Dr Lalit Gurnani Also known as Nantwich Health 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 assessed all quality statements from this key question. At our last inspection we rated this key question as good. At this assessment the rating remains the same.

Leadership, management, and governance arrangements supported the delivery of high-quality, person-centred care, with clear systems in place to ensure care was delivered safely and effectively. Leaders demonstrated capability, compassion, and inclusivity, with a strong focus on workforce equality. Staff understood their roles and lines of accountability and reported feeling well supported.

Information was used effectively to monitor and improve care, although some aspects of record-keeping and data management required improvement. These issues were discussed during the assessment, and the practice responded promptly and positively, taking immediate action to address them and demonstrating action for improvement and development.

The provider had processes in place to support staff to raise concerns. However, these were not always fully effective in practice, and some staff did not always feel listened to when concerns were raised. While leaders understood some of the challenges affecting service quality and sustainability, systems for promoting consistent learning and improvement across the practice were not always effective. Opportunities to share learning and embed improvements were sometimes missed, which limited the provider’s ability to drive continuous improvement across all teams.

This service scored 68 (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 shared vision, strategy and culture which the provider said was based on transparency, inclusion and engagement. However, not all staff felt included in this. The provider understood the challenges and needs of people and their communities and was working with partner agencies to support people effectively. Staff spoke of a shared vision to provide a high quality, patient centred service that was responsive to people’s needs. All staff we spoke to felt positive about working at the practice, apart from feeling overwhelmed at times with workload. Feedback from staff questionnaires however, was mostly positive. They described good teamwork and a service that was clear on its function to work in the interests of patients and providing the best patient experience they could. Members of the team told us that communication could be improved to ensure that staff in all disciplines received the right information at the right time in the right way.

The management team had been in place for a long time and included leaders who encouraged an open culture at all levels. Leaders understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. However, feedback demonstrated that this was not always felt by all staff.Leaders had the skills, knowledge, experience and credibility to lead effectively and mostly did this with integrity, openness and honesty. Most staff told us leaders in the practice were approachable and responded to any concerns raised.

The leadership team demonstrated good work with other practices in the PCN and were engaged in the development of primary care services within the local area.They had the skills, knowledge, experience and credibility to lead effectively. Theymonitored and acted upon data about outcomes for patients and made improvements when required. Feedback from people who used the service was mostly positive and when improvements were suggested, leaders and staff worked to ensure patient satisfaction, such as upgrading access.

The practice had an appointed Freedom to Speak Up Guardian within the PCN and within the practice. Leaders stated that they encouraged staff to speak up, promoted a culture of openness, and had policies and procedures in place to support this. Although staff told us they knew how to raise concerns, felt confident in doing so, and believed their concerns would be taken seriously, not all staff were aware of freedom to speak up, who their guardian was and what their role constituted.In addition, not all staff felt their concerns would be addressed if they were raised.

The provider valued diversity within the workforce and actively promoted an inclusive and fair culture by supporting equality and diversity among staff. Reasonable adjustments were made to help staff carry out their roles effectively. The provider supported staff with caring responsibilities through flexible working arrangements and adjusted schedules to meet their needs. Staff had completed training in equality, diversity, and inclusion and demonstrated awareness of how to support individuals with protected characteristics, such as age, gender, religion, and disability. There were no concerns reported regarding workforce equality at any level, including recruitment. The practice had an established equality, diversity, and inclusion policy in place.

There were arrangements in place for governance, management, and accountability. The provider used data to monitor performance and drive improvement. Audits demonstrated positive impact and outcomes for patients. All staff we spoke with understood their individual roles and responsibilities. Managers held meetings with staff although this required review to ensure consistent messages were being communicated across the whole workforce around incidents and complaints. A regular programme of clinical system searches was carried out to identify patient needs and ensure these were addressed, and our review of clinical records showed this was mostly effective. Staff were able to access all necessary policies and procedures and demonstrated an understanding of patient confidentiality and information security. There were systems in place for identifying, managing, and mitigating risks, and a major incident plan was in place. The provider had established governance processes appropriate to the service. However, some areas for improvement were identified including learning from events and complaints and medicines management. During the assessment, the provider took all identified issues seriously and acted on them immediately.

The provider demonstrated a clear commitment to collaboration and partnership working to ensure services operated seamlessly for patients. They shared information and learning with partners and engaged in joint initiatives to drive improvement. The provider worked with other practices within their PCN to deliver extended access services and to coordinate flu and COVID-19 vaccination programmes. They also collaborated effectively with external stakeholders, commissioners, and partner agencies to provide and enhance service delivery. The Patient Participation Group was very active and undertook education and communication with patients of the practice.

The provider demonstrated a considerable focus on continuous learning and improvement in patient care across the service. They shared information with the wider PCN.The provider worked collaboratively and in partnership with stakeholders to improve the experience of people who used the service and those within the locality.Leaders told us they maintained strong external relationships that supported improvement and innovation, and we saw evidence of this. The practice had been training students for several years and 1 of the nurses was being supported to become a non-medical prescriber. The practice had received a gold award for supporting medical students.

Internally, although there were processes to ensure that learning was shared when there were incidents there were ways in which that could be improved to ensure all members of the workforce felt supported that any incidents raised would be listened to and acted upon to ensure compliance with regulations.