Musters Medical 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 we rated the service as outstanding in well-led. This meant the service was consistently managed and well-led. Leaders were very compassionate and inclusive, and staff felt supported and valued. The culture they created promoted high-quality, person-centred care.

This service scored 86 (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.

There was a clear mission statement, which was displayed within the practice. The service’s vision showed aspirations to provide the highest possible standard of professional interaction with their patients, staff and wider community. The service committed to provide high quality and accessible healthcare and to treat patients with courtesy and respect and strive to develop the practice to be a leader within the community.

The service had a shared direction and culture with the NHS to provide proactive and preventative medicine and keep people healthier and out of hospital for longer. For example, the service’s future plans were aligned to the NHS 10 year forward view plan 2025; looking to increase the skills within the community with a view to reducing hospital admissions and shifting the focus from hospitals to caring and treating more people within the neighbourhood and community.

Leaders told us they held an annual planning meeting to agree a practice development plan, succession planning and review staffing levels to promote sustainability. The service’s vision was “to be the first-choice practice in our PCN for accessible, personalised and digitally-enable primary care.” Their mission statement was “to provide professional, accessible, high quality, comprehensive healthcare services which inspires confidence in our patients and our community.”

We saw evidence of collaborative working with their local primary care network (PCN) to achieve collaborative local response to challenges, enhance resilience and reduce the variation in the quality of service provision.

The service had engaged in a review of their information and technology systems commissioned by Nottingham and Nottinghamshire Integrated Care Board.

This aligned with their aspirations to improve digital technology systems by utilising technology to streamline systems and processes to increase clinical capacity. The aims of the project were to improve the ability to consult with and treat more people.

Staff were positive about the culture within the service and described it as open, transparent and supportive.

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. The service had an experienced and strong leadership team. There had been significant changes in the partnership and management in recent years due to retirements of long serving staff and death. The remaining partners adapted to the changes quickly and worked hard to ensure stability of the service whilst undergoing change. A new practice manager had been appointed who was described by leaders as “an asset to the team” and instrumental in building a stable and secure team. This was echoed by staff who spoke positively about the leadership, that they were approachable and responded to any concerns raised.

Leaders were immensely proud of their current team and told us they planned to continue to invest in their staff, diversifying and developing skills and knowledge base to ensure they have highly skilled, resilient and adaptable workforce to meet the needs of people and communities. There had been recent promotions within the team and upskilling of staff to support progression and build resilience within the management team. A member of the nursing team was supported to undertake a university course. Leaders planned to recruit a salaried GP to increase appointment capacity.

The service held regular management and staff meetings to ensure all staff members were aware of changes to service delivery. This was supported by notice boards communicating changes to all staff members. The practice had an equality and diversity policy and promoted equity to all people, including staff, with diverse needs and protected characteristics, such as sexuality (LGBTQIA+) age, religions, disability, race. Staff told us that leaders cared about their wellbeing and provided mindfulness sessions for their mental health and had yoga sessions at the practice

Leaders told us that “they continue to invest in staff, diversifying and developing skills and knowledge base to ensure we have highly skilled, resilient and adaptable workforce to meet the needs of our patients and communities.” Staff told us they “felt valued by the leaders and that leaders regularly thanked them for their work”. The service had nominated a wellbeing champion to support staff internally with team building events to foster team working. Leaders celebrated staff weddings, birthdays and held social events for the whole practice team. The service held team building away days as part of professional learning and development. For example, the service hosted a team building and connection afternoon which began with a riverside walk, lunch, followed by quizzes, games, and a fun mug-painting activity. The afternoon was welcomed by the practice team, and feedback from staff was highly positive about the event. An employment assistant program was provided free of charge for staff to access if they had personal problems, for example, housing or debt problems.

Representatives from the Patient Participation Group (PPG) told us they felt the provider was open to constructive challenge and proactively made improvements to the service.

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.

The practice had carried out an independent and anonymous staff survey to allow staff to freely give their views on all aspects of the running of the practice. Staff felt that they could speak up and felt that their voice would be heard and acted upon.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service had clear responsibilities, roles, systems of accountability and governance which they used to manage and deliver good quality, sustainable care, treatment and support. They acted on information about risk, performance and outcomes.

