Naseby Medical Centre

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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 assessed 5 quality statements in this key question, capable, compassionate and inclusive leaders, freedom to speak up, governance, management and sustainability, partnerships and community and learning, improvement and innovation. We did not assess the other quality statements and the score for these remains unchanged from the previous inspection. At our last assessment, we rated this key question as inadequate. At this assessment, the rating remains the same.

Leaders demonstrated an overall lack of understanding and up-to-date knowledge about how to manage and run a modern GP practice. Proposed governance processes were not clear, comprehensive or effectively embedded with staff. The use of technology to improve communication, information sharing and governance had not been adequately addressed. Significant shortfalls in risk management and premises safety remained unchanged. The practice did not engage in open, effective collaboration to support their improvement journey.

The service was in continued breach of legal regulation in relation good governance.
 

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

During our previous inspection we identified that the practice did not have inclusive leaders at all levels who understood the complexities of the service they delivered. Leaders did not demonstrate that they had the skills, knowledge, experience and credibility to lead effectively. The leadership team comprised of a clinical lead GP who was also a partner, the salaried GP and the practice manager.

The clinical lead GP and the salaried GP were fully involved in planning for the potential lifting of the suspension. However, the other GP partner and the practice manager did not take part in this inspection despite being invited to do so, which limited the provider’s ability to demonstrate there was a cohesive and effective leadership team.

At our previous inspection we raised concerns about the skills, experience and competence of some members of the leadership team, both clinical and non-clinical. Although some evidence was provided to demonstrate that the clinical leader had completed limited clinical updates, no evidence was submitted to show that relevant individuals had undertaken development relating to leadership or managerial capability. Following this inspection, the scope of both roles was significantly reduced, indicating that the provider recognised limitations in their ability to undertake key leadership responsibilities.

Leaders did not demonstrate an improved understanding of governance procedures or risk management. Although a multiplicity of written policies and procedures were provided the leadership team could not discuss cogently how these would translate into practice.

The leadership team did not demonstrate that they understood the requirement or method to analyse the staffing capacity required based on demand for any job role. Following this inspection, they advised us that this has been carried out by an external company, however, the actual capacity / demand analysis was not provided to evidence how staffing decisions had been made. Capacity planning did not include contingencies for covering staff leave which could create multiple risks including delays to patient care or administration and risks to patient safety. We were not assured that that the leadership team had clear understanding of resource planning and rostering to ensure that staff resources were aligned with predicted demand or that they would be able to manage this effectively in the future.

There was evidence of limited engagement with the Integrated Care Board (ICB) and the caretaker provider prior to this inspection, some of which had only been arranged following the announcement of this inspection. When we asked the provider to describe the agreed arrangements for a smooth and orderly transition of services from the caretaker should the suspension be lifted, they advised that no discussions about this had taken place. This transition necessitated the transfer under TUPE Transfer of Undertakings (Protection of Employment) regulations of existing Naseby staff. The provider could not explain when or how this would happen. This is a time of uncertainty for the affected staff members and yet minimal engagement with staff had occurred to explain, reassure and support them through this process. When we discussed this with the leadership team, they displayed little insight into how the events surrounding the suspension may have impacted staff morale and had no proactive plan to address this.

Throughout both the previous and current inspections, the provider’s decision‑making appeared to focus on meeting minimum compliance requirements rather than demonstrating a commitment to high‑quality, person‑centred care. This was reflected in the provider’s reactive approach to remedial action, limited engagement with stakeholders, and reliance on others to determine the improvements required. Whilst urgent enforcement action can encourage providers to drive improvements for the benefit of patients, the provider did not demonstrate an understanding of the importance of rebuilding safe, supportive and trusting therapeutic relationships or placing patients at the centre of service delivery.
 

At our previous inspection, the provider told us that one of the Patient Participation Group (PPG) members acted as the freedom to speak up guardian for staff if they had concerns that they could not take to the practice manager. However, the practice could not provide evidence that this person had completed appropriate training for the role, or that they were registered with the National Guardians Office.

