Two Rivers 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 service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last inspection we rated this key question as good. At this assessment it was rated requires improvement. The provider’s governance systems for identifying, capturing and managing organisational risks and issues were not effective as they had failed to identify and act on shortfalls we found during the assessment. Furthermore, systems of accountability were not always effective and where governance systems had identified some areas for improvement, further work was needed to ensure these were acted on. However, the practice had a culture of openness, teamwork and care. Leaders were visible and helped staff develop in their roles and staff felt supported to give feedback. Staff engaged with partners and focused on continuous learning, innovation and improvement across the organisation and local systems.

The provider was in breach of legal regulation in relation to good governance.

This service scored 62 (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 vision, strategy and values. These were based on delivering excellent, high quality, compassionate person-centred care, investing in staff, innovation and technology, and promoting preventative health by empowerment, engagement and collaboration with all partners. They understood the challenges and the needs of people and their communities. Practice leaders said their culture was one of openness, teamwork and care both for people who used the service and each other. The core practice values were caring, inclusive, aspirational, accountable, collaborative, learning and innovative.

Most staff we spoke with and received feedback from told us that there was a people focused, friendly and inclusive team culture within the practice and that they felt supported by the GP Partners and practice leaders. They told us they were able to contribute to discussions about service improvements, incidents and complaints and felt able to raise concerns without fear of retribution. For example, one staff member told us how they felt overwhelmed with the workload when they started in their role. They raised this with leaders who increased the number of catch-up slots and gave additional clinical supervision until they had had gained more confidence in their role.

The practice had a workforce strategy which included a range of objectives and actions for example, to ensure safe staffing levels, attract, recruit and retain staff and to embrace digital healthcare and innovation.

The service 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, knowledge, experience and credibility to lead effectively and did so with integrity, openness and honesty.

The majority of staff told us there was compassionate, inclusive and effective leadership. The leadership team worked with the other practices in the North East Ipswich Primary Care Network (NEIPCN) and were engaged in the development of primary care services within the local area.

Practice leaders optimised their skill mix and had proactively recruited to a range of roles themselves and via the NEIPCN. These roles included for example, Advanced Nurse Practitioners, First Contact Physiotherapists, Paramedics, Clinical Pharmacists, Pharmacy Technicians and Physician Assistants. They also supported the upskilling of existing staff to meet current and future practice needs.

Practice leaders advised they obtained staff feedback through anonymous surveys twice a year to gain insight into staff wellbeing, identify areas for improvement and help shape future initiatives. The highest satisfaction scores from the staff survey in January 2025 were for enjoyment from working in my team, feeling valued by my team and having a good work life balance. The area of most mixed feedback related to positive action being taken on health and well-being. In response, a meditation and yoga evening was being planned for staff.

The service fostered a positive culture where staff felt they could speak up and their voice would be heard. There were processes for staff to speak up. The practice had Freedom to Speak up arrangements in place which included an internal Freedom to Speak Up Ambassador and external Freedom to Speak Up Guardians. Information was available on the staff notice board which detailed these arrangements. Practice leaders planned to arrange Freedom to Speak Up training for staff.

All clinical staff and the majority of non-clinical staff told us leaders were visible and approachable and responded to any concerns raised. We were given examples where staff had used the arrangements in place to positive effect. For example, the layout of clinical rooms was standardised so clinicians who worked from different rooms were more easily able to locate equipment and stock.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. There were systems and processes in place to support workforce equality, diversity and inclusion, with an emphasis on the safety and well-being of staff. This included an equality, diversity and inclusion policy. Reasonable adjustments were in place for staff, for example modified workstations and equipment and quieter rooms for work or study. Leaders told us they supported social events to boost staff morale and support team building. They were planning bingo and meditation evening events.

The majority of staff told us they felt supported by the practice leaders and their peers. Staff confirmed social events were held which included quiz nights. The practice had a workforce strategy which included a range of objectives and actions for example, to improve diversity, inclusion and equality. Staff gave examples of support they or their peers had been given, for example with reasonable adjustments and flexible working. All staff had completed equality and diversity training.

The provider’s governance systems for identifying, capturing and managing organisational risks and issues were not effective. They had failed to identify and act on shortfalls we found with safeguarding training levels, summarising, and monitoring required for some specific medicines and long-term conditions. The provider was unable to evidence improvements made in response to the concerns we identified were sustained or embedded as some of these changes were recent or yet to be made.

