Clifton Court Medical Practice

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

The provider had a clear vision statement, which had recently been updated and reviewed in collaboration with the staff team.

Culture was based on transparency, equity, engagement, and understanding the challenges and needs of people and communities. Leaders and staff had an exceptional understanding of the challenges and the needs of people and their communities and used their in-depth personal knowledge to innovatively work with partner agencies to support people. There was a focus on continuity, accessibility, and a passionate focus on wider health and social determinants, and barriers to care, and this information was used to reduce health inequalities.

Staff and leaders actively monitored and anticipated current and future risks to delivering the strategy, including relevant local factors. Equality, diversity and human rights approaches were embedded in the organisation and understood by all staff.

Staff demonstrated a shared vision to provide a high quality, patient centred service that was responsive to people’s needs. Staff we spoke to felt positive about working at the practice and feedback from staff questionnaires was positive about their working environment and about their leaders. They described good teamwork and a service that was clear on its function to work in the best interests of patients, providing positive outcomes.

Staff described an open and supportive culture, where they felt empowered to speak up and raise concerns to help learn and improve, and were routinely asked for their feedback. Protected learning time (PLT) was made available for staff training, and people were encouraged to further their learning. We saw examples of where staff had been supported to develop, for instance from a non-clinical to a clinical role. Another example was when clinicians and administrative staff expressed reduced confidence in managing a range of complex women’s health conditions. In response, leaders organised a structured learning intervention to enhance knowledge, clinical capability, and confidence across the team. We saw how this subject was also reflected as a clinical audit area, demonstrating improved patient outcomes and increased clinical confidence.

The provider had inclusive leaders 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. Staff feedback was positive about leadership, with staff members saying they felt supported by leaders, and were aware they could request check-ins and valuing regular meetings. Leaders showed ambition to continually improve staff welfare and wellbeing, by providing multiple routes for feedback and acting on this. There were clear examples of how a supportive and collaborative leadership style had led to better safety, more integrated care, and a stronger focus on meeting people’s needs and addressing health and social inequalities.

Equality was embedded into many practice policies, such as the patient registration and chaperone policies. 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. Good practice and findings from research and pilot projects was shared.

The practice population was in a group with high levels of deprivation and complex health and social difficulties. However, the practice had successfully put in place strategies to provide services to meet the needs of their population, and measured these to ensure they were delivering to patient’s needs. For instance, longer appointments, flexible ways to access the service and the tailored individualised support from the dual care co-ordinator/social prescribing roles which allowed practice staff to get to know patients and their needs very well on an individual level. This was shown in high patient satisfaction levels in how they could access the service, despite considerable health and socio-economic challenges within the local area.

We saw there were Freedom to Speak Up Guardians in place and supportive mechanisms for staff to raise concerns.Staff told us of an open, blame free, inclusive environment in which everyone could speak up. Staff knew how to raise issues, said they felt confident to do so and felt their concerns would be acted upon. Leaders demonstrated how they encouraged staff to raise concerns and promoted the value of doing so.This was underpinned by a Freedom to Speak Up policy.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by supporting equality and diversity for people who worked for them.

Reasonable adjustments were made to support staff to carry out their roles. In the latest staff survey, 100% of staff members who identified as a carer or volunteer said they felt supported and had clear channels to raise concerns.

Staff had completed training in equality, diversity, and inclusion and were aware of supporting people with protected characteristics such as age, gender, religion, or disability. We saw and heard of no concerns with regards to workforce equality at any level including the recruitment of staff. The practice had an equality, diversity, and inclusion policy.

The provider had clear responsibilities, roles, and systems of accountability. There were established governance processes that were appropriate for the service. The provider used these to manage and deliver good quality, sustainable care, treatment and support. The service acted on the best information about risk, performance, and outcomes, and shared this securely with others when appropriate. Whilst we found that in some cases systems to support safe and effective medicines optimisation could be improved the practice responded well to our clinical search feedback and followed up patients where highlighted and showed a commitment to continuous improvement.

