Crosslands Surgery

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, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 79 (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 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.

Leaders promoted a positive, compassionate and listening culture. Staff reported high levels of support, fairness and well-being, and felt able to raise concerns and contribute to service development. The strategy was monitored through governance processes, with progress reviewed and risks to delivery identified and acted upon.

The practice 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 staff survey showed no staff reporting that they felt unsupported.Leaders prioritised staff well-being and responded to staff and patient feedback.High levels of long-term staff retention further demonstrated a positive and supportive working culture.

Staff also told us leaders modelled the values of the practice. We saw the leadership team worked with other practices in the primary care network and were engaged in the development of primary care services within the local area.

The practice fostered a positive culture where people felt they could speak up and their voice would be heard. Staff we spoke with felt that leaders were approachable, listened, and acted in response to matters raised.

There were processes in place to support staff to speak up. The service had appointed a Freedom to Speak Up Guardian and had a whistleblowing policy in place, which provided guidance for staff on raising concerns and signposted external organisations if they did not feel confident doing so internally.

The practice valued diversity in their workforce and had taken steps to support an inclusive and fair working environment. Staff described a positive culture, and the practice provided opportunities for development through structured internal progression pathways. Some members of the administrative team had advanced into clinical support roles through in‑house training.

Policies relating to equality, diversity and inclusion were in place and understood by staff. Reasonable adjustments were made where required, and staff survey results indicated that staff felt supported and valued at work. Leaders worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The practice had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. The provider had established governance processes that were appropriate for their service. Staff could access all required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Staff took patient confidentiality and information security seriously.

Operational oversight was strengthened throughleaders away days, which led to focused improvements and changes to the service. The leadership team also worked closely with GP practices within the primary care network and the integrated care board, supporting shared learning and coordinated improvement across the system.

The practice demonstrated a strong understanding of its responsibility to work in partnership so that care and support were coordinated and accessible for local people. Staff and leaders engaged routinely with partners and the community to share learning and identify opportunities for improvement, including active participation in primary care network (PCN) forums and local community.

Collaboration within the PCN supported service development and access improvement. They offered extended access on evening and weekends. Working relationships were maintained with neighbouring services, including the use of Additional Roles Reimbursement Scheme Staff (ARSS) to enhance patient access. Staff had made adjustments to improve coordination of their service with community healthcare services, including through established meetings centred on the care of those at higher risk.

The service strengthened access and equity through a wide range of community‑based initiatives aimed at reducing barriers, improving health literacy and promoting prevention.They hosted educational sessions on long term conditions at the local church, and this was offered to local members from the community. Leaders informed us that patients that were not registered had their monitoring results sent to their respective GPs’. The PPG members we spoke to, spoke highly about how the educational sessions helped to improve care in the community. This approach improved access to support, strengthened community trust and reduced health inequalities. Findings following a hypertension session found that those without a blood pressure recorded in the previous 12 months reduced from15% to 6.8% patients, exceeding the PCN target of

The practice had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Evidence showed shared learning and staff involvement at all levels, with data, patient feedback and system insight routinely used to inform service development. Access redesign and educational initiative programmes were introduced in response to identified need. Outcomes were regularly evaluated, with learning shared across the primary care network and borough in relation to the practices’ access and community engagement interventions. This led to improvements in the borough with the local primary care network introducing patient education events as a funded local initiative.

Learning and innovation were further supported through participation in ambient voice technology (AVT) research. The practice worked with Great Ormand Street Hospital and Tortus to help develop and evaluate AVT within UK general practice as the lead primary care provider. Staff were actively involved in interpreting performance, and the data was used for changes, ensuring improvements were grounded in frontline experience and responsive to the needs of patients, staff and the wider system. Survey results from staff found accuracy of consultation notes increased from 80% to 100% within a 5 month span. Leaders told us their contribution gained national recognition with NHS England, and the provider submitted evidence for the research.

External feedback further reinforced this learning culture. The practice achieved 100% across all assessed domains from West Middlesex GP training scheme. The results were above the schemes’ average, and the practice did not receive any negative feedback from trainees. Leadership oversight supported continuous improvement. Assurance systems were reviewed regularly, with clinical audit and quality improvement activity demonstrating positive impact on service quality. Quality improvement activity included structured protocols focused on access and appointment systems, with staff encouraged to propose and test new ways of working.

Robust systems were in place to report, investigate, and learn from incidents, near misses, and complaints. As a training practice, there was a clear organisational commitment to learning at every level. They created a clinical hub and had a library area for staff. During staff meetings, the whole team discussed and learnt from clinical issues. These meetings enabled multidisciplinary reflection on both clinical and non-clinical issues, fostering continuous professional development and service improvement.