The Harefield 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 this first assessment of the service since its registration with CQC, this key question has been rated as good because leadership was shown by the leaders to ensure service delivery, care and treatment met the needs of the people; the culture was open and transparent; learning and innovations were actively encouraged to ensure the staff carried out their daily responsibilities with confidence.

This service scored 75 (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 an exceptional understanding of the challenges and the needs of people and their communities. The practice was aware of the projected increase in the local population and was working with the Integrated Care Board (ICB) to become a Health Centre within the Harefield Village to address future challenges. Staff contributed to the development of the practice vision and strategy which was kept under review. The practice built a holistic patient-centred primary care service within the Harefield Village. All partners were open and encouraged the staff to share concerns and ideas to improve the service delivery. The leaders were deliberate about the concept of team and ensured the right staff were recruited. Team building exercises include paint balling and away days for the staff.

The practice 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. Leaders had the skills and knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. The leaders took staff temperature checks anonymously to gauge the staff morale and wellbeing to ensure staff needs were listened to and met correctly. Feedback about the leaders received by CQC from the people using the service was very positive. Staff told us they were a happy practice and could approach the leaders with any concerns. The practice worked with the primary care network and were engaged in the development of primary care services within the local area.

The practice fostered a positive culture where people felt they could speak up and their voice would be heard. The leaders ensured a bullying-free environment and encouraged staff to speak up. The practice had a current whistleblowing policy and there was external contact information to liaise with the North West London Integrated Care Board and a named guardian was allocated after contact was made. Staff we spoke to during our site visit at the practice knew how to raise concerns.

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. The practice trained staff in equality and diversity. The leaders ensured the practice was a place staff felt capable to work and enjoy their daily responsibilities. Leaders recognised any act of kindness from the staff that went above and beyond to ensure patient experience satisfaction.

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 acted on the best information about risk, performance and outcomes and shared this securely with others when appropriate. Leaders and managers supported staff and the staff we spoke to, told us the leaders were very supportive of them and working environment felt like a family. All the staff knew and understood their roles and responsibilities. Regular appraisals and performance reviews were completed and clearly recorded.

Leaders regularly held practice and clinical meetings where clinical concerns and changes were discussed and responses to risks were clearly highlighted to the staff. Actions that arose from these meetings were recorded and were shared with the staff widely. The practice leadership had arrangements to monitor and improve the quality of care for their patient population having understood the uniqueness of the local area and needs. For example, care for patients in care homes were elevated through the Harefield Additional Care Home Enhanced Service (‘HACHES’) initiative, which saw the care homes under this project allocated a named GP who was allocated a weekly session to address any non-urgent needs of the care home patients while urgent needs were handled by the duty doctor. Another part of the ‘HACHES’ initiative created a virtual care home to support patients who were housebound and living in their own homes to receive sufficient level of primary care. Since the inception of the HACHES initiative, 148 care home residents in Harefield had benefited from the service provided.

The practice understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated to ensure improved primary care service delivery. For example, the practice updated its gabapentinoid policy to include the documentation of the medication response in patients and in the clinical notes and review which was also shared with the pharmacist at the primary care network level.

The practice 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. They actively made contribution to safe, effective practice and research. The innovations developed by the practice included health roadshows to raise awareness of key health issues (ARCHField- which focused on controlled drug medication overuse to reduce the risk of stockpiling and overdosing among the patient population); early diagnosis of atrial fibrillation was promoted through the ‘Harefield Kardia Clinics’ and a few patients were identified who needed further investigations. The practice established its Patient participation Group (PPG) and actively listened to the feedback received from the group which improved service delivery. The medication by phone service at the practice enabled patients who were digitally excluded to request medication amid strict security checks. The practice bake-off event in support of the Dementia UK Charity helped people to feel more comfortable to talk about the disease. However, the practice had yet to determine the overall level of benefits and impact on patient health and wellbeing.