Leaders made ongoing efforts to improve how services were delivered, using feedback from staff and patients to reduce risks and enhance care, and had a clear understanding of the challenges facing the provider.

All staff we spoke with were clear on their individual roles and responsibilities. Learning points were discussed at governance meetings and cascaded to staff.Managers met with staff regularly to complete appraisals and performance reviews, and staff felt these were supportive and useful processes. Staff and leaders monitored and anticipated current and future risks to delivering the strategy, including relevant local factors. Staff knew where to access all required policies and procedures and understood the importance of patient confidentiality and information security. There were arrangements for identifying, managing, and mitigating risks and a major incident plan was in place.

The provider understood their duty to collaborate and work in partnership, ensuring services ran smoothly for patients. Feedback was gathered through surveys, patient participation groups, complaints and compliments.

We saw they collaborated for improvement across the wider practice group with their Federation and Primary Care Network (PCN) and participated in PCN audit activity. Staff made ongoing efforts to engage with safeguarding teams.

We saw multiple examples of successful partnership working, notably the opioid reduction project work which was a multi-disciplinary research project working in conjunction with university research teams, and resulted in practice staff winning an award for innovation and presenting their findings to national audiences. The frailty pilot work which the practice was engaged in aimed to strengthen collaborative working across the PCN, share good practice and ensure that patients living with moderate and severe frailty receive coordinated, proactive and person‑centred care. In the previous year the provider had seen a 13% drop in AE attendances compared to the year before, and a similar drop in admittances to hospital, since providing proactive, tailored interventions.

The practice had an established Patient Participation Group (PPG). The practice encouraged patient involvement through regular feedback surveys and newsletters. The practice ran regular ‘You said- we did’ updates with examples including a review of the appointment system and changes to the balance between pre-bookable and same day appointments, allowing patients to plan more easily.

The practice had invited PCN mental health practitioners and members of various local charities to be involved in a quality improvement project on trauma informed care focussing on patients with multiple complex physical and mental health needs, to foster a collaborative community approach to the project. Case studies were provided where individual patients had greatly improved quality of life and gained employment and had greatly reduced medical needs as a result of interventions.

The practice was a ‘Gambling harms’ accredited practice, and a veteran friendly accredited practice. Each year staff picked a local charity and carried out fundraising events to donate to them, such as holding a raffle for hampers.

The practice had participated in or led many area wide projects to boost collaboration and area-wide improvements, such as system improvements to enable identification of patients following a laboratory issue, frailty digital tool and a PCN-wide reasonable adjustments template.

The provider encouraged continuous learning, innovation and improvement across the organisation and local system. Staff told us of projects they had been involved in or initiated, including streamlined vaccination clinics and patient lists, to help improve uptake in attendance in childhood vaccinations by enabling earlier identification and proactive communication with families of children due or overdue their vaccinations.

Clinical staff had access to regular clinical supervision, protected learning time and annual appraisals, with a record maintained of their competencies. Staff spoke of a culture where learning and innovation was valued and encouraged, and leaders were passionate about developing and nurturing staff.

We saw examples of completed audits which included improvements in care and outcomes for patients. Audit subjects were identified through a number of routes including incidents, both internal and external, and special interest areas.

Protected Learning Time (PLT) sessions were used to discuss learning opportunities to enhance patient outcomes. These were highly valued by all staff.

Quality Improvement Plans were put in place and kept under review where there was identified need.

The practice was carrying out an improvement project around complex patient care, continuity of care and Trauma Informed Care, where it is recognised that some patients face significant health inequalities, socio-economic deprivation, childhood adversities and mental health problems. Clinicians would compile lists of patients facing multiple complex issues, and these patients would be offered their preferred clinician, longer appointment times and multiple routes of personalised support. One anonymised case study was provided where a patient had reduced their presentations to frontline services (including AE and ambulance) from over 50 a month to once or twice a month, given the higher level of support. The project was ongoing.

The practice was part of a pilot for the use an AI accredited medical scribe tool to enhance the way they took clinical notes. The programme ‘listens’ to consultations and generates a summary which the clinician can review and add to after the consultation.