Askern Medical 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-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment, we rated this key question as requires improvement.

At this assessment, the rating has changed to inadequate.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found that the service had a vision, and leaders demonstrated an understanding of the challenges and the needs of people and their communities.

At the previous inspection, this quality statement was scored as 2. This was because the majority of staff and whistleblowers told us that they did not feel they could raise issues with leaders for fear of repercussions. Some described bullying. They told us the atmosphere was tense, staff were stressed, morale low and was concerned about complaints and significant event management.

Following our last inspection, we requested an action plan from the provider on how they planned to address these concerns and improve their service. Although at this assessment we saw some improvements had been made, such as appointment access and telephony systems, most concerns remained unaddressed. This included complaint management, staff recruitment processes and the ability of staff to speak up and be listened to.

There was insufficient evidence of recognition of the need for improvement, and a lack of effective action taken to address these issues.

Feedback about leaders being capable, compassionate and inclusive was mixed. Positive experiences were shared following recent management changes, with many staff reporting they felt more listened to and valued. However, concerns were also raised, indicating that some aspects of leadership continued to have a negative impact on staff experience and the overall leadership culture. Staff also reported inconsistencies in processes, mixed messaging and limited management presence.

While leaders often promoted compassion and inclusiveness, based on evidence collected and from our observations at the time of the assessment, our findings did not align with this. The evidence did not demonstrate that all leaders embodied the culture and values of their workforce and organisation. We were told of pressures placed on staff and examples where their issues were dismissed, or their importance disregarded.

At the previous inspection, this quality statement was rated as 1. This was because of negative feedback from staff. We reported that staff were concerned about the leadership acting with openness, honesty and transparency where some staff felt they could not raise concerns without fear was retribution.

At this assessment we found similar concerns. The action plan submitted by the provider from the previous inspection set out actions to address identified concerns. Although some improvements had been made, the ability of staff to speak up and be listened to and concerns about the leadership acting with openness and honesty, remained unaddressed. Consequently, previously identified concerns from the last inspection remained evident, with limited or no demonstrable improvement. There was insufficient evidence of recognition of the need for improvement, and a lack of effective action taken to address these issues.

Feedback about the ability to speak up was mixed. Although some staff reported positive experiences following recent changes to management and freedom to speak up arrangements, with staff reporting they felt more listened to and supported to raise concerns without fear of blame, other staff shared negative experiences, including allegations of coercive control by some leaders. There was insufficient evidence of recognition of the need for improvement, and a lack of effective action taken to address these issues that we previously identified at the inspection in February 2024 that remain unaddressed at this assessment.

The practice had Freedom to Speak up arrangements both internal and external to Askern Medical Practice. In feedback to the CQC however, some staff reported that they were not aware of these arrangements.

The service valued diversity in their workforce. There was a diverse workforce working at the service. We were told within the practice staff could speak 12 different languages.

Policies and procedures to promote diversity and equality were in place. We saw senior leaders had addressed concerns related to discrimination.

Equality and diversity training formed part of the mandatory training for staff. Training records provided to CQC indicated that those staff listed had completed this training. However, not all staff working at the practice were included in the training record, and therefore it was not possible to determine whether everyone had completed this training.

At the previous inspection, this quality statement was scored as 2. This was because staff feedback indicated a lack of clarity around roles and responsibilities, with reports of limited structure. Although policies were in place, some staff did not feel these were effective in practice. Processes for complaints, significant events, and record keeping were not always sufficiently robust.

At this assessment, the quality statement is rated 1, reflecting increased concerns identified during our assessment. We found the provider did not have effective governance processes in place that ensured people were kept safe from avoidable harm.

The action plan submitted by the provider from the previous inspection set out actions to address identified concerns. Although some improvements had been made, concerns remained unaddressed. Consequently, previously identified concerns from the last inspection remained evident, with limited or no demonstrable improvement. There was insufficient evidence of recognition of the need for improvement, and a lack of effective action taken to address these issues.

The provider did not have established governance processes that were appropriate for their service. This included ineffective systems and processes relating to safe and effective staffing which included the safe recruitment of staff, being able to demonstrate they met regularly with all staff to complete appraisals and performance reviews, safeguarding of service users from abuse, following their own policies and procedures, complaints and significant events management.

Staff could access all required policies and procedures. We were told that extensive work had been carried out reviewing and updating the policies and procedures when the assessment was announced to the provider. However, policies and procedures were not always followed and were not sufficiently detailed. For example, the recruitment and safeguarding policy.

Regular practice meetings took place with standing agenda items, during which staff could discuss clinical concerns and emerging risks. However, we saw evidence that agendas were not always followed. Although actions arising from these meetings were noted to be shared with staff, the follow up of actions in minutes was not always evident.

However, we did see nurse meetings had recently been introduced by the practice manager which they chaired with the nursing team. They told us they had introduced these as the team needed a space to talk about issues relevant to them. The minutes of the first meeting were detailed and showed a lot of areas had been discussed with clear actions for follow up on.

The service did not demonstrate they collaborated and worked in partnership with others, so services worked seamlessly for people.

Whilst some positive examples were shared with us, we identified significant concerns relating to the management of tasks and requests, including those from external healthcare partners that were not completed in a timely manner. We also identified concerns that the service was not working effectively in partnership with other health and care organisations.

At the previous inspection, this quality statement was rated as 3.

At this assessment, the quality statement is scored as 1, reflecting increased concerns identified during this assessment. Following our previous inspection, we requested an action plan from the provider that outlined how they would make the necessary improvements to their service. Although at this assessment we saw some improvements had been made, several significant concerns remain unaddressed, with limited or no demonstrable improvement of learning and improvement. There was insufficient evidence of recognition of the need for improvement, and a lack of effective action taken to address these issues.

For example, at our last inspection, we identified concerns relating to systems and processes not being fully established, to assess, monitor and develop the quality of services and to make improvements, concerns regarding record keeping, policies and procedures not always being followed, complaints management and staff in fear of speaking up.

Despite this being included on the provider’s action plan, we did not see that sufficient action had been taken and the concerns remained unaddressed at this assessment.

Feedback from the staff and the PPG told us the service mostly demonstrated a commitment to listening and responding to feedback from both patients and staff. However, the negative staff feedback we received was one of not being listened to, being allowed to make changes to deliver improvements to systems and apportioning blame. The provider described a strong commitment of the team to learning improvement and innovation. They were positive about their involvement in research and learning both in the UK and overseas. Examples of learning, changes and new initiatives introduced since our last assessment were provided.