Although the provider’s governance systems had identified some areas for improvement, our assessment found further work was needed by the provider to ensure these were acted on. For example, although practice leaders had identified staff training gaps and were improving their system to monitor the completion of training, the controls in place and mitigating actions were not effective. We found their system did not clearly identify gaps where training had not been completed by staff or was overdue and reminders for staff to complete training were not effective. This included for example, basic life support, mental capacity act, sepsis, fire safety and infection prevention and control. We raised this with the provider and on the site visit we noted an increase in the completion of staff training and an updated policy on mandatory training was submitted. The recent improvements made to the completion and oversight of the completion of training deemed mandatory needed to be sustained and embedded.

The practice did not always have effective systems of accountability and good governance. Although GP Partner leads were identified for a range of areas, which included for example, clinical services, clinical training and prescribing, these arrangements were not always effective. We found poor governance systems for the effective and timely review of policies. We identified some gaps in the oversight of staff immunisation history. Practice leaders told us the lead nurse planned to develop a policy for staff immunisation to support effective oversight. We found some policies had been recently reviewed, and did not contain up to date information. For example, the correct levels for staff safeguarding training, and the training records we reviewed confirmed this. When we raised this with the provider, they acted and updated their policy. Some policies we reviewed had been newly written, for example, the Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)/Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) policy. A GP Partner confirmed improvements were being made to the governance arrangements for these decisions. Further work was needed to ensure policies were in place, were up to date, and newly written and recently updated policies were effective and embedded.

However, we found the practice used digital services securely and effectively and conformed to relevant digital and information security standards with arrangements in place for the confidentiality of data management.

The service 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. For example, they engaged with local pharmacies whose staff randomly checked people’s blood pressure and if it was raised, forwarded this information to the practice to act on.

There was a newly re-established Patient Participation Group (PPG) who represented the views of people who used the service. This had been re-established for approximately 18 months. The PPG met four times a year with a representative from the practice management team, a GP Partner, and a practice administrator. The PPG members also met without practice staff as needed. The most recent meeting minutes were available on the practice website along with details of how to join.

The practice was part of the North East Ipswich Primary Care Network (NEIPCN) which had been established for approximately 5 years. A PCN is a group of GP practices who work closely together. One of the GP Partners was the Clinical Director along with 2 NEIPCN managers, who were all based at the practice. The NEIPCN employed for example, Clinical Pharmacists, Pharmacy Technicians and Paramedics. People benefited from the additional staff members they employed. We received positive feedback from Integrated Care Board (ICB) representatives in relation to the responsiveness and engagement from NEIPCN staff. The Clinical Director represented the NEIPCN at Integrated Neighbourhood Team (INT) meetings. The INT worked on a joint approach to local complex issues which related to people’s wellbeing, including mental health, social prescribing and reducing emergency admissions.

Stakeholders fed back that practice leaders were keen to trial new ideas and initiatives, and they worked proactively and collaboratively with partners. For example, practice staff worked on a childhood immunisation pilot with the Integrated Care Board (ICB) to explore and address vaccine hesitancy. As a practice they recognised there was more that could be done to support the community they served.

The service focused on continuous learning, innovation and improvement across the organisation and local systems. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. There was a learning culture in the practice which staff and leaders actively encouraged and participated in. This included learning from significant events, complaints, pilot projects, and audits where learning had been embedded and improvements sustained.

Staff gave positive feedback about their experiences of joining and working at the practice, and the ongoing development they received. Staff told us that leaders encouraged development. For example, they were currently supporting a trainee Nurse Associate, and a Practice Nurse to qualify as a non-medical prescriber. The practice was a training practice for medical students and GP Registrars (qualified doctors training to become GPs). They had 7 GP trainers and currently had 6 GP Registrars working at the practice. The practice also supported placements for Student Nurses, Physician Associates, and work experience students.

In June 2024, the practice were involved in a pilot project to develop a checklist for the 6-8 week postnatal appointment. This prompted new mothers to ask questions they may not otherwise think to ask and enabled them to access wider support organisations. This work was rolled out to other Suffolk and North East Essex practices in December 2024.

The practice was an accredited research ready practice with a lead GP and administrator who were trained to undertake research. They had recently participated in a ‘Screening for Atrial Fibrillation with ECG to Reduce stroke’ study, for people aged 70 years and over. A total of 1034 people were recruited, of which 282 were screened. The study resulted in 20 people being identified as possibly having Atrial Fibrillation who required a GP consultation.