Friargate 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 identified one breach of the legal regulations.

Leaders were not always compassionate and inclusive and staff did not always feel supported and valued. Staff shared examples of poor communication between leaders and staff, as well as inconsistency in behaviours which created tension and anxiety for staff. Governance processes needed strengthening, as minutes of recent clinic meetings were chaotic and unclear, and some risk assessments not been completed.

Processes were no longer in place to engage with the local primary care network, resulting in people missing out on services provided through the network, for example the social prescriber, extended access and Team-Up services for people living in care homes. Staff also missed out on support from other practices due to the lack of regular engagement with other local health organisations.

Staff were supported through a Freedom to Speak Up Guardian if they had any concerns.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were aware of the practice’s mission statement, which was,‘ Striving for excellence, utilising technology with care and compassion for our patients’. However, staff had not been involved in deciding this.

The practice had embraced digital technology and this was reflected in the mission statement ‘Striving for excellence, utilising technology and compassion to care for our patients’. The mission statement was supported by aims and objectives.

The practice participated in the national General Practice Improvement Programme(GPIP) looking at capacity and access. This had resulted in streamlining reception work and the introduction of a new telephone system. There was also a plan to move towards the new One Patient One Visit objective for people with long term conditions, to streamline the process and combine all aspects of the review into one visit.

Staff expressed some concerns about poor communication between the partners and staff and gave examples of when this had occurred. The behaviours of the partners was inconsistent. Sometimes they were approachable and supportive, other times they were not. Several members of staff described incidents they had witnessed when a partner had been verbally aggressive to staff and caused them to cry, which had shocked them and made them feel very anxious when working at the practice. Several members of staff described the behaviour of the partners as poor role models and unprofessional. Feedback for the practice manager was positive, and they were fantastic and very supportive when dealing with aggressive behaviour from people towards staff.

Staff commented communication was starting to improve through the use of notifications. However, improvements were still required, for example, informing staff when other staff were off sick.

The partners had plans to create more clinical space within the building, by creating an additional treatment room and 2 consulting rooms, as well as adding a sluice area. The management team was being further developed and an assistant practice manager had recently been employed to support the practice manager.

The provider was knowledgeable about their practice population, the majority of which were under the age of 65 years. The digital systems that had been introduced suited the majority of the practice population but not necessarily all of them.

Staff were aware of who the Freedom to Speak Up Guardian was. One member of staff told us they had spoken with the guardian regarding concerns within the practice. They found them to be supportive however, when things were escalated about the behaviour of someone who worked in the service, nothing had changed.

There was a policy in place to support staff to whistle-blow or seek support from the freedom to speak up guardian who was named in the policy.

Staff feedback about the partners was mixed. The atmosphere within the practice had changed recently. Staff comments included that the partners could be supportive and approachable, but could also be distant, tense, lacking in sensitivity and hierarchical. This inconsistency in approach caused anxiety and uncertainty amongst the staff team and impacted on their well-being.

The flexibility around working hours was valued by staff. There were good working relationships between teams and the practice manager was approachable and supportive, especially when dealing with challenging people. The practice offered a zero tolerance procedure and staff safety had been taken into account as part of the refurbishment.

A staff wellbeing session had been held during a monthly practice meeting, and a member of staff acted as the well-being champion.

Staff had access to a dedicated well-being champion and relevant information was on display within the practice. There were systems in place to ensure that staff completed training in equality, diversity and inclusion. We found no evidence of discrimination in the recruitment of staff.

Staff were aware of how to access the practice’s policies to support them in their roles and attended monthly team meetings. The majority of staff were clear about their roles and responsibilities.

Formal minutes from clinical meetings with standard agenda items, for example significant events and safeguarding, had been in place up to January 2024. However, minutes after this date were chaotic and unclear and a formal agenda did not appear to be in place. The provider told us they planned to return to the previous process they had in place to provide clarity about what was discussed at the clinical meetings. Minutes from staff group meetings were in place and were detailed.

There was a lack of oversight and monitoring of risk within the service. For example: assessments for reception staff in relation to Hepatitis B had not been completed and evidence to support the 5 year electrical installation condition report had been completed was not available. In addition, training appropriate for any tasks staff are expected to carry out had not been provided, for example how to triage safely, and not all staff were up to date with appraisals.

There were also missed opportunities to improve the quality of the service as only written complaints were accepted.

A business continuity policy was in place to support the practice to continue to deliver services in the event of an unplanned disaster such as loss of the main surgery building, a pandemic, service outages, or other potential threats. However the policy needed amending to reflect the change from Clinical Commissioning Group to Integrated Care Board, and include reference to notifying CQC of events that stops a service running safely and properly.

The practice did not have access to services available to other local practices which impacted on the services available to people. For example: social prescriber, extended access and Team-Up services for people living in care homes.

Staff missed out on the support from other practices within the locality as there was no regular engagement with these organisations. However, the practice manager and partners attended relevant meetings organised by the local Integrated Care Board.

The practice worked with local organisations to arrange community events for people. These included a community police drop in session, providing people with the opportunity to discuss policing in the local community and the prediabetes educational session.

Arrangements were in place to enable people to access the first contact physiotherapist service as this was longer accessible via the PCN.

Following the inspection the provider told us they continued to work towards resolution so they were able to access the services for people that were available to other local practices. We saw evidence of ongoing communication between all parties concerned.

Staff from a care home where the practice provided care and treatment, communicated via email with the practice. They had to chase the practice to get emergency appointments and prescriptions for some people living in the home and that there had been times when people had had to go without their medicines.

Commissioners informed us that due to issues experienced by a care home where the practice had provided care and treatment, the care home had removed all of the people that lived in there from Friargate Surgery to an alternative surgery. Following the inspection the provider told us they had requested the care home to communicate with them via the online system, telephone or face to face, as they recognised the risk of emails not been acted upon in the timely manner.

There were no processes in place currently to engage with the local PCN and limited engagement with local Integrated Care Board. This meant people did not have access to or benefit from the range of services or initiatives provided through the PCN, and staff did not receive or benefit from interactions and support from other practices.

Health related information was shared with people via the practice newsletter. Recent updates included information on a women only course for diabetes prevention, updates about child and young people’s vaccinations and how to order repeat medicines.

Following engagement with Healthwatch Derby as part of the capacity and access work, it was hoped they would be able to attend the practice on a quarterly basis to speak with people and obtain their views.

Staff put forward ideas and suggestions for improvements but the partners did not actively invest the time to listen or engage with them. We discussed this with the partners and they acknowledged that they needed to review this, and implement a system that would improve the flow of information for staff to the partners.

The opportunities for staff to learn from other practices and share good practice was hindered by no longer being part of the local primary care network, resulting in staff feeling isolated from colleagues and peers. Following the inspection the provider told us they had taken action to engage on a more formal basis with staff. The service had introduced heads of department meetings as well as a dedicated management email to improve communication, and the partners now led and participated in the learning afternoons.

The provider used learning from significant events and complaints to drive improvements. The practice had undertaken quality improvement work specifically targeting improving the uptake of the MMR vaccine following the national measles outbreak. The practice had also sought the views of people regarding the use of digital technology to contact the practice and access appointments. This had highlighted a potential inequality for people from the deaf community, which the practice was looking to address.