Mallard Medical Practice

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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

There was a lack of effective leadership, cohesive vision, and strategy within the practice. This was compounded by a negative workplace culture and ineffective communication mechanisms. Governance processes were ineffective, which meant leaders did not always act on the best information about risk, performance, and outcomes, or share this securely with others when appropriate. Governance, management, and accountability arrangements were not working effectively. Staff reported the lack of a practice manager had caused difficulties in the practice governance structures, leadership, and effective communication. At our last assessment, we rated this key question as Good. At this assessment, the rating has changed to requires improvement. The service was in breach of legal regulation in relation to good governance. We have asked the provider for an action plan in response to the concerns found.

This service scored 54 (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 did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities. There was a failure in effective leadership within the practice, which had cultivated a negative workplace culture. The partners were not working effectively together to create a positive, inclusive, and supportive culture for staff to thrive. The lack of cohesion within the partnership was also impacting on the well-being of the leaders themselves. Staff told us they felt demotivated and devalued. Communication from leaders was ineffective and staff told us it felt like ‘them’ and ‘us’. Regular meetings were not in place for all staff groups. There were no effective arrangements in place to ensure that staff got accurate and consistent messages about the direction and strategy for the practice. Learning was not consistently shared and there were ineffective mechanisms for staff to feedback their experiences and ideas about how the practice could improve. Staff told us when they raised concerns or ideas these were dismissed and ignored.

Leaders did not always understand 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 within the practice had made proactive improvements in some areas, such as the reduction in waiting times for appointments. The GP Partners had developed a greater understanding of the challenges the practice faced whilst preparing for the CQC inspection and had started to work together to develop and implement improvements. They demonstrated a willingness to learn and improve as a result of the CQC inspection. However, improvements were at an early stage. We were concerned that without the support and buy in from staff, any changes would be unsustainable. Staff gave us positive and negative feedback about leaders within the practice. They told us there were arrangements to seek support and supervision when required. However, poor and inappropriate communication was not tackled and addressed at an early stage, meaning it had become accepted practice. Staff observed the breakdown in communication between the partners and had adopted ways of trying to circumnavigate the situation. All staff we spoke with or received questionnaires from raised concerns that a lack of a practice manager had caused issues within the practice. They told us there was a lack of structure, leadership, and effective communication. The practice had not been able to recruit a substantive practice manager at the time of the site visit but had sourced some temporary practice manager support. Staff told us that the lack of leadership in the practice had impacted on working relationships between staff and the GP partners. We saw the leadership team worked with other practices in the primary care network and were engaged in the development of primary care services within the local area.

People did not always feel they could speak up and that their voice would be heard. The practice had established Freedom to Speak up arrangements with other practices in the primary care network. However, due to the culture within the practice these were not effective. Staff told us they did not feel their views and opinions mattered, and when they had raised concerns these had been dismissed and ignored.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance, and outcomes, or share this securely with others when appropriate. Governance, management, and accountability arrangements were not working effectively. Staff reported there was a lack of structure in place. We found concerns across a number of areas. This indicated even where policies, processes, and procedures in place, these were not always effective. For example, staff recruitment, appraisals, training, call and recall of patients, infection prevention and control and health and safety. There had historically been a lack of leadership oversight of governance information to ensure processes had been implemented as expected and were effective at supporting the practice to operate safely and improve where needed. The partners had identified a large number of improvements needed in the time between the inspection being announced and the site visit taking place. Whilst steps had been taken to address these, most were still at very early stages.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.