Adelaide Surgery

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• 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.

This is the first inspection for this service since its registration with CQC at the current location. This key question has been rated as inadequate.

The service was in breach of a legal regulation in relation to good 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.

The practice did not have a clear shared vision, strategy and culture.

The practice told us they had a vision and mission statement, but it had not been updated for many years. During our assessment leaders emailed staff to ask for their ideas to update it.

There had been 3 different systems for storing policies in recent months, so some staff were unclear of how to access them.

There was no overall system for holding meetings or sharing information with staff. Some staff groups told us they met regularly, some said meetings were rare and they would benefit from attending more, and some said they never attended meetings.

GP partners and senior leaders told us there was a positive and compassionate listening culture in the practice. Although some staff said they felt listened to and thought their views would be acted on, a high number did not agree. Staff felt their immediate managers and supervisors were approachable, but not the partners or some senior leaders.

The practice did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not all have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

Some staff gave examples of a disconnect between GP partners/senior leaders and other staff. Staff said that communication within the practice was poor, and they were unable to approach the GP partners. They told us a lot of staff had left recently, and this had affected the atmosphere and culture at work.

Leaders were not knowledgeable about issues and priorities for the quality of services. GP partners and senior leaders told us they were aware of some issues within the practice, but they had been unaware of some issues found during the assessment. Information we requested was not readily available, and we had to send reminders to the practice when we did not receive responses. Information such as policies were being updated at the time we requested them. Not all grievances made by staff had been actioned.

Staff did not feel they could speak up and that their voice would be heard. Not all staff knew what whistleblowing was. The practice had a Freedom to Speak Up policy, naming a staff member and an external person as Freedom to Speak Up Guardian. They also had a Whistleblowing policy naming 2 staff members as Freedom to Speak Up Guardians. The staff members no longer held that role. Leaders told us the staff had not been trained and thought the role was overwhelming, so now they only had an external person. Most staff did not know who the Freedom to Speak Up Guardian was, and some thought they didn’t have one. Some staff told us they felt unable to raise any concerns about the practice in case there were reprisals. We saw examples of where staff had raised concerns and the actions from the practice were not positive.

The practice did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. We heard examples of where roles had been allocated internally to staff without a fair an open process.

Leaders gave an example of reasonable adjustments being put in place for staff.

The practice did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

GP partners and senior managers did not always support staff. Staff were not all clear on their roles and responsibilities, or the roles and responsibilities of those they worked closely with. Some staff did not know who their line manager was.

There had been a high staff turnover, and there had been 3 practice managers in the previous 2 years.

Performance reviews and appraisals were not regular. Where appraisals had been held these often did not contain sufficient information, and some did not include a date or name of an appraiser. The provider did not have established governance processes that were appropriate for their service. Although policies and procedures were available, recent changes to how they were stored meant some staff reflected there were too many systems to be able to find them. Teams worked well with their supervisors, but this did not extend to the GP partners or some senior leaders.

Practice meetings were not held regularly, and meeting minutes were scarce. Staff reported that communication within the practice was a particular issue. There was a large nursing team but there was no lead nurse.

The system for managing complaints was not effective. The system for managing significant events was also not effective; not all incidents were being recorded and although staff told us incidents were discussed in meetings, minutes about these were not always clear. There was little evidence of complaints or significant events being discussed with the wider team.

Leaders told us that some staff registered with the practice as a temporary patient so they could consult a GP if ill at work. There was no staff as patient’s policy.

Patient confidentiality and information security was not always taken seriously. We saw an example of a data breach due to unauthorised access to clinical records. This had been investigated, and actions had been suggested. The suggested actions had not been taken and there was a reluctance by the practice to rectify this.

The practice had a Patient Participation Group (PPG). There were 3 members but only 2 attended meetings. In addition, another person attended who was not a patient or staff member. The group was not representative of the practice population. The practice manager told us they would like to develop the group. They had an agenda and a chat, but the practice would like the PPG to support them. The practice had not carried out their own patient survey, and the PPG had never carried one out on behalf of the practice.

The practice did not focus on continuous learning, innovation and improvement across the organisation. Processes to ensure that learning was shared when there were incidents were not effective. We saw not all significant events were recorded or actioned appropriately as per the provider’s own policy.

We asked the practice to provide us with evidence that the quality of treatment and services had been monitored within the last 12 months. Leaders told us there was no audit programme. They told us that all audits were in an electronic folder, and they were not kept elsewhere. There were 4 audits in the folder, but 1 had not been completed. They were single cycle audits, mainly undated. They did not contain any action plan for improvements and did not contain a timeframe to reaudit.

The practice did not have a system of oversight or audit of clinical consultations or record keeping for nursing staff or other clinicians. Where records of appraisals were kept there was limited input from GP partners.