Archived: Little Lever Health Centre-2

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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 assessed all quality statements in this key question.

Leaders and staff did not have a shared vision and culture. Learning was not a priority and was not shared, and staff said the provider did not listen. Managers were visible for the hours they worked, and they supported staff, but the provider was not supportive. Staff did not feel they were treated equally or fairly. The culture was not one of continuous improvement and staff were not given time and resources to try new ideas.

This is the first inspection for this service since its registration with CQC at the current location. This key question has been rated as inadequate. We identified a breach of regulation in relation to good governance.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders told us there was no business plan. Although the provider described their succession plan, this was not formalised and there were no GPs included in the plan. Staff told us they were not listened to.

The practice had a vision: “To enhance the health, well-being and lives of those we care for by working within the local, national guidance and regulations”. We did not find the provider worked within all guidelines or regulations. There was a business continuity plan, but this did not effectively detail how the practice would manage if the GP was not available. It stated the Strategic Health Authority should be informed, but Strategic Health Authorities ceased to exist in 2013. It also mentioned the remaining partners providing cover, but there were no partners; the provider was a single-handed GP. The provider worked full-time, but all other staff, including all clinicians, were employed part time. There were 2 practice managers, employed for the same 20 hours a week. There was no-one else with any management responsibility employed, so for over 50% of the time no manager was available should a problem arise.

Staff told us they felt able to provide feedback to their managers, who they thought listened to them. However, feedback was consistent that the provider did not always listen to staff concerns, and did not allow the managers to fulfil their line management responsibilities for all staff. We heard examples of 1 staff member being treated differently from all other staff members, and this had a detrimental effect on the team.

The practice had recently carried out a staff survey and feedback was mixed. Staff commented that there were not enough staff to do the job, the job was stressful, and there was a lack of clinical guidance. Staff had also commented in their appraisals about the lack of staff. This feedback was reflected in our interviews with staff. The provider worked every morning and afternoon, and these sessions usually ran late. The managers worked for 20 hours a week. This meant there was a lack of visible leadership for long periods of time.

Staff told us they could raise concerns with the practice managers, but they thought these concerns were not taken seriously by the provider. Managers told us they were unable to act on staff concerns. For example, staff had not been replaced when they left, and the provider would not employ more staff or pay overtime. This left the practice short-staffed. Not all staff knew who the Freedom to Speak Up Guardian was, with some thinking it was the provider.

The practice supplied is with their Freedom to Speak Up policy, titled, “Freedom to Speak Up in Primary Care”. This was a document from NHS England, published in November 2017, that the practice had adopted. It gave the names of 2 external Freedom to Speak Up Guardians but did not detail how to contact them. Elsewhere in the policy a different person was named as the Freedom to Speak Up Guardian. The policy stated the provider was committed to an open an honest culture, and what people said would be investigated. We did not find this during this assessment.

Staff and managers reported concerns that not all staff were treated equally, and concerns raised about staff members had not been acted on. We received information that requests for particular equipment needed for staff to comfortably carry out their duties had not been actioned for several months, although reminders had been given to the provider.

The practice had an equality and diversity policy, and staff had completed equality and diversity training. However, processes were not in place to ensure equality of opportunity for all staff. Some staff consistently worked above their contracted hours for no additional pay and the provider had not put processes in place to prevent this.

Staff told us they were clear on their roles and responsibilities, but due to a lack of staff they found it difficult to fulfil these roles fully. They said staff had not been replaced when they left, so there was no cover when staff were on annual leave or sick. Staff worked additional hours but were not paid for this. They were able to take time off in lieu of this work, but said this put additional pressure on the workforce. The managers told us the provider did not give them any responsibility to make changes, and they were not able to fairly manage the staff team.

Governance processes were not effective. Practice meetings were held infrequently. The locum GPs did not attend these so although significant events were mentioned, there was limited discussion and no challenge about clinical concerns. We saw some policies were not being followed.

The recruitment policy stated all new starters would have weekly 1 to 1 meetings with their manager, and a probation review, usually after 3 months, with the lead GP and practice manager. There was no evidence of these for the 2 most recently employed staff members.

People were not involved in developing the practice or formally suggesting improvements.

Leaders only engaged with the patient participation group (PPG) once a year, stating there were not the hours available to do this more often. PPG meeting minutes indicated the meetings were for people to raise concerns and for the practice to give information about the practice. They were not used as a way of improving outcomes for people. Leaders engaged with the Primary Care Network (PCN) and attended regular meetings.

Partners reported there were tensions between the practice and other practices sharing the same building.

The practice held infrequent practice meetings. Documents described a culture of openness, trust and respect within the team. We saw that some team members worked well together but this was not true for the whole team. The provider and managers attended regular meetings with the wider health team.

Staff said they felt supported by managers, but they said the managers were not empowered to make changes within the practice. Managers said they had expressed their concerns to the provider, but no action had been taken.

Learning from significant events was not managed. Clinical significant events concerning the provider did not have oversight or scrutiny by other clinicians, so improvements were not put in place or monitored. The practice carried out some clinical audits, but their value was limited. For example, an audit from July 2024 highlighted some issues, and the clinical searches carried out as part of this assessment showed the provider had a lack of understanding about the issue. There was a PPG that met once a year. We were told it was not possible to set up more regular meetings due to a lack of staff resources at the practice.