Uni-City Medical Centre

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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 practice 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 practice since its new registration with CQC. This key question has been rated as Inadequate .The provider was in breach of legal regulation in relation to good governance.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Senior leaders did not always ensure staff were aware of the roles and responsibilities of others within the practice. For example, senior leaders did not always ensure policies were up-to-date and include the names of designated leads.

Staff told us that a vision had been created however this had not been shared with the wider team. Staff meeting minutes were not always detailed or clear and had no standard agenda items. The meetings did not detail staff were kept informed of recent events within the practice. However, senior leaders demonstrated awareness of the local demographics and adapted access needs accordingly.

Leaders did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. Staff told us there was a need for better communication across teams; for the leadership team to be more visible and engaged with their staff. There was a desire for better engagement with higher-level management; and to understand the vision of the practice. Staff also expressed concern about lack of supervision and appraisal support. However, the leadership team worked with the local primary care network and were engaged in the development of primary care practices within the local area.

The practice had a Freedom to Speak up policy in place, however not all staff knew how to access this. The policy also did not contain the name of a Freedom to Speak Up Guardian, and leaders were unable to confirm the name of the person with this role. Guidance from NHS England (Freedom to speak up in Primary Care, 2016) states that primary care providers should name an individual as the Freedom to Speak Up Guardian who is independent of the line management chain. Without this information, staff may not know how to raise concerns, or where to seek advice and support, particularly if their concern is about someone senior in the practice or their direct employer. If concerns about patient care are not addressed, there is a potential risk of harm to patients. However, all staff members we spoke with during the inspection reported they felt able to raise concerns to senior leaders.

Staff spoken with reported they felt respected within the practice and stated that colleagues would support one another. Staff explained that each colleague offered different skills and experience, both from current and previous employments, and individual input was valued amongst the team. The practice did not have effective systems in place to engage and involve staff . For example a staff survey had been completed for this year. We received 17 staff feedback forms as part of this inspection. We identified staff did not have display screen Equipment risk assessments in place and we identified staff were not being supported to have the right equipment to support their needs. However, the practice told us they held social events to promote wellbeing amongst staff, including Christmas parties and staff quizzes. Staff received Equality, Diversity and Inclusion training.

The practice did not have clear responsibilities, roles, systems of accountability and good governance. Leaders did not act on the best information about risk, performance and outcomes. Leaders and managers who supported staff, were not clear on their individual roles and responsibilities. Managers did not meet with staff regularly to complete appraisals and performance reviews. The provider had not established governance processes that were appropriate for the service. For example, the review of policies to reflect updates and staff changes within the practice was not effective; there was a lack of oversight of rota management, staff training records and recruitment records; there was a lack of evidence to demonstrate effective workforce planning; a lack of evidence of learning from events and incidents to improve the service and prevent recurrence. Staff did not have access to all required policies and procedures There was no risk register in place to proactively identify and mitigate risk. In the absence of a risk register, it was unclear how the practice was monitoring both risk mitigation, and subsequent learning and improvement. We found improvements were required in relation to the management of risks, the management of patients’ with long term conditions; patients prescribed medicines requiring monitoring; safety alerts; the practice’s safeguarding register; and staff immunisation records. Managers held regular practice meetings with staff, however clinical concerns and emerging risks were not discussed, nor was learning from complaints shared to reduce the risk of recurrence. Managers did not clearly record any actions arising from these meetings and ensure these were shared with staff.

The practice understood their duty to collaborate and work in partnership, so practices work seamlessly for people. The provider worked with other practices within their primary care network to offer extended access, and flu and covid vaccination programmes. Staff worked with other local community healthcare teams to improve outcomes for patients at risk. For example, monthly meetings were implemented, centred around frequent attendees, to focus on the care of those at higher risk of hospital admission. The practice attended the gold standard framework meetings within the locality of the primary care network. This is a model of good practice designed to improve care for individuals nearing the end of their lives.

The practice did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research. We saw a lack of a learning culture, for example, from significant events, where staff were not aware of these events and therefore not able to be part of the learning from these.