The Green 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-centres care; supported learning and innovation and promoted an open, fair culture. At our last assessment in June 2023, we rated this key question as requires improvement. At this assessment, the rating remains the same. The service was in breach of regulation 17, related to good governance.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff understood the direction of the practice to be patient care, quality and satisfaction. However, leaders did not always ensure people were adequately informed of how to participate in activity to ensure they understood their roles in improving service delivery at this practice for example, patients the practice listed as PPG members were not aware of their membership when we spoke to them. Leaders informed us that messages were sent out to the patients about the PPG but received no responses and there was no action plan by the service to improve the situation. This showed poor culture and lack of understanding of the challenges faced by the patient population to develop an appropriate action plan to mitigate the issues.

Staff told us leaders were approachable and responded to any concerns raised. However, not all leaders 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. Leaders did not always have the skills, knowledge, experience, and credibility to lead effectively. During the assessment, we found that the leaders agreed with the business manager’s proposal as confirmed by the GP Partners, to backdate and add in bulk clinical tasks such as medication reviews to patient records.

The service fostered a positive culture where people felt they could speak up and their voices would be heard. The service established Freedom to Speak up arrangements external to them. Staff were aware of how to raise concerns internally and externally.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them. Policy to promote diversity and equality was in place.

The service did not have clear responsibilities, roles, systems of accountability and good governance. During the site visit, we found some of the policies were not always specific to the practice and did not have relevant information such as occupational health contact details in the needle stick injury policy; decontamination policy and waste management protocol had no information of the relevant company contact details. The service made needed corrections when we gave feedback. The practice manager added in bulk medication reviews and advice on clinical tasks on instruction of the 2 GP partners and backdated the entries. The service informed CQC following the site visit that they were in the process of removing backdated entries and contacting all the affected patients to complete the process correctly. The practice did not always secure and monitor prescription stationeries which was also identified at the previous assessment in June 2023.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. The service was actively involved in primary care initiatives within the primary care network. However, there was evidence of a lack of an effective PPG to improve service delivery.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not fully demonstrate improvement since last assessment in 2023 because of the new breaches related to safe care and treatment and good governance identified with one of the failings identified in relation to prescription stationery a repeated breach.