Middleton Health 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

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

This service scored 93 (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 had a very clear shared vision, strategy and culture, which was reviewed and adjusted accordingly. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.
There was a whole practice ethos of working to empower people, reduce barriers to health care and improve people lives. This was evident in their continued funding of focused care workers based on positive independent evaluation. They based their vision and strategy on a commitment reducing health inequalities. The strategy reflected the challenges of the practice patient population and working innovatively to address barriers. Leaders actively monitored and anticipated current and future risks through data to delivering the strategy and had a clear understanding of the impact of people living in an area of high deprivation.
The practice operated as a not-for-profit community interest practice, with a clear focus on identifying local population needs and delivering care to those who required it most. Staff had contributed to the development of the practice’s vision and strategy, helping to create a shared sense of purpose and ownership across the organisation. The strategy had been developed in collaboration with stakeholders and was regularly reviewed and discussed with staff and patients through the Patient Participation Group (PPG) to ensure it remained relevant and responsive to evolving needs.
As a well-established training and teaching practice, there was a strong commitment to developing a sustainable workforce and ensuring the future resilience of primary care services. The practice had robust GP training and development programmes in place to support the recruitment, retention, and progression of clinicians and shared this expertise by providing training and development opportunities to other practices.
Staff development was a clear organisational priority, supported through structured training programmes, mentorship, and continuous professional development opportunities. Staff told us they felt valued and supported to develop their skills and progress within their roles. Communication and engagement across the practice was highly effective, with a range of well-established forums used to share information, encourage collaboration, and promote learning. These included regular team meetings, practice-wide updates, and whole-team learning events.
 

The service had exceptionally 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 always did so with integrity, openness and honesty.
Leaders had access to support from the entire Hope Citadel provider team. Together this enabled leaders at practice level to develop a credible framework in which they could work with staff to meet people’s diverse needs.
Staff told us leaders in the practice was approachable and responded to any concerns raised. Staff also told us leaders modelled the values of the practice. We saw that leaders were accessible and although the practice manager had an office, they spent majority of their time in the administration office with staff, so they were available and had a clear understanding of the day to day challenges staff faced.
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. Leaders were clearly committed to meeting the needs of the most vulnerable in their cohort of patients. Leaders were proactive in reviewing data, seeking out partner agencies and organisations that would support them in promoting the best outcomes, services and amenities for people who used the practice, such as ‘Child Mortality in Temporary Accommodation’. The ‘GM Deprivation – GPST Training Programme’ formed a robust framework to ensure equal opportunities and drive to promote and recruit people to work with patients facing health inequalities as a result of deprivation. Leaders also demonstrated a willingness and ability to share best practice and learn from others by opening up training to other practices within the PCN. There were leads within the practice for infection control, safeguarding, dementia, focussed care and chronic disease and staff knew who they were. These leads provided expert guidance and support to ensure care was tailored to individual patients’ needs, particularly those with complex conditions, vulnerabilities, or additional support requirements.
 

The service fostered a positive culture where people felt they could speak up and their voice would be heard.
The practice had established Freedom to Speak Up arrangements with other practices in the primary care network. Staff were aware of how to raise concerns, and we saw examples where staff had used the arrangements in place to positive effect. Staff informed us of an ‘open door policy’ and felt comfortable approaching other staff and leaders at all levels with concerns and feedback.
 

The service strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved 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 felt safe, for example a security gate in reception, private locked admin offices, emergency buttons situated in the rooms as well as the clinical systems response. Staff told us they felt valued, supported, and an integral part of the team. They described a positive and inclusive culture in which contributions from all staff groups were recognised and appreciated. The practice also organised dedicated staff celebration and recognition events, ensuring that all roles were acknowledged, including nurses, reception staff, administrative teams, and GPs. Staff also highlighted the use of an employee appreciation page, which provided opportunities for colleagues to give and receive positive feedback and recognition from one another. This approach encouraged a culture of appreciation, strengthened team relationships, and contributed positively to staff morale and wellbeing. Interviews with staff confirmed that the practice was proactive in providing training and funding for relevant courses to enhance individual development and skills for the benefit of patients.
 