At this inspection evidence was submitted to show that the provider had proposed to engage a company who could provide a freedom to speak up guardian for the practice. However, there was no signed contract in place, no detail as to who the guardian would be, no evidence of the training or registration of this person or that staff had been informed of this change.
 

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

At our previous inspection we found that the practice did not have clear responsibilities, roles, systems of accountability and good governance. There was no clear overarching governance policy and governance processes were haphazard, inefficient and documentation was not easily accessible. We also had concerns regarding the performance and competence of the existing practice manager.

At this inspection, the provider initially told us that they planned to support the practice manager by recruiting an assistant manager 1 day a week. It was unclear how the roles would be split and who would be accountable for what.

Following this assessment the provider revised their plan and advised they would recruit 3 assistant practice managers to support the existing manager. However, it was again unclear how many hours the assistant practice managers would be working and whether the staff were permanent or temporary There was no evidence provided of an interim plan to support the existing practice manager during the on boarding period for the assistant managers.Evidence submitted following the inspection defined the job role for each manager, however, the majority of new policies provided referred only to the ‘practice manager’. It was unclear whether this referred to the existing practice manager and it did not align with the governance accountability framework that was submitted at the same time. We were not assured that the practice management team had clear roles, lines of accountability or effective oversight.

At this inspection we found gaps in risk management and safety governance remained. The provider was unable to provide assurance that all necessary risk assessments had been comprehensively updated and that suitable testing and servicing of the water and fire safety systems had been carried out.

During our inspection we discussed whether newly recruited staff would be ready to start work immediately should the suspension be lifted, given the requirement for induction and training periods. The provider advised that all new staff would be asked to complete this training voluntarily, in their own time and without being reimbursed prior to the start date for their employment. However, they did not provide an updated recruitment and / or induction policy to demonstrate what had been agreed with the potential candidates. This does not align with safe employment practices and indicates a lack of effective governance regarding recruitment procedures.
 

The provider had undertaken some limited engagement to support partnership working with the ICB and the caretaker provider in order to understand how the caretaker provider had restructured the practice and completed a review all patients affected by the clinical concerns we had raised.

Following this inspection, they submitted evidence of further meetings which enabled them to understand the full complexity of the work undertaken at the practice. However, there was no evidence of discussion or agreement as to the timeframe and nature of the handover of the practice should the suspension be lifted.

Existing staff are currently employed by the caretaker provider and arrangements must be made under the transfer of undertakings (protection of employment) (TUPE) regulations. During this inspection, the provider advised that they wished to negotiate an overlapping transition period whereby the caretaker provider initially supported them during the handover. Given the complexity of the organisation, we would have anticipated that this transition phase would require careful planning, agreement about the roles and responsibilities of each party and a clear, agreed timetable of actions. No evidence was provided that negotiations of this type had been undertaken or that any such agreement was in place.

Following the inspection, the provider arranged further meetings to discuss these aspects of the proposed transition with the caretaker. However, these negotiations occurred close to the decision making for the suspension so there was insufficient time to ensure they were fully embedded or that they would facilitate a smooth transition without disruption of services to both staff and patients.
 

At this inspection we did not see evidence that the leadership team had fully integrated the learning from our previous inspection and the resulting suspension of their registration in respect of the delivering regulated activities to reform and restructure the practice and services. A limited amount of work had taken place with stakeholders who offered guidance and support. However, most planning appeared to have happened in isolation and without reference to the changes put in place by the caretaker provider.

Following this inspection, the provider increased their engagement with external stakeholders; however, this appeared to be a reactive response to feedback given during the inspection. While this engagement enabled the provider to submit a clearer plan for the transition of services, the information did not demonstrate a fully developed or agreed working arrangement with the caretaker provider. By the time this partial plan was submitted, there was insufficient time to implement it safely before the suspension expiry date.