Trinity 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 assessment, we rated this key question as good. At this assessment, the rating has changed to outstanding.

This service scored 96 (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 very clear 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 service had a commitment to providing tangible support that benefitted the GP practices and people of Wakefield. Conexus Healthcare CIC based its approach on 5 strategic pillars of:

• Restoring generalism with the GP seen as a neighbour anchor.
• Improving flow between the interface of primary and secondary care.
• Leading neighbourhoods with multi-organisational teams.
• Strengthening GP leadership and having a representative GP voice.
• Sustainable and digital with financial and digital resilience.

The organisation had adopted as a measure a North Star Metric (a single key measurement that best captured the core value the service delivered to its customers). This measure was to reduce the proportion of General Practice appointments that ended without resolution or added value. Performance data regarding appointments and patient outcomes showed that this measure was being met.

To enable this approach the service worked closely with stakeholders such as constituent GP practices/Primary Care Networks and other external partners. For example, we saw that the service worked with others including 2 local mining charities to deliver their mining respiratory project.

Direction of travel for their shared direction, underpinned by their strategy, was closely monitored and managed. The service recognised that their direction needed to be reviewed frequently and be flexible due to the changing nature of the health and care environment. Their strategy was co-designed across local health and care services, as well as with staff.

The service told us that their onboarding process sought to embed their vision and values, and that the ethos of these vision and values in part formed part of their individual staff performance reviews. Staff we spoke with were very clear to us that they were committed to the organisational vision and values, and sought to always provide the best services to their patients. Staff told us they would recommend the service to others and were proud to work there as they felt the service was making a real difference to people.

The service 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.

Leaders and managers ensured effective planning, delivery, and reviews of their services. We saw that senior staff had specific key roles and responsibilities for activities such as clinical safety and effectiveness, operations and support services. Other staff roles included a dedicated lead for quality and audit work. Interviews and discussions with these staff showed them to be knowledgeable and experienced, with a high understanding of issues, service delivery, challenges, and local needs and priorities. We saw the leadership team worked actively with partners and were engaged in the development and delivery of primary care services and projects within the local area. The organisation had embedded leadership behaviours within the competency framework and as part of their performance review process.

Both substantive and sessional staff we spoke with were complimentary about their leaders and managers. They told us that they were visible, approachable and supportive and felt able to raise concerns with the expectation that these would be investigated compassionately and fairly. They said communication routes were in place, ranging from more formal appraisals to direct approaches and one-to one contacts. Staff also told us that as well as induction and ongoing support being provided, they were able to access specific support such as mentoring and coaching.

Leaders and managers engaged well with staff, and annual surveys were undertaken to assess their views. We saw that results from these surveys were analysed and actions undertaken to investigate areas of concern or low staff satisfaction. In addition, diversity data was captured during onboarding and through surveys.

To better support staff the organisation had engaged in the Investors in People programme and had recently been awarded accreditation.

We found that the service fostered a positive culture where staff and patients felt they could speak up, and their voice would be heard.

The provider had put into place freedom to speak up arrangements, and staff we spoke with fully understood who to contact if they had a concern that they needed to raise. Freedom to speak up and other related topics such as grievance and whistleblowing processes were accessible to staff on the service’s shared computer drive and organisational App.

Leaders and managers told us that they operated an open-door approach which allowed staff to raise concerns with them directly, and this was corroborated by feedback we received from staff who told us that they were empowered to raise concerns and felt confident to do so if needed. Staff told us that they felt that leaders and managers were approachable, and friendly, and they felt any issues they raised would be listened to and investigated fully.

The service strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who work for them.

The service had developed policies and procedures to support workforce equality diversity and inclusion (EDI). This included an EDI, recruitment, reasonable adjustments and bullying and harassment policy. Engagement work with staff showed that:

• 86% of staff felt the service valued their contribution regardless of sexuality.
• 84% of staff felt the service valued their contribution regardless of race and ethnicity.
• 84% of staff felt the service valued their contribution regardless of social background.
• 83% of staff felt the service valued their contribution regardless of gender.

The service had also in place a menopause at work policy and supporting action plan. This was in anticipation of changes to the Employment Rights Act.

We saw that the service had recently been accredited with Investors in People status. An area of this accreditation assessed the organisation “Living inclusion and diversity”, including the lived experience of staff. The service’s performance development review processes and competency framework ensured equality and diversity was built into their performance management structure. Protected characteristics of staff data was being collected to be used to assess the progression of staff moving forward.

Other staff engagement activity showed overall high satisfaction with results from the 2025 survey showing that 96% of clinical staff and 98% of non-clinical staff would recommend working for the organisation. We heard example, of how staff had been supported to develop their careers, and had used apprenticeships as a route into the organisation.

The service 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 act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had developed a sophisticated and effective governance structure with supporting policies, and procedures.

