Cricklade Surgery

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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

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 inadequate. At this assessment, the rating remains the same.

The service remained in breach of legal regulation in relation to good governance.

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 have ashared 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.

The service had not shared the warning notices in a timely way with relevant staff to support improvements. This had prevented staff from working together to ensure compliance and meant some improvements introduced by staff had been implemented after the compliance date had expired.

The service had still not implemented a culture that supported and promoted learning among staff. Staff told us they did not receive regular communication, updates, or information relating to learning from significant events. Meeting agendas we reviewed did not have significant events as a standing agenda item which demonstrated it was not routinely discussed among staff. Staff told us during the inspection that they did not consistently receive updates regarding incidents or situations where learning or actions had been identified.

Some staff also told us service leaders were not regularly available in the service, and it was not always clear who held clinical responsibility in their absence. This meant staff may not always have been clear who to escalate clinical concerns to or seek support from when making decisions relating to people's care. However, staff said that the practice manager was consistently available and accessible.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

People did not always feel they could speak up and that their voice would be heard.

Not all staff we spoke with were able to identify the freedom to speak up guardian. However, they told us they were able to locate the policy if required.

We saw the service now had a Freedom to Speak Up policy which correctly identified the new internal Freedom to Speak Up Guardian.

The service still did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who work for them.
The service still did not have effective systems to engage and involve staff. For example, no staff surveys had been carried out to obtain feedback.

The service still lacked effective systems to ensure inclusion for staff in the service. Three out of 5 staff records we reviewed did not evidence discussions had taken place regarding staff physical or mental health and wellbeing, including whether any reasonable adjustments were required. In the remaining 2 records, staff employed since our previous inspection had disclosed health conditions that required risk assessments; however, these had not been completed, and no adjustments had been implemented.

The service still did not have clear responsibilities, roles, systems of accountability and good governance. They still did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The service still did not have effective oversight of internal processes to ensure compliance with its own policies and national legislation. For example, we identified concerns relating to recruitment processes, staff induction, staff immunisation records, supervision arrangements and the management of significant events and complaints. Systems and processes were not operating effectively to ensure these areas were consistently implemented, monitored and reviewed.

The service still did not have effective systems to ensure people received care and treatment in line with national guidance. For example, there were concerns regarding the management of people impacted by Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts.

The service did not have effective systems of oversight to ensure test results were monitored during staff absences. At the time of the inspection, the service was unable to provide a policy or protocol to support staff in managing test results when key members of staff were absent from work. We identified abnormal test results assigned to a clinician who was absent from work, which had not been identified by the service.

The service had still not ensured policies contained the necessary information to give appropriate guidance to staff. For example, the service’s infection prevention and control (IPC) policy contained inaccurate or irrelevant information, as it referenced contact links from an NHS trust and named the incorrect IPC lead.

The service still did not have effective oversight of risk in relation to health and safety, fire safety and infection prevention and control. Areas identified on risk assessments as requiring action had not been completed as required and not all risks had been identified. For example, risks relating to COSHH had not been identified by the service.

The service did not have necessary systems to support staff who were lone working.

The service could not evidence they operated necessary systems to ensure staff received learning outcomes from complaints and significant events.

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.

The service still did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

The service did not have effective systems to demonstrate how it monitored and tracked improvements from action plans. Action plans submitted to CQC following the previous inspection did not contain necessary information to demonstrate how the service planned to improve the standard of services provided. For example, action plans submitted were incomplete, and without identified compliance dates. This meant the service could not demonstrate, that identified concerns had been effectively addressed or that learning had led to measurable improvements in practice.

We received feedback from partners as part of this assessment. Themes included confirmation of some improvements including implementation of new policies and procedures. However, partners remained concerned these actions were not yet fully embedded and that the service needed to improve oversight further to ensure consistency.