Leaders told us about challenges the practice had faced since our last inspection. The practice team had been well-established for more than twenty years, however, in the past two years there had been partnership changes, retirement of GPs, nurses, nurse practitioner and practice manager. The partnership went from seven partners to two partners. These changes left the two current partners with limited GP resource and without a practice manager. Despite these challenges the new partnership had maintained a high-level of care to people registered with the service and demonstrated resilience. We interviewed a member of the Patient Participation Group who confirmed that “they were looked after very well” by the doctors and nurses, and “couldn’t wish for a better practice.”

The service recruited a new practice manager in 2023 who joined the practice with a financial background. The practice manager identified the need to implement new financial governance systems and processes to promote financial sustainability. These changes followed identification of some historical financial irregularities in which NHS counter fraud department and other regulatory authorities were involved.

Leaders told us that they had implemented a supportive and non-hierarchical governance structure. For all areas of governance responsibility, we saw evidence that there were lead people appointed with deputies to ensure continual oversight. For example, leads and deputies had been appointed to oversee finances, safeguarding, prescribing, to ensure that the service had oversight.

The manager had implemented robust governance systems to monitor and record delivery of services to people and ensure that people remained safe. They demonstrated a high level of organisational skills by having a suite of risk assessments and tools to efficiently monitor all aspects of the management of the service. For example, diary dates were in place for monitoring staff training with reminders sent before training became overdue. Electronic records were managed efficiently to be accessible and easy to understand. At our previous inspection we found there were no robust systems for the storage of staff appraisal documentation. The new practice manager had developed systems to store all staff information safely, securely and confidentially in an electronic format. In addition, at our previous inspection we found that staff undertaking chaperone duties did not have a clear understanding of their role and responsibility. During our recent assessment we saw evidence that staff had received chaperone training and were competent to chaperone. Staff told they recorded that they had been a chaperone within the persons medical record to safeguard the person and themselves. We saw signs around the building informing people that there were able to ask for a chaperone in their appointment.

Staff could access all required policies and procedures. Managers held regular clinical meetings with staff, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and shared these with staff. Staff told us they discussed complaints, significant events and death reviews, and audits were highlighted to clinical staff to facilitate shared learning.

Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Processes were in place for appraisals and performance reviews for all staff. Staff knew how to access all required policies and procedures.

The service designed and implemented Quick Response (QR) data collection codes to collect quality improvement data. For example, electronic QR codes were used to monitor fridge temperatures and fridge stock control and expiry dates. Emergency equipment checks and emergency medicine checks were recorded via QR codes. Clinical room cleaning checks were completed by QR codes at the end of each clinical session to evidence that infection prevention control (IPC) measures were upheld. All data entered via the QR codes was stored electronically and leaders had effective oversight of IPC.

Staff took patient confidentiality and information security seriously. A data security and protection toolkit policy set out the practice framework for maintaining and enhancing high-quality data such as complete, accurate, appropriate, accessible and timely data in all forms. The manager completed spot checks on adherence by the staff to the data security and protection principles and any learning needs identified for the staff were immediately addressed.

There was a comprehensive overarching risk assessment system in place to monitor risks to the service. For example, fire, legionella, Disclosure and Barring Service checks, immunisations, premises. These mandatory risk assessments were electronically diarised by the manager prompting when reviews were required.

An audit programme was in place to monitor performance and promote quality improvement. Leaders were engaging in a continuous improvement program, across several areas including, digital innovation, patient access, and service quality. The program was facilitated by an external organisation to support learning and reflection of in-house systems and processes and improvement of delivery. The program interrogated digital communication with people, to include text messaging, email and the NHS app; GP appointment data; management of administration process and workflow, such as in-house messaging and messaging from people. For example, the practice manager had instigated new electronic routes to communicate with people to improve the rates of attendance for cervical smears, childhood immunisations and long-term condition reviews, taking into account the diversity of the practice population. The manager had developed and individualised Twitter, Facebook, Instagram, text messaging, with improvement to the practice website, to target and reach different age groups, cultures, languages, and religions. Also, appointments times were offered at flexible times to meet the needs of the individual person versus times which were convenient for the service. To support these strategies, the service also reached out to community leaders to share the importance of attending appointments. The service’s website proactively communicated a range of support services and activities for people to engage in with the facility to translate into difference languages. For example, ‘Musters practice park run and picnic’, ‘getting back to strength fitness classes.'

