Hythe 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

We looked for evidence that practice leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture

This is the first inspection for this practice since its registration with CQC. This key question has been rated as good.

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 practice had a shared vision, strategy and culture. This was based on transparency, equity, equality, human rights, diversity, inclusion and engagement. Staff had a good understanding of the needs of people who use the practice and collectively expressed that access to healthcare for vulnerable groups was a high priority. We saw multiple examples of ways in which staff had adapted how they work to remove barriers to people receiving care at the practice.

The practice vision and strategy statement was understood by all staff groups and we saw it displayed in prominent staff areas to ensure it was the focus of daily working. It was regularly reviewed by leaders and updates shared in staff meetings. The practice was aware of the projected increase in the local population and desired further growth to their practice size, which had been planned and analysed in respect of the design and move to a new, much larger premises.

Having secured funding for the completion of a new permanent building on the same site, leaders had involved staff in the planning and design of the physical space and potential service provision.

The practice 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 at all levels described leaders as highly visible, accessible and responsive, and told us they felt valued, listened to and empowered to contribute to the development of the practice. We also received positive feedback about practice leaders from members of the patient participation group, who praised their receptive and open manner of engaging with them.

Leaders fostered a no-blame culture where staff felt able to report incidents with a shared desire for change and improvement. There were well established lines of management to ensure effective oversight of how staff worked and to maximise capacity to meet patient demand. We also saw that leaders ensured effective oversight and supervision of clinical staff to maintain very high standards of care. Leaders worked to identify areas for improvement within the leadership structure and welcomed ideas for change and innovation. For example, the recent appointment of an experienced reception manager had facilitated the strengthening of defined roles within the reception team to enhance administrative processes.

Staff told us leaders modelled the values of the practice and staff feedback we received was hugely positive for the management and leadership at the practice. Staff felt able to seek advice or support from all members of the leadership team and were clear on how roles and responsibilities within the team were shared. We saw examples of financial and physical support for career progression, which enabled the development of skills and enhanced the care provision offered by the practice. For example, the lead nurse was being upskilled with necessary training for delivering care within the practice whilst being supported to maintain her district nursing skills. This enabled the practice to bridge the identified gap between practice-based and home-based care for the most vulnerable groups in the patient population.

Whole practice and team meetings were held regularly to ensure information and concerns were shared with all staff. Comprehensive minutes were shared for those unable to attend and urgent updates were shared through email, in messaging groups or directly to relevant staff.

We saw the leadership team worked with other practices in the primary care network (PCN) and many of the leadership team were involved in the management and leadership at PCN, local GP Federation and Community Care Provider level. Leaders were actively engaged in the development of primary care services within the local area through their senior leadership roles, which they utilised to promote the needs of their patient cohort and those of the wider community.

The practice partners showed a deep understanding of the challenges facing their patients and shared details of how their strategic plans for practice development aimed to address these using models of holistic care.

The practice 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 with other practices in the primary care network. Staff were aware of how to raise concerns, and told us they were confident they would be listened to. Some staff expressed that they did not feel they would ever need to use this facility, as they felt confident in the learning culture at the practice to address matters of all kinds in a supportive and blame-free way.

A freedom to speak up policy was in place and all staff had completed the mandatory training for this. We saw details of external arrangements for speaking up, displayed in all relevant staff areas.

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

Policies and procedures to promote diversity and equality were in place. The practice employed a diverse workforce which reflected the diverse nature of the local population and enhanced the understanding of local cultural needs.

Leaders explained staff wellbeing was a priority and provided examples of action they had taken to support staff and make improvements for the workforce. Learning and development opportunities were available for all staff. The practice employed many long-term staff who told us they felt valued and appreciated in their roles. Newer staff felt welcomed, and their ideas and suggestions were listened to and often adopted. Throughout the year, social and team building events were held and had been well attended.

The practice had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. Clinical staff received comprehensive clinical supervision which was both ad-hoc and scheduled, and documented to show clear plans for learning and development.

A comprehensive programme of clinical audits assessed standards of compliance with current guidance on care delivery including prescribing. Leaders used audit results to assess clinical performance and outcomes to ensure a very high standard of care, as evidenced by our clinical searches and other evidence collected as part of this inspection. Audit results and actions identified from them were shared with staff during clinical meetings, to enable sustained and targeted improvement.

The provider had established governance processes that were appropriate for the practice and regularly reviewed how these processes were performing to meet set targets. Management maintained oversight of the appointment system and balanced capacity with demand to maximise their availability. The leadership team regularly reviewed these figures to identify where additional slots were needed for specific staff groups, and proactively anticipated times of higher demand. This proactive approach enabled the practice to respond rapidly to fluctuations in demand and maintain timely access for patients despite increasing workload pressures.

