Henmore Health - Brailsford 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 assessment for this service since its registration with CQC. This key question has been rated as requires improvement.

This service scored 54 (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 vision, strategy and culture which had been shared with staff following our recent assessment of the practice’s other practice. The vision was based on equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The provider was aware of the projected increase in the local population and were working with partner agencies to address future challenges. For example, the development of a pharmacy within the practice and plans to build a new purpose built practice on nearby land owned by the provider.

Feedback from staff and whistleblowers showed that most staff had not been involved in developing the vision for the service showing low engagement with staff.

Not all partners understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Some staff expressed concerns that a partner did not know how to care for staff and pleaded with the CQC to inspect the practice and make partners complete training to understand how to behave with staff teams.

The CQC had received 16 whistle blowing concerns specific to this practice and 12 relating to both of the provider’s 2 practices. There were multiple allegations of bullying, and staff used words such as oppressive, toxic, arrogance and treated as a commodity to describe their experiences. The provider told us they did care about their staff and had provided training opportunities, development opportunities and compassionate leave when needed. They had paid for all staff to attend annual Christmas parties and a summer barbeque. Following our feedback, the partners told us they recognised there were issues they had not been aware of which had resulted from the required changes needed within the practice.

Some staff did not always feel they could speak up or that their voice would be heard or acted on.

There was a mixed response from staff regarding the culture within the practice. Some staff were positive about the culture and described it as open, collaborative and supportive although all staff felt that if their concerns were listened to, they were not always acted on.

Other staff told us they felt there was a closed culture and staff feared repercussions if they spoke out. Some staff told us they had been silenced with threats of destroying and sacking staff who spoke out of turn to the CQC. One member of staff told us they were beside themselves with worry and had not been able to be honest with the CQC team during interviews because they had been taken to one side and threatened with losing their job if they said anything negative. Some staff told us they had been put off speaking with CQC staff or completing CQC staff feedback forms (only 5 feedback forms were returned to the CQC) because they had been told by leaders that CQC investigators were not pleasant to talk to and very difficult. The provider denied making any of these threats and told us there was a policy not to intervene or influence staff feedback to the CQC.

Some staff did not feel listened to and some staff felt there was a blame and bullying culture. Staff expressed concerns they were not kept up to date with changes in the practice; communication needed to improve; rash decisions were made without consulting staff and patients before implementing them; there was a blame culture; and when leaders were challenged they failed to reflect on the challenges and closed down. The provider recognised there were adverse feelings and told us they would bring in a third party to understand and address the concerns.

A representative of the Patient Participation Group (PPG) expressed concerns regarding staffing levels within the practice due to the loss of most of the clinical staff at the practice. They told us there was a lack of openness from the provider when the PPG had requested details of staffing levels and appointment capacity.

The practice had established Freedom to Speak up arrangements with the Integrated Care Board (ICB). Staff were aware of how to raise concerns, and several members told us they had used this service.

Following our feedback to the provider, they told us they were hugely grateful to their staff, without whom the significant improvements within the practice would not have been possible. They acknowledged the staff feedback, both good and bad, in full, and were grateful to the CQC for bringing these fears and concerns to light. They told us they did not fully understand the cause or impact but hoped that staff would work with them in a spirit of openness, honesty and compassion so that they felt as valued as they truly were.

The service valued diversity in their workforce. They worked towards a diverse culture by improving equality and equity for people who worked for them. Two members of staff described how reasonable adjustments had been put in place to support them in the working environment. For example, adapted chairs and offers to move a member of staff to another room to meet their needs.

Policies and procedures to promote diversity and equality were in place. Staff had completed training in equality and diversity.

The service mostly had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. A list of leads within the practice had been put in place following the assessment of the provider’s other practice. Staff were clear about most leads in the practice with the exception of the infection prevention and control lead as the previous lead had recently left the practice. Staff were clear on their individual roles and responsibilities.

The provider had established governance processes that were appropriate for their service. 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 took patient confidentiality and information security seriously.

However, staff and a member of the Patient Participation Group (PPG) expressed concerns that the operations manager, who had previously worked 4 days in the practice, had left and been replaced with a manager who worked 2 days. Despite partners being contactable by telephone, staff told us they rarely visited the practice so were not visible. The partners confirmed they did not visit the practice on a regular basis due to other work pressures. Staff felt unvalued, excluded and commented that this made them ‘feel like the poor relative’. As partners rarely visited the practice, they had failed to pick up on the mood of their staff.

The service mostly understood their duty to collaborate and work in partnership so services worked seamlessly for people. A representative of a care home, where the practice provided care and treatment, expressed concerns that changes in the delivery of care of people living in the home had not been communicated to them effectively. A representative from the Patient Participation Group (PPG) expressed concerns regarding the lack of visibility of partners in the practice and the loss of a manager who had worked 4 days at the practice with a manger who was only working 2 days. They told us they had asked to view organisation charts and roles and responsibilities to aid their understanding of the structure in Brailsford

The service collaborated and had made adjustments to improve coordination of their service with community healthcare services, including the community support team and Health Visitors. The relationship between practices within the Primary Care Network (PCN) had broken down however, there were short and long-term systems under review to ensure people continued to receive the services previously provided by the PCN.

The service mostly focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. The provider used complaints and significant events to drive improvements. System wide audits had been completed, for example infection prevention control. The dispensary participated in The Dispensary Services Quality Scheme (DSQS) and had carried out audits. The 1st audit focused on ensuring patients prescribed steroids were issued a steroid card and the 2nd focused on monitoring paracetamol dosing against people’s weight. Where changes were required they had been actioned. Clinical audits to drive improvements in patient outcomes had not been completed recently. The provider told us this would be re-established once the salaried GPs had settled into their new roles.

The provider had applied learning from the recent assessment of their other practice to drive improvements within the practice.

The service gathered feedback from people through the Friends and Family Test which they shared with us.