Castle Healthcare 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, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment, we rated this key question as Good. At this assessment, the rating has changed to 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 service had a very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities. All staff had contributed to the development of the practice vision and strategy, which was kept under review. Staff told us they had all recently been involved in developing the practice values. At a recently protected learning time day they had completed team activity around what they felt described the service they provide to patients. The practice had these on display on a large banner in a staff corridor. The practice’s vision was printed on mouse mats and screen backgrounds.

The practice was aware of the projected increase in the local population and was working with partner agencies to address future challenges. The practice was in a purpose-built environment which allowed them to facilitate additional treatments including ultrasounds, midwifery clinics and diabetic nurse clinics. The building had a lead lined room, should the practice choose to provide x-rays in the future.

Management told us when they chose the name of the practice, they had made a conscious decision to call it “Castle Healthcare” and not “surgery” or “practice” as they did not want the practice to be medically led but have a holistic approach to healthcare for the local community.

The service 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, experience and credibility to lead effectively. They always did so with integrity, openness and honesty. Staff told us leaders in the practice were approachable and responded to any concerns raised. They told us they could approach all partners and management team without fear of retribution.

Staff also told us leaders modelled the values of the practice. Staff told us they could approach any clinician for support and regular debriefs were put in place for clinical staff.

Leaders often set up campaigns (including the flu and covid vaccine campaigns) so that staff from all levels worked together pairing clinicians with administrative staff who they would not always work with daily to build team spirit and sense of belonging across the practice. Staff told us this was a positive way to get to know the whole team as they were such a big practice.

We saw the leadership team worked with other practices in the primary care network (PCN) and were engaged in the development of primary care services within the local area. We saw examples where the practice shared their learning with other practices through their PCN.

The management team had set staff rotas to ensure all staff had a lunch break together. This space allowed staff to integrate with each other and have an informal debrief if required. Managers had a monthly lunch and learn session in place where they invited external speakers including community teams or pharmaceutical reps to share information.

The service fostered a positive culture where people felt they could speak up and their voice would be 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 Integrated Care Board.

However, no staff had felt the need to contact them as they felt they could speak with the management team in place or any partners if they had any concerns.

We spoke with 16 staff and received 33 staff surveys and all staff felt there was a positive culture within the team and all felt supported by the leadership team.

The service had clear responsibilities, roles, systems of accountability and good governance. Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. The practice had a clear and strong clinical and governance management structure in place. Each partner had a lead role that they took responsibility for. They were allocated dedicated management time during the week to help fulfil their leadership role. The management team met every 2 weeks at alternate partner and executive meetings. This allowed them to follow up on action and have both clinical and managerial oversight of the practice.

They used these to manage and deliver high-quality, sustainable care, treatment and support. For example, the practice clinical lead produced an annual prescribing audit and presented it to the integrated care board, evidencing how the practice was performing in line with local commissioning requirements and national standards.

Managers met with staff regularly to complete appraisals and performance reviews. Every staff member had an annual appraisal in place that was development focussed. All staff we spoke with told us they always had the opportunity to develop if they chose to.

They always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. Governance processes were in place for sharing safeguarding information with partners including the local authority and other community teams.

Staff could access all required policies and procedures. All practice policies and procedures were available on the practice’s shared drive, which all staff had access to. There was a clear policy review process in place to ensure all policies and procedure were reviewed regularly and were in line with new guidance.

Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. The practice had a regular protected learning time in place, team meetings and serious event review meetings in place. In addition, following the pandemic the practice had continued to have daily morning meetings where they discussed the structure for the day and any emerging risk or changes. This was communicated through electronic cascade systems in place ensuring all staff were up to date with all revenant information and changes. Managers ensured there were regular staff touchpoints in the day to allow collaboration and debriefs; this included in the morning, at lunch and at the end of the day.

Staff took patient confidentiality and information security seriously. All staff had appropriate information security training in place.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

Manager regularly invited local partners to attend team lunches and share initiatives. The practice environment lent itself to allow the practice to help facilitate community clinics including diabetes clinics, health visitor clinics, physiotherapy clinics, and midwifery clinics. This allowed partnership working and ease of communication as these professionals were regularly at the practice.

There were processes in place to work in partnership with key organisations and agencies to support the provision of care and joined up working. Staff told us they regularly went over and above for people by referring them to services within the community such as the local health and wellbeing service to support them to live healthier lives.

The practice had an active PPG who told us they were involved in campaigns and had recently undertaken projects including displays around the practice, signage review and displays on the screens in waiting areas. A partner always attended PPG meetings to ensure they had clinical support.

The provider worked with other practices within their primary care network to offer extended access, and flu and covid vaccination programmes. The integrated care board (ICB) informed CQC the practice was engaged with the ICB and the primary care network. Partners attended monthly operations meetings with their primary care network where they shared initiatives, referral processes and learning.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research. Castle Healthcare was an accredited research practice.

All staff were encouraged to put forward and test out new ways of working. For example, a healthcare assistant had suggested the idea of a sit and wait phlebotomy clinic to help deliver an efficient phlebotomy service. This had been a success (evidenced through patient feedback and speed at which tests were completed), and the healthcare assistant told us they felt valued as the management always treated everyone ideas equally. In addition, at a recent staff protected learning afternoon staff discussed ways in which they could further improve the practice’s patient blood pressure monitoring. As a result, the practice had invested in a blood pressure monitor patients could access throughout the week at the practice to take their blood pressure. Patients whose blood pressure had not been measured in the last 5 years were invited in to use this equipment at a time that suited them. In addition, the practice had bought several blood pressure monitors that patients could borrow to help improve their preventative practice. As a result of this initiative 1 of the first patients to use this machine identified they had severe hypertension and was treated immediately.

The practice was always looking for innovative ideas and ways of delivering efficient care. They were in the process of teaching their IT system to review and automatically code certain conditions. They were working with hospitals to help standardise letters to make this process efficient and ease the workload on staff as well as improve the timeframe in which information was shared with clinicians and patients. Castle Healthcare was a pilot site for the new Medical Examiners death certificate process. They were 1 of 2 practices involved in this project, working alongside the medical examiners office, helping to streamline processes and improve family experiences at a difficult time.

The practice not only shared learning internally but also across the local area. Following a recent incident involving the practice being unaware of a patient having a pessary fitted before accessing their services, they conducted an internal audit and shared this best practice piece of work with other local practices through their integrated care board (ICB).