Staff could access all required policies and procedures and were allocated time to complete mandatory and role-specific training. Oversight of training was maintained to ensure all staff were up-to-date with relevant skills for their role. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff.

Roles and responsibilities in addressing concerns from significant events and complaints were very clear, and action plans were shared with all staff to promote wider learning. All identified concerns were added to a risk register which was regularly reviewed and updated. Whilst driving improvement was the ultimate responsibility of management, all staff were engaged in playing their part in providing a high standard of care and patient engagement.

Staff took patient confidentiality and information security seriously. Leaders drove continuous efforts to maintain and improve understanding of ways of working, and invited feedback on staff and people's experiences to proactively mitigate risk and improve care delivery. Staff surveys were undertaken internally and all forms of patient feedback were reviewed and analysed to identify concerns and paths to improvement. This included the NHS Friends and Family Test, the National GP Patient Survey, other online feedback services and internal surveys of various patient groups. Figures and feedback were shared with staff and discussed in team meetings.

Through leadership roles within the local healthcare system, practice leaders were involved in regional initiatives, pilots and changes that improved access and reduced inequalities for the wider population. The practice also benefitted from the addition of primary care network (PCN) staff who provided care to patients at the practice. Effective oversight of their suitability, skills and competencies was maintained through information sharing arrangements with the PCN.

The practice understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Leaders had identified groups within their patient population who were at higher risk of needing support and worked with local health and wellbeing services to improve their outcomes. For example, the practice led on, and were the first to implement, an initiative to provide a health and wellbeing coach to their diabetic patients. This provided holistic support for lifestyle changes, to reduce the impact of the disease.

They used available social prescribing to link patients to services to address social, financial and housing issues, in order to promote their model of for holistic care delivery. Practice leaders detailed their ambition to create a ‘health hub’ of services within the new practice building, to further develop relationships with local voluntary and community organisations, and provide them centrally to the wider community.

The practice worked collaboratively with other practices within the primary care network (PCN), with the local GP Federation and with the community healthcare provider, with practice leaders holding strategic leadership roles in these organisations. This collaboration identified needs within the practice patient population and the wider community and facilitated new initiatives and improvements. For example, the practice had undertaken work to establish a GP Integrated Mental Health Service within their primary care network (PCN). This allowed their patients to be seen by secondary care psychologists and consultants at a PCN practice in their local community setting, avoiding long waits for secondary care referrals.

Strong links were maintained with local care homes, other local practices, secondary care services and the community as a whole. The practice was proud to lead on projects and to pilot schemes to improve the health outcomes for the local population, including its own patient group.

The practice 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 contribute to safe, effective practice and research.

All staff were encouraged to put forward and test out new ways of working. Leaders were visible and approachable and invited suggestions for change and improvement. Implemented changes were regularly reviewed and discussed within teams to adapt and refine processes. For example, the process for addressing safeguarding alerts had been amended to ensure all notifications were seen by the duty doctor on the day they were received. This aimed to avoid delays in actioning information of concern and all staff involved in this process understood the importance of their role in achieving this.

We saw how leaders maintained oversight of appointment demand and call volume and worked through established processes to address shortfalls. By adapting existing clinic provision and having administrative staff work flexibly between their usual roles and answering calls, the practice was able to ensure that patients could access care when they needed it.

Quality improvement activity was well established at the practice in clinical and non-clinical areas. We heard how leaders worked with clinical teams to identify areas to target. Results of audits were benchmarked against national performance indicators and shared with appropriate staff. Multiple-cycle audits enabled leaders to evidence sustained improvements and compliance with guidelines. For example, work undertaken in asthma prescribing demonstrated improved and embedded prescribing practices, meeting targets in multiple indicators. Areas of quality improvement work were undertaken at primary care network (PCN) level and leaders used their roles within this organisation to collaborate with other local practices, and drive improvements for the wider community.

The practice partners provided information about their strategic planning activity, which detailed expansion of the practice into a new, larger, permanent premises at their main site. They anticipated this move would facilitate an increase in patient numbers for the practice and enable the creation of a community hub for use by the wider population. Community services, voluntary organisations and space for training and collaboration with other local practices would all be included. Designs for the new building had been shared with patients and the PPG, and opinions and suggestions sought. Advice had been taken from specialist organisations to ensure that designs met the highest standards for access, to enable every patient to benefit from the space. For example, disabled toilets in the new building were planned to include a registered ‘Changing Places’ facility, providing fully accessible toileting and changing equipment including hoists and adult-sized changing tables. We learned this will be available not only to those in the practice population but also the wider community, as a registered accessible facility.

The practice planned to welcome trainee GPs in the near future, with support from the GP partners who are registered GP trainers. We heard how this formed part of the practice development plan and supported routes for succession and expansion of the service.