to positive effect; for example, being provided with protected time for the completion of training.

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, however not all staff feedback was positive in this area.

Leaders told us they had an open-door policy. Policies and procedures to promote diversity and equality were in place. Equality and diversity training was part of the mandatory training and records confirmed this training was completed by all staff.

The majority of staff told us they felt they could approach local leaders at any time if they required support. However, not all staff felt they were included in decision making processes and several staff in the surveys raised a lack of support and communication from senior leaders.

We saw examples of how the practice had regular meetings with staff although noted the opportunity for non-clinical staff meetings was much less frequent.

The service had governance structures and processes in place.

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. There was oversight to ensure mandatory training was kept up to date. Staff could access required policies and procedures on the practice’s computer system. There were named leads in place for key areas, however staff were not always clear about the leads name or their roles and responsibilities.

Managers held range of meetings with staff however the frequency, structure and recording of these were clearer for clinical staff meetings than for non-clinical staff meetings. Non-Clinical staff feedback regarding meeting frequency, structure and content was varied which reflected this. We saw copies of 2 non-clinical staff meetings minutes which did not include a note of the staff attending, apologies given or actions from previous meetings.

Results from the National Patient survey for access had declined from 49.6% in 2023 to 28.7% for the same period in 2024. We found work regarding access had been carried out since our last inspection, however the more significant changes were in the months prior to the inspection for example the Care Navigation system and Chatbot function . Whilst these further changes were evident, we observed the changes to systems and processes were newly formed and would take time to fully embed and show sustained improvements for both staff and patients.The Practice also conducted its own patient surveys in April and November 2024. The data is unverified however leaders reported that the results showed some improving data.

The latest available data from the National GP Patient Survey results from 2024 show that the practice achieved less than local and national averages regarding patients who responded positively to the overall experience of their practice. The practice achieved 65.4% compared with 73.9% nationally.

The service had been through a restructure for staff which included roles such as finance, human resources, medicines management, chief nurse support role, IT lead role and senior management support being centralised, to free up resources within the practices. In the last year the provider also confirmed an increase in clinical staff. However, of the 11 staff surveys received from all levels of staff both clinical and non-clinical, 9 reported issues such as increased staff turnover particularly administrative staff, too few staff, poor morale, increased sickness and high workloads especially for staff remaining who supported the training of replacement staff. We raised this with the provider who confirmed staff turnover from April 2024 to March 2025 was 17.3% consisting of 11 staff of which 73% were administrative staff.

The provider recognised that the premises at Rowlands Gill was no longer suitable as a GP practice and was actively working with the Integrated Care Board and local authority to obtain land to build a more suitable premises.

The provider had a business continuity plan in place. There were effective arrangements for identifying, managing, and mitigating risks.

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 collaborate for improvement.

The provider worked with other practices within their primary care network (PCN) to offer extended access, and flu and covid vaccination programmes. For example, the practice had visiting PCN staff such as a social prescriber, a mental health worker and a physiotherapist to provide further services to patients.

In the GP national patient survey, 70% of patients said they had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. This was in line with local and national results.

The practice had an active Patient Participation Group (PPG) with 40 members and a waiting list of those wanting to join. The last full meeting with the practice was August 2024 however at the time of the assessment there was a forthcoming meeting planned in March 2025. The PPG in 2024 had drawn up a comprehensive action plan in response to CQC and Healthwatch reports which was being considered by the practice, although no action had been taken at the time of the inspection.

The service focused on learning and innovation across the organisation and provided us with examples of this.

Leaders told us they supported the development of their staff. Clinical staff told us they discussed and learned from complaints, incidents and audits, however the response from non-clinical staff was mixed and most told us they did not learn from complaints or incidents. Staff worked with the primary care network to deliver a wider range of services.

The practice had a quality improvement plan in place to help drive improvements in the access of services for patients. This included the new care navigation system recently introduced as well as the website chat function commenced in January 2025.

The organisation had introduced two digital feedback tools for staff to use to suggest improvements. They had also recently published organisation wide newsletters to improve communication and share learning.