Longtown Medical 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

Leaders and staff had a vision and culture based on listening, learning and trust but this was not evidenced in all actions taken by the practice. Leaders were visible, knowledgeable, and supportive. Staff felt they could give feedback and were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities; however, it was not clear the processes they had to follow were sufficient. Governance arrangements were in some areas lacking in quality control and auditing. There was a lack of monitoring of performance. There was no effective system to identify, capture and manage risks. There was limited completed evidence of ongoing quality improvement.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice did have a shared vision and culture which was based on equity, equality and human rights, diversity and inclusion. However, there was limited evidence that the practice understands the challenges and the needs of people and their expanding patient community.

All staff had contributed to the development of the practice vision and strategy, but there was no evidence to indicate a formal review of this had taken place. We spoke with leaders regarding formalised minutes they told us due to being a small practice they did not feel this was necessary as conversations with staff took place informally on a regular basis.

The practice had recently appointed additional clinical staff to address an recent increase in the patient population but it was unclear how they would respond to future increases in the local population. Leaders told us they did not consider a total triage model necessary for the practice.

Staff had completed equality and diversity training.

Leaders told us they had varying strategies for communicating with staff, this included emails and some face-to-face meetings. Staff were also given the opportunity to join meetings via Teams. Records showed that meetings that included all staff were not held regularly. The practice could not demonstrate how all relevant information was shared with staff effectively. When information was shared there was a lack of oversight of whether staff had read, understood and taken appropriate action. Leaders told us this is done via email but acknowledged this could be improved.

Although at the time of the assessment patients were satisfied with access to appointments, however regarding governance, audit and processes, leadership could not demonstrate they had oversight. Leaders told us they monitored reception staff opportunistically however was not a formalised process.

We asked leaders to explain the way in which triage worked within the practice. e-Consult was available for patients; however, it was unclear having spoken to staff who had overall responsibility for triaging these. We requested a policy relating to this process after our site visit, it is unclear when this policy had been implemented and whether it was embedded within the practice. We will review this at our next assessment.

Staff told us they felt the leadership team was approachable and visible. There was a positive culture between staff and leaders. Staff felt any issues raised would be listened to.

We were not assured that there were processes in place which demonstrated leadership within the practice was effective or that leaders maintained an oversight of process and if they were effective. For example, the capabilities of working in reception. Leaders told us administrative staff were trained in care navigation; they explained 1 member of staff had completed a care navigator course run by the ICB. This learning was then cascaded to others. It was unclear at the time of the inspection how leaders where assured staff were capable and confident in using this process, as there had been no supervision or audit carried since the training was completed in July 2023. Since our assessment leaders have begun auditing eConsults and care navigation and have told us they are confident staff are using this process correctly. We will review this completed audit at our next assessment.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. All staff had access to a suggestion box to raise issues if they needed to.

The practice had a Freedom to Speak up Guardian within the practice and other guardians in the primary care network. Staff were aware of how to raise concerns.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Policies and procedures to promote diversity and equality were in place. We saw senior leaders had addressed concerns related to discrimination. Adjustments had been made to ensure all staff were valued, for example we saw reasonable adjustments to support staff were in place.

All staff we spoke with were clear on their responsibilities. However, the provider did not have established governance processes in place. Leaders did not regularly audit staff interactions with patients via telephone or during the triage process. Staff could access all required policies and procedures; however, the provider could not demonstrate that all required policies were in place when we undertook this assessment.

The practice couldn’t demonstrate they had oversight of policies, that they were up to date and relevant.

Leaders gave contradictory answers regarding the triage process for e-Consultations. It was unclear whether GPs or reception staff would triage e-consults or whether initial triage was done by reception staff, appointments booked (if urgent) and then sent to GPs for actioning. Due to lack of clarity on this process and no clear auditing processes, potential errors could have been missed.

The senior leadership team held regular meetings during which they discussed known clinical concerns and emerging risks. Managers recorded any actions arising from these meetings and ensured they shared these with staff via email.

Staff were trained in patient confidentiality, and we saw evidence of leaders effectively monitoring access to patient records.

Managers met with staff to complete appraisals and performance reviews.

The practice had a business continuity plan which contained information on disaster management.

The practice understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborate for improvement particularly in relation to safeguarding.

The provider worked with the local secondary care centres within their network to offer extended access appointments, and flu and covid vaccination programmes. Staff also collaborated with local community healthcare services.

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

There was limited evidence that demonstrated clinical improvements in the practice. The quality improvement process was informal, and final outcomes were not completed. Leaders told us they did not formally complete quality improvements with documentation. Since our site visit, the practice has provided us with evidence of planned quality improvements, including updating the practices' asthma management protocols. Whilst some of these improvements have been inititated they are not complete. We will review this at our next inspection.

The practice had a working relationship with a local Medical School and undergraduate medical students attended the practice as part of their primary care placements.