Harraton 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

At our last assessment, 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 good governance.

This service scored 62 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff told us there was an open and honest culture within the practice. They felt confident to raise concerns without fear of retribution and believed that their views were listened to and valued. Staff also said that there was a clear vision for the future.

The service had 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.

Staff told us leaders in the practice were approachable and responded to any concerns raised.

The practice worked with the local Primary Care Network (PCN) and was actively engaged in PCN-led initiatives to improve patient care, including collaboration on medicines optimisation.

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

The practice had established Freedom to Speak Up arrangements, and staff were aware of how to raise concerns if needed. Staff who responded to the feedback questionnaire confirmed that they understood what whistleblowing was and how to report concerns.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Policies and procedures were in place to support equality and equity, and staff told us they felt respected in their roles. Leaders promoted open communication and described having an open-door policy to encourage feedback. Staff gave examples of positive changes made in response to their feedback, such as the provision of new chairs for staff and reception areas.

The service did not always have effective systems of governance to support oversight of risk, performance and quality of care.

There were weaknesses in governance arrangements that limited the practice’s ability to maintain appropriate oversight of safety and clinical effectiveness. For example, there was no robust system for the oversight of staff immunisation status, and no formal risk assessments were in place. Records were not maintained to support emergency medicines stock checks, and mandatory training records for locum staff were incomplete or unclear, limiting assurance that training requirements had been met.

In clinical areas, there were gaps in documentation and data management, including poor clinical coding of missed diabetes cases, inconsistent recording of clinical reasoning in patient records, and a failure to routinely download blood test results from the hospital system onto the practice’s clinical system.These issues posed a risk to effective clinical oversight and continuity of care.

However, leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Managers held regular 1-to-1 meetings and appraisals, and staff had access to policies and procedures. Practice meetings were held routinely to discuss clinical concerns and emerging risks, with actions clearly documented and shared with the wider team.

Staff also demonstrated an understanding of patient confidentiality and information security and took these responsibilities seriously. In addition, the practice had begun to strengthen clinical governance through internal audits. For example, in December 2024, a targeted audit was carried out to review the quality of documentation and prescribing by both a locum and a salaried GP. This was used to provide developmental feedback, improve clinical oversight, and support adherence to evidence-based guidelines.

Results from clinical coding audits were also reviewed during administrative staff appraisals and 1-to-1 meetings, helping to identify training needs and improve the accuracy of clinical coding across the practice.

The service understood its duty to collaborate and work in partnership so that care was seamless and person-centred.

The practice engaged positively with external partners to meet the needs of its patient population and worked closely with its Primary Care Network (PCN), including participation in medicines optimisation initiatives and other shared clinical priorities. It was also actively involved in multidisciplinary meetings focused on supporting patients living with frailty. The practice made regular use of social prescribing to connect patients with community-based support and was engaged in wider public health work through the Integrated Care Board (ICB), such as obesity and weight management initiatives, including awareness of the weight loss treatment pathways where appropriate.

The service supported continuous learning and improvement across the organisation. Leaders encouraged new ways of working to help ensure patients received consistent and equitable care.

As part of the GP Improvement Programme, the practice analysed telephone system data and identified a high volume of missed calls. In response, administrative staff, including the Practice Manager, increased capacity by actively answering phones while on-site. This approach ensured that all available staff supported call handling to improve patient access. The practice also extended its advance booking window from 2 weeks to 8, improving access to routine appointments.

Care navigation training was completed by staff in late 2024, supporting better patient signposting. A dedicated bypass number was introduced for health professionals to streamline external communication.

The practice used multiple channels to gather and act on patient feedback, including Friends and Family Test responses, text surveys, and on-site questionnaires. Complaints about clinics overrunning led to improved communication with patients, encouraging them to book double appointments when discussing multiple concerns.

Leaders also introduced digital tools to support innovation. Diabetes monitoring equipment was standardised, improving consistency and reducing costs. The practice also implemented a digital recall system for long-term condition reviews, which allowed external staff to access the clinical system and book appointments directly with patients—freeing up administrative time and improving access.

Staff development was supported through structured learning and career pathways. As a teaching and training site, the practice regularly hosted medical students. Staff were encouraged to build on their roles—for example, one team member was supported to progress from Healthcare Assistant to Trainee Nursing Associate (TNA) and completed additional training in ECGs, spirometry, and interpreting blood results.