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.
For example, the practice identified that some patients faced barriers to engaging with preventative healthcare services and, in response, implemented a targeted recall process to improve uptake and ensure patients received timely and appropriate care. They did this by allocating a designated member of the administration team managed weekly recalls for cervical screening and childhood immunisations. Using a live EMIS-generated list of patients who were due or overdue, they proactively contacted patients to encourage attendance, followed up non-responders and those who had not attended appointments, and recorded all outcomes in clinical records. This ongoing process helped identify and support eligible patients to access important preventative healthcare services and address any barriers to engagement.
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 a wide range of robust governance processes that were appropriate for their service and enabled leaders to have oversight of delivery and mitigate risks. They embedded a quality improvement programme which they used to drive improvements across all areas of the service with a clear focus addressing health inequalities and improving patient outcomes. Improvements were supported by strong leadership and a shared commitment across the whole team to delivering better outcomes for service users. The provider undertook a range of audits to monitor performance and risk, and they had established an independent evaluation framework to monitor and learn from the work of the focused care worker and other initiatives.
Staff and leaders actively anticipate current and future performance and risks to the quality of the service and had system in place to review and respond to changing needs of the patient population. There is an informed approach to positive risk taking to support innovative ways of working, for example establishing the recoffery and missingness projects
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. The practice made regular use of locum GPs to support service delivery and had robust processes in place to ensure that all required recruitment and HR documentation was completed and maintained appropriately. Locum clinicians were provided with a comprehensive welcome pack containing all relevant information about the practice, including local processes, policies, procedures, and key contacts, enabling them to work safely, effectively, and consistently within the service.
 

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.
The provider worked with other practices within their primary care network to offer extended access, and flu and covid vaccination programmes. Staff had made adjustments to improve coordination of their service with community healthcare services. The practice was run by Hope Citadel Healthcare CIC, which was actively in partnership with Focussed Care, The Deep End and The Shared Health Foundation. Each of these partnerships uniquely focussed on the health and well-being of the direct population of the practice, supporting the most vulnerable patients and those in poverty and deprivation. This also enabled a training development scheme for GP registrars to train and retain GPs who specialise in these population groups, creating a more person centred and successful provision of care.
Stakeholders consistently described the practice as collaborative, innovative, and responsive. They highlighted strong multidisciplinary team (MDT) working, effective communication, and a commitment to sharing expertise and leading new initiatives that supported improvement across the wider health system. Patient involvement was also a key strength, with an active and engaged PPG contributing to service development.

The service 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.
The practice had a strong and well-established culture of continuous learning, innovation and improvement, driven by evidence and the needs of the local population. This approach helped improve outcomes, promote equitable access to services, and enhance people’s experiences and quality of life. The practice team demonstrated a proactive and innovative approach to service delivery and was actively involved in local pilot initiatives aimed at improving outcomes for patients within the community. For example, the ‘Low Carb Diabetes Group’ and the ‘Missingness’ initiative. The practice had implemented a focused care model, recognising the complex needs of its population and adopting a holistic approach to care. This model integrated patients’ physical health needs with their emotional, psychological, social, and economic circumstances, enabling staff to address the wider factors affecting health and wellbeing. This is supported by the investment of the focused care workers, and the work the practice does to invest in independent evaluation to learn and develop and ensure the programme continues to add value.
They use data and continually evaluate the range of innovative projects such as the substance misuse group to ensure they are achieving the desired outcomes and positive impact on people.
The practice had established a deprivation training scheme to support the recruitment, development, and retention of staff, ensuring they were equipped with the skills, knowledge, and experience needed to effectively meet the needs of the local population and work within an area of significant deprivation. As a result, patients were supported in a more personalised and coordinated way, helping to improve engagement with healthcare services and achieve better overall outcomes.