The organisation was governed by a Board of Directors composed of 7 GP Directors representing each of the 7 Wakefield Primary Care Networks (PCN). In addition, membership included a Nurse Director, Practice Manager Director and 2 Non-Executive Directors, with members of the organisations own Senior Leadership Team (SLT) also attending meetings. Beneath the Board level there are 3 Committees:

• Quality Assurance Committee – with an oversight and assurance role for the delivery of clinical services including monitoring quality, safety and clinical risk.
• Audit and Risk Committee – leading on integrated governance and corporate risk management including financial reporting.
• People and Renumeration Committee – with oversight and assurance of staff terms and conditions, health and safety and workforce development.

Their SLT dealt with the day to day operation of the organisation including operational decision making. Other organisational functions and teams supported this management structure such as human resources and communications and marketing.

Outside of this structure the organisation governance also included an Enhanced Access Board composed of PCN representatives, the Integrated Care Board and members from Connexus Healthcare CIC. This Board oversaw collaborative working across partners as well as contract management.

A service lead (referred to as a Duty Manager) was available and provided on-site management support throughout the operating hours of the service, with other senior support being available when required.

We saw that both Board meetings were held frequently, and that in addition monthly clinical meetings were held, as were weekly clinical service meetings which were used to discuss real management of the service and emerging issues. We saw that key performance and activity areas such as capacity and demand, and significant risks, incidents and concerns were reported, as were findings of quality improvement activity, and future development planning. New services and projects were managed through a structured governance programme which included project planning, risk management, mobilisation oversight, quality review and Board reporting. The organisation had effective monitoring procedures in place to give assurance of activities up to Board level.

We saw that the service met regularly with the provider who delivered the clinical assessment service in conjunction with them, as well as taking part in the weekly clinical services meeting. Performance management oversight was in place for this sub-contract. Similarly, the service met with partners and stakeholders in relation to their projects to discuss operational delivery, performance and outcomes.

Staff we spoke with were very clear on their roles and responsibilities and confirmed that they had access to support, supervision and appraisal as required by the job roles. Staff took patient confidentiality and information security seriously and had undertaken mandatory information governance training.

Communication and information access routes had been developed to support operational delivery and governance. This included access to policies and procedures via the GP Care Wakefield App, a monthly staff bulletin, staff forums and meetings and direct one-to-ones.

Risks including those related to the disruption of delivery were managed, and the organisation had a business continuity plan in place.

The service clearly understood and carried out their duty to collaborate and work in partnership with others, and we saw that services worked seamlessly for people. They shared information and learning with partners and collaborated with others to develop and improve their service.

Conexus Healthcare CIC was a confederation composed of local Primary Care Networks and GP practices which covered the Wakefield area and therefore collaborative partnership working and meeting local needs was central to how it operated and was governed.

The service had measures in place to share information with partners including sharing between GP Care Wakefield and the GP practice of patients who accessed both the clinical assessment service and their health projects. This included direct tasking of follow-up concerns regarding patients to their own practice.

We saw that the service had developed joint working projects with a number of partners and stakeholders. This included working with a local Hospital Trust to deliver lung health checks, and charities when delivering their mining respiratory project. The service was also actively involved in their local Place Provider Partnership which worked across Wakefield with other providers to develop and enhance local services.

Community involvement, engagement and feedback was central to the delivery of their health projects. We saw for example that the service, as part of their mining respiratory project, had carried out engagement exercises with local target populations including the use of social media and hosting drop in sessions and coffee mornings. Nurse feedback from this outreach engagement was very positive and we saw good examples about how well the service had tapped into the local community, breaking down traditional barriers to accessing services.

The service 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 contributed to safe, effective practice and research.

The service had an extensive quality improvement programme which included clinical audits such as an audit based on the Royal College of General Practitioners urgent and emergency care toolkit and which was used to assess consultations. A full audit cycle of all GPs and Advanced nurse and care practitioners was completed annually. Other audits included practice nurse and healthcare assistant audit, antibiotic prescribing audit and reception call audit. Projects were also subject to audit, and we saw as an example of this that as part of the lung health checks programme that 5% of patients were audited. Results and learning were again shared with staff via routes such as the monthly team bulletin and during individual supervision and quality improvement sessions. To support this work, the service had appointed a quality and audit lead who had 2 dedicated sessions per week to focus on those tasks.

Data was used to better understand and improve the service. For example, health data was used to identify patients to invite to lung health checks. In addition, utilisation and capacity monitoring was used to assess and manage service delivery. Results from evaluations were also used to make funding and reinvestment decisions such as continued respiratory activity.

New technologies had been adopted by the service. As examples the service had introduced fractional exhaled nitric oxide (FeNO) breathing test equipment which it used during the mining respiratory project. The service had also adopted the live transcription and capture of patient-clinician consultations using an artificial intelligence tool which allowed clinicians to focus on the patient instead of manually typing notes into the patient record (processes were in place for patient consent and safe usage of this technology).

The service, in conjunction with partners, had developed and delivered a range of new models of care to meet local need including respiratory projects.

We saw evidence that the service had processes and procedures in place for learning from incidents, near misses and complaints, and actively shared this learning across their workforce and led to service improvements and changes to practice. We also saw that the service had acted on points raised at their last CQC inspection in 2019.

To develop the service, we saw that staff had received specific training in quality improvement methodologies, as well as enhanced clinical training to deliver better patient care and improve patient outcomes.