Christchurch 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, this key question was rated Good. At this assessment, the rating has remained the same. However, the service was in breach of legal regulation in relation to good governance.

This service scored 71 (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. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. There were clear, established and effective systems and processes for leaders to share their vision, experience and support with colleagues. This was achieved formally through governance meetings and clinical discussions.

A review of themes and trends from staff feedback surveys received by CQC indicated a positive working culture. Staff told us they were regularly updated about service changes. The majority of staff told us there was a positive team culture and they felt supported by GPs and senior leaders. They told us they were able to contribute to discussions about service improvements, incidents and complaints. All staff we spoke with were proud to work for the service and shared a commitment to delivering high quality care.

The service’s mission statement and values were available and accessible to staff. Positive learning culture was demonstrated through meeting minutes which showed that performance, incidents, feedback and complaints were routinely discussed.

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. They did so with integrity, openness and honesty.

The majority of staff told us leaders at the service were approachable and responsive to concerns raised. Staff also told us leaders modelled the values of the service. We saw the leadership team worked with external stakeholders and other healthcare services involved in the development of primary care services within the local area. For example, the service worked with other practices within the primary care network (PCN) and local hospitals to improve collaboration and coordination of services provided.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. The service had established Freedom to Speak up arrangements, as well as a whistleblowing policy.

The service had oversight of themes and trends, including staff feedback and indicators of staff experience. Where areas of improvement were identified, leaders told us actions were considered through the service’s wellbeing and improvement plans.

Staff told us they felt respected, supported and able to raise concerns without fear of negative consequences. They were aware of the service's whistleblowing arrangements and understood how to escalate concerns if required. Staff were confident leaders would listen, act appropriately and provide feedback when issues were raised. The service encouraged open discussion through regular team meetings and staff engagement activities, creating opportunities for staff to share ideas and contribute to service improvement. Examples of changes made following staff feedback demonstrated leaders valued staff contributions and acted on suggestions to improve the quality and delivery of care.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality for people who work for them. Policies and procedures to promote diversity and equality were in place. Mechanisms were in place to address concerns relating to discrimination. Adjustments had been made to ensure all staff were valued. For example, we noted there were reasonable adjustments to support the health and safety for staff in relation to workplace display screen equipment, ergonomics and movement and handling.

We received 31 staff feedback surveys as part of the assessment. Feedback highlighted a positive culture which supported staff wellbeing, with leaders described as approachable and contributed to an inclusive working environment where individuals felt supported to contribute fully to service delivery.

Staff told us they were encouraged to undertake professional development. However, feedback indicated a desire for more regular formal opportunities to review progress against objectives through appraisals, competency based and additional staff to meet workplace demand. In response, leaders told us previous partnership redundancies had affected some teams, and the service was monitoring potential changes to local primary care provision which could impact commissioning arrangements. The service monitored staff capacity by role type through policies and audits which determined arrangements were currently in line with service expectations.

The service did not always have effective systems and processes to support good governance. Risks were not always effectively identified, assessed, or mitigated in areas relating to health and safety, workflow and artificial intelligence (AI). The service had not sought and documented assurances in relation to the AI triage system to ensure this was safe to use in line with NHS digital standards as well as auditing triage outcomes. This meant the service may not identify whether the AI tool is incorrectly categorising triage outcomes and reliance on staff review increases the risk of system issues being missed or inconsistently managed.

Internal quality monitoring systems had not identified shortfalls in these areas, and did not always act on information about risk. The service did not have fully effective and embedded processes for monitoring people’s health in relation to medicines requiring monitoring, asthma management and safety alerts.

The service monitored medicine safety and prescribing through monthly clinical governance meetings. However, the service did not have effective systems to ensure monitoring and appropriate actions had been taken, in particular, for people prescribed medicines for anxiety or insomnia. Clinical searches identified not all people had been reviewed to ensure continued prescribing remained appropriate and supported by an effective dosage reduction management plan in line with national guidelines. A governance gap existed in identifying, tracking and addressing these monitoring shortfalls. Clinical search findings also showed the service lacked effective oversight to identify and follow up people with acute exacerbations of asthma who had received 2 or more rescue steroids prescriptions in the last 12 months. We found examples of people who had not received a follow-up or an annual asthma review, and governance processes had not ensured timely action, creating a risk of unmet needs.

Although the service had undertaken individual staff health and safety assessments, governance processes were not fully effective in ensuring local procedures were clearly defined. The policy did not detail local health and safety arrangements for assessing staff, people using the service and the premises at agreed intervals. Supporting schedules, guidance and health and safety risk assessment appendices were not included within the policy. This meant the service could not demonstrate assessments would be completed consistently and in line with national guidance.

The service’s governance systems had not identified the shortfall in managing workflow to prevent backlogs. This included documents such as people’s hospital discharge letters, AE cases and people’s registration information were awaiting filing. Unactioned workflow tasks including death notifications; ‘GP connect’ records requiring review and private medical reports, meant there was a potential risk of delays in supporting safe and effective care and treatment. The lack of timely completion of actions represented a gap in governance and assurance processes.

However, the service had a business continuity plan which provided guidance for staff in the event of major incidents. Staff were able to demonstrate how to access service policies and procedures and gave examples of how working arrangements had been adjusted due to past risks or incidents.

Information was stored securely in line with digital security standards, with relevant information available through privacy notices, consent information and general data protection regulations. This included information about consent and how to protect online data through notices within the service, registration forms or online via the service’s website.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners including community teams and external stakeholder healthcare providers.

The service worked with other services within their local primary care network to offer extended access, and flu and covid vaccination programmes. Staff had made adjustments to improve coordination with community healthcare services, including through recently established weekly meetings centred on the care of those at higher risk of hospital admission.

The service reinstated the patient participation group (PPG) in January 2026, following changes to the service commissioning arrangements. Feedback from members of the PPG highlighted they were listened to, valued and had seen positive changes to improve people’s experiences of the service. The service had plans to work with the PPG to better understand and reflect to people’s needs, including improvements to the service website and regular publications of service newsletters.

The service focused on continuous learning, innovation and improvement across the organisation and the wider local health and social care system. They encouraged creative ways of delivering positive outcomes and experiences for people.

Staff were encouraged to participate in training and competency-based development and protected learning sessions.

The service had a programme of quality improvement and used audits to review the effectiveness and appropriateness of the care it provided. There was a clear audit schedule covering both clinical and non‑clinical areas, and findings were shared with staff so that learning and recommendations could be implemented.

For example, the service carried out audits relating to people with leg ulcers, which reviewed whether appropriate assessments had been completed, healing progress and supported referrals to specialist tissue viability services where required. This included reviews of Doppler assessment (ABPI – Ankle Brachial Pressure Index) to ensure treatment reflected assessment findings and people were referred appropriately when arterial disease was suspected. This demonstrated the service monitored compliance with local leg ulcer pathways.

The service was listed as a ‘training practice’ which helped support and mentor GP registrars and foundation doctors and medical students. A GP trainer acted as a mentor and provided tutorial support. This contributed to the development of the future primary care workforce and supported long-term workforce sustainability.

The service worked with the primary care network (PCN) to participate in research commissioned by the NHS to help improve care and treatment. For example, the PCN had contributed learning towards included Coenzyme Q10 (COQ10) as a supplementary treatment in people with heart failure, through a clinical trial run by the University of Bristol.