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 collaborated for improvement.

The service worked with other practices within their primary care network (PCN) to offer a wide range of services. For example, the service led on the Proactive Care Pilot for the PCN, which reviewed people over the age of sixty-five who had qualifying factors to indicate that they were severely or very severely frail. The pilot identified people who required some form of intervention to prevent hospital admission and help them stay in their own homes. Interventions included being referred to their usual GP, referred to a Social Prescriber for additional social support and reviewed at a multidisciplinary team meeting to include community and geriatrician services.

Patient Participation Group (PPG) meetings were held in collaboration with practice staff representatives and demonstrated a commitment to engage with service users and seek their views in shaping services to ensure people’s views are heard. We saw minutes of PPG meeting to support this collaboration.

The PPG spoke positively about how the practice worked with them to make improvements. For example, the practice involved and discussed proposed changes to systems and processes with the PPG. During our assessment we saw PPG members in the waiting room explaining to people how changes to the practice’s appointment system would work and how to book appointments once the new system had been implemented.

The PPG had their own notice board in the waiting area and were actively encouraged by the practice to have their say in the media content on the board.

In collaboration with the PPG and local diabetes support group, an expert by experience attended the service to help raise awareness of diabetes and encourage engagement with the diabetes community-led support service. In addition, the service held a Men’s Health campaign and invited eligible men to attend for PSA blood testing. As a result of the campaign the service identified clinical results that required additional and timely follow-up with hospital.

Within the PCN the practice leads on the development of social prescribing services in the community. Social-prescribing services, and social prescribers employed by the PCN, provide non-health related services to promote people’s holistic wellbeing. For example, in collaboration with local practices the service worked in partnership to develop a local health directory to signpost people to stakeholders who provide a range of support services. These services include financial help and housing, gambling support, employment and volunteering, carers support services, groups to combat loneliness, sleep services.

The service takes an active role in the development of the social prescriber who are invited to attend the service for monthly clinical supervision development meetings. In addition, the social prescriber attends multiple disciplinary team meetings to support the ongoing care of people. For example, the palliative care multidisciplinary team meetings and the support of people with long term conditions. Working in collaboration with the PCN the service has helped in the development of new support groups to include support for people with young onset dementia, people struggling with social isolation. Staff at the service told us that they were aware of the social prescribing role and that their services had been embedded within the culture of 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 a health and wellbeing coach to support them to live healthier lives.

The practice manager established an informal mentoring group for Practice Managers in Nottinghamshire, bringing together colleagues from seven different practices across four Primary Care Networks (PCNs). They met every other week to share ideas, offer peer support, and mentor one another. This collaborative approach had resulted in several of the participating practices being ranked among the top 10 GP surgeries in Nottingham, a testament to the positive impact of shared learning and mutual support. Given the success of this initiative, the practice manager was exploring opportunities for wider promotion and potential support, with the aim of extending its benefits to more practices across the region.

The service focused on continuous learning, innovation and improvement across the organisation and local system.

The service participated in a project to review GP information and technology (GPIT) computer systems facilitated by an external project implementation officer. The review was commissioned by the Nottingham and Nottinghamshire Integrated Care Board. The project interrogates GPIT systems to support continuous improvement. For example, digital communication with people, to include SMS text messaging, email and the NHS App. Patient-facing digital services and online consultations. Support for practice in areas of deprivation. Interrogation of GP appointment data. Improvements to workflow management. Electronic referrals to external services, such as hospitals and including advice and guidance from hospital consultants.

The service was an established training practice for nurses and doctors training to become GPs. Systems were in place to support trainees and students during their placements.

Staff participated in quality improvement work, including their own audits and primary care research.

The service used learning from patient feedback, significant events and complaints to continually improve the service they provided, and changes were made within the practice if needed. For example, the telephone system had been upgraded to cloud telephony to improve access on the telephone with call back functions enabled, as a result of learning from feedback.