Stirling Road Medical Centre

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

Well-led – this means 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. This key question has been rated requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Leaders and managers did not have full oversight of systems and processes to promote effective and safe service provision.

Governance systems and processes had been developed but had not been fully implemented at the time of this assessment. This included complaints and significant event processes and monitoring of people’s care and treatment.

Feedback from staff was not consistently used to improve the service.

Improvements were needed to training provision to ensure that staff were well supported, received appropriate training and development; and were able to contribute to the running of the practice.

The service was in breach of legal regulation in relation to governance at the service; culture; listening to and involving people and staff in the development of the service.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. There was a strategy and mission statement, but this had not been produced in collaboration with all staff. During our interviews with some leaders conversations indicated they considered there had been some resistance to change within staff teams. The practice management team said they were focusing on building a supportive environment for staff and wanted staff to be included in decision making processes.

Not all leaders understood the context in which the provider delivered care, treatment and support. They 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. We received mixed views on communication with managers and leaders. Staff said their line managers were usually supportive, but they had limited interaction with senior leaders. Negative comments received from staff included they did not feel they were listened to and meetings were cancelled at short notice, so communication was not always effective. Some staff said changes were not communicated effectively and it was difficult to keep up to date with them. Other comments included how they were asked to do extra work, without time being allocated and this added to their stress levels. However, positive comments included that leaders were supportive and time was given to develop in their role, for example time allocated to undertake training courses.

People did not always feel they could speak up and their voice would be heard. Not all staff were aware of who the speak up guardian was and some said when they did raise concerns these were dismissed. There were limited opportunities for staff to speak up as appraisals and supervision sessions were not occurring on a regular basis; and specific staff group meetings were not in place.

The provider had started carrying out staff surveys, but an action plan had not been fully developed in response to the results.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. Practice leaders did not always listen to and act on staff feedback and did not create a culture where staff felt empowered and valued.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance processes were not sufficiently developed and effective to ensure risks to patients were minimised. The provider did not have oversight of monitoring systems to ensure action had been taken so that patients received appropriate care and treatment when on high risk medicines. The training processes for staff had not been fully monitored to ensure staff received appropriate training to carry out their duties and had sufficient time to complete this training. Other areas which required improvement included handling of complaints and significant events to ensure trends and themes were identified, learning was shared appropriately; and actions taken were monitored.

The only planned formal meeting with staff was the quarterly clinical meeting, the provider planned to introduce other staff meetings once a full staff complement was reached. Work was continuing on developing the overall staff structure for the practice and decisions were yet to be made on how the service would be provided across all 5 sites to enable patients to access care and treatment in a timely manner.

The practice manager had oversight of documentation which required processing. A protocol had been developed and implemented to manage documentation more effectively. This included administration staff being trained to code and summarise records and the pharmacy team managing discharge summaries and medicine changes.

Health and safety risks assessments had not always been carried out and actions to reduce risk were reactive rather than proactive.

The provider had started to work in partnership and collaborate with other service providers, but this was in the early stages and formal meetings had yet to be established fully.

The practice manager who had oversight of documentation workflow had contacted secondary and community teams requesting that whenever possible information was sent electronically to avoid duplication of correspondence and information.

The provider was implementing continuous learning, innovation and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research. Practice staff who knew the patient population were not routinely consulted on how services could be developed and improved to meet people’s needs.