- GP practice
Larkside Practice
Report from 5 February 2024 assessment
Contents
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
Well-led
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 has changed to Requires Improvement. This is because while we found that the practice had freedom to speak up arrangements for staff and valued diversity in their workforce; we also found areas for improvement in the remaining quality statements. For example, the practice did not have a shared vision, strategy and culture in place and while leaders understood some challenges affecting the service, the strategic leadership and oversight of the day-to-day running of the practice and risks affecting the service were not always effective. Additionally, the provider did not always have effective assurance and governance systems in place, which were regularly reviewed and improved. The practice is also yet to fully involve the PPG in service planning and improvement and a focus on learning, innovation, and improvement for all staff, was not embedded. We found breaches of regulation in relation to governance. We have asked the provider for an action plan in response to these 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 we spoke with said that there were mostly good relations between staff members and that they worked well together as a team. This positive feedback around the culture of the practice was reiterated by staff in their questionnaires. However, some staff members also referred to instances when they had not felt supported by another colleague and how at times, allocated tasks had a negative overall effect on the atmosphere at the practice, due to the impact on staff’s capacity. Additionally, while the atmosphere at the practice was described by one staff member as ‘caring and good’, morale was noted as ‘could be better’.
We heard from staff on how they shared a common aim to do the best they could for patients and strived to provide safe, high-quality, and compassionate patient care. However, not all staff were aware if the practice had a clear vision for the future and/or had been involved in the development of the practice’s mission statement, vision and values.
During the inspection, leaders told us that the senior leadership team of the practice was currently going through a period of transition and as part of this, they would be reviewing and developing, with staff involvement, a shared vision and plans for the future of the practice. Leaders were also aware of the projected increase in the local population and said that they would be working with partner agencies to address future challenges. While the practice provided us with an overview on how they would be developing and monitoring the delivery and progress of their strategy, this would require more in-depth work, as they proceeded with the changes to their senior leadership team, ensuring systems put in place are fully embedded in the practice, and that improvements are sustainable.
Capable, compassionate and inclusive leaders
Staff fed back in their questionnaires that generally they felt well supported by most members of the senior leadership team, including the practice manager, who was approachable, caring, supportive and visible. However, staff also told us that not all GP partners were visible and communication across the practice needed improving, particularly by the senior leadership team, with requests for more ‘all practice staff’ team meetings. While some staff told us leaders listened to their feedback, sharing examples where changes had been made as a result; a few staff members said that leaders did not always respond to suggestions and concerns about the running of the practice. They were therefore not always supported to be able to provide the quality of care they desired for their patients; making them feel unappreciated. In our discussions with staff, this mixed feedback around the practice’s leadership was reaffirmed.
During this inspection, leaders took on board feedback from their staff regarding the leadership of the practice, recognising it as an area for improvement, as the senior leadership team was currently going through a period of transition. Leaders told us that they were reevaluating their succession planning, with practice wide team meetings planned for 2025. A practice’s staff newsletter had been recently created to strengthen staff communications, with arrangements in place to promote staff wellbeing, such as, staff gatherings. A member of the management team was a trained mental health first aider.
While leaders understood some challenges affecting the service, the strategic leadership and oversight of the day-to-day running of the practice and risks affecting the service were not always effective. For example, the monitoring of the competency and performance of all staff employed in advanced clinical practice, to minimise risks and support staff development. During the inspection, leaders recognised this staffing matter, as an area for improvement.
Freedom to speak up
The practice had a Whistleblowing Policy which included details of the practice’s Freedom to Speak Up Guardian who staff could contact outside of Larkside Practice, if they felt they needed to. Freedom to Speak Up Guardians offer support to staff to raise concerns, or speak up, when they feel they cannot in other ways. However, not all staff we spoke with were aware of the practice’s Freedom to Speak Up Guardian arrangements. This lack of awareness was also fed back by some staff in their questionnaires. During the inspection, leaders amended the practice’s Whistleblowing Policy and added a sentence about Freedom to Speak Up to clarify the use of words in this area. This updated policy was then shared with staff for their reference, with an explanation of the amendments made.
Workforce equality, diversity and inclusion
Reasonable adjustments had been made to ensure all staff were valued. For example, working hours arrangements to accommodate periods of ill-health. The practice had policies and procedures in place that promoted workforce equality, diversity and inclusion.
Governance, management and sustainability
Staff we spoke with were clear about their roles and responsibilities. They had access to policies and procedures and knew who they could talk with, if they had a concern or question. This feedback was generally reaffirmed in staff questionnaires.
However, the provider did not always have effective assurance and governance systems in place, which were regularly reviewed and improved. These included those to ensure patients received safe and effective care that was in line with up-to-date national guidance; the management of risks for patients and staff, such as fire safety and legionella; and those regarding staffing matters, such as regular appraisals for all staff and making sure all staff kept up to date with required training, as set by the practice.
While the practice provided us with an overview on how they would be regularly reviewing and monitoring effective assurance and governance systems put in place in these areas, this would require more in-depth work, as they progressed with senior leadership team changes, to ensure systems are fully embedded in the practice, and that improvements are workable.
Partnerships and communities
We did not receive any feedback from people who use the service about partnerships and communities.
The practice was in the process of reforming their Patient Participation Group (PPG), as the old one disbanded during the Covid-19 pandemic. Leaders told us that they had not yet had the opportunity to elect a chairperson and as part of the practice’s complaints process, they would regularly provide patients with details of the PPG and would encourage them to join the group. A registration form for joining the PPG was also available on the practice website. During the inspection, while the PPG’s constitution, terms of reference and minutes from meetings dated September 2023 and June 2024 was shared with us, the practice had yet to fully involve the PPG in service planning and improvement.
We heard from staff on how they worked with other GP practices within their Primary Care Network (PCN). For example, by facