Dr Murthy Motupalli Also known as Blackburn Road 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

Leadership, management and governance arrangements did not support the delivery of safe, high-quality, person-centred care. Systems and processes were not sufficiently robust or effectively embedded to ensure care was delivered safely and effectively. Leaders did not demonstrate the capacity, capability or oversight required to drive improvement or address identified risks. While some staff understood their roles and lines of accountability, this was not constant across the organisation, and not all staff reported feeling adequately supported. We identified concerns in relation to record-keeping and data management, which indicated weaknesses in governance and oversight.

This service scored 32 (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 demonstrate a stable or embedded vision, strategy or culture. While elements of transparency, inclusion and engagement were described by the provider, this was not supported by all staff and was not reflected in day-to-day practice. As a result, the service could not evidence that its stated values were driving delivery in a meaningful or consistent way.

Although the provider showed some understanding of the challenges and needs of people and their communities, we did not see evidence of this through effective partnership working. Arrangements with external agencies lacked coordination, which limited the service’s ability to respond proactively and effectively to people’s needs, particularly in relation to safeguarding.

Staff said they felt they delivered a high-quality, patient-centred service, however, this was not clearly demonstrated throughout. Feedback from staff was variable, and not all staff reported a positive experience of working at the practice. While some examples of teamwork were provided, these were not embedded across the service. There was a lack of clarity and consistency in how the service operated to ensure the best possible outcomes and experiences for patients.

Communication systems were not sufficiently robust. Staff reported that information was not always shared in a timely, accessible or effective manner. This meant that staff across different roles and disciplines did not always have the information they needed, increasing the risk of misunderstanding and impacting on the delivery of safe and coordinated care.

The management team was fragmented, and the provider could not demonstrate effective leadership. While leaders described an intention to promote an open and inclusive culture, this was not fully embedded across all levels of the organisation. As a result, the service could not evidence that staff experienced a culture of openness or felt fully supported to raise concerns.

Leaders showed some awareness of the context in which care, treatment and support were delivered; however, this understanding was not translated into effective leadership or service delivery. There was limited assurance that leaders embodied the values of the organisation or that these were reflected in day-to-day practice.

Although leaders were described as approachable by some staff, this was not a complete view. Some staff we spoke with reported that managers were not always visible and were not always able to support them. Systems for responding to concerns were not sufficiently robust to ensure that issues raised were addressed in a timely and effective way. Engagement with other practices within the PCN was evident; however, it was not clear that this involvement resulted in improvements to the quality of care delivered within the service.

Leaders did not demonstrate that they had the capacity, skills or oversight required to lead effectively. Processes for monitoring performance and patient outcomes were not sufficiently embedded, and action taken in response to data was inconsistent.

The practice did not have a clearly embedded or accessible Freedom to Speak Up (FTSU) function. Although we were told there was an individual in place, and there were signs to support this, we were told that this had only been implemented the evening before our assessment. Not all staff were aware of the change. After further evaluation throughout the assessment, it was clear there was no designated individual within the practice to fulfil this role, and not all staff were aware of any FTSU person within the ICB. This limited the visibility and accessibility of the FTSU process for staff.

While leaders stated that they encouraged staff to speak up and promoted a culture of openness, evidence gathered throughout the assessment did not support this. This indicated that systems and processes to support speaking up were not sufficient.

As a result, the practice could not demonstrate that all staff were supported or empowered to raise concerns in line with Freedom to Speak Up principles, and we found evidence where issues were identified and escalated but were not sufficiently managed.

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.

We saw diversity in the workforce along with an inclusive and fair culture supporting equality and diversity among staff. The provider said they supported staff with caring responsibilities through flexible working arrangements and adjusted schedules to meet their needs. However, we did not see reasonable adjustments made to help all staff carry out their roles effectively and some staff spoke of unfairness.

Governance, management and accountability arrangements were not effective. While the provider used some data to monitor performance, this was not sufficiently robust or embedded to drive sustained improvement or demonstrate a positive impact on patient outcomes. Things identified for action, such as escalated incidents or the management of workflow tasks were not addressed in a timely or effective manner.

Although staff were aware of their individual roles and responsibilities, this did not translate into consistent or effective delivery across the service. Management oversight was limited, and while meetings with staff took place, these were not sufficiently structured or effective to ensure that clear messages were communicated across the whole workforce. The provider was noted as giving their apologies for all the meetings of the minutes we reviewed which was over a period of 3 months.

Systems to identify and respond to patient need, such as clinical searches, medicines reviews, patient safety alerts, pathology results and safeguarding were in place but these were not well managed. Our review of clinical records identified gaps and inconsistencies, indicating that these processes were not reliably embedded in practice.

While staff had access to policies and procedures and demonstrated some understanding of patient confidentiality and information security, this was not applied. Governance systems for identifying, managing and mitigating risks were not sufficiently robust, and although a major incident plan was in place, there was limited assurance that it was well understood or effectively implemented.

The provider had established governance processes; however, these were not operating effectively. Significant weaknesses were identified, including in task management, learning from events and complaints, maintenance of records, and medicines management. These issues indicated a lack of effective oversight and assurance.

Although leaders told us they took identified issues seriously and acted on them, the concerns identified during the assessment demonstrated that action taken to date had not been sufficient to ensure safe, consistent and high-quality care.

The provider did not demonstrate a clear commitment to collaboration and partnership working to ensure services operated seamlessly for patients. They did not always share information and learning with partners or engage in joint initiatives to drive improvement. They told us they worked with other practices within their PCN to deliver extended access services and to coordinate flu and COVID-19 vaccination programmes. However, we did not see evidence of collaboration with external stakeholders, commissioners, and partner agencies to provide and enhance service delivery. There was no Patient Participation Group to manage any feedback or improvement offered by patients using the services. Although the provider reported working collaboratively with stakeholders, this was not evidenced in practice. There was no evidence of improved outcomes or experiences for people using the service. Partnership working lacked clear impact and was not sufficiently coordinated to support service-wide improvement.

The provider did not demonstrate a constant or effective focus on continuous learning and improvement across the service. Whilst clinical audits were being undertaken by student staff, the provider was not able to demonstrate any ongoing clinical audit plan, or any follow up and action taken from these. While processes were described for sharing learning from incidents, these were neither embedded nor effective in practice. There was limited evidence that learning was translated into meaningful action, and ongoing issues indicated that improvements were not sustained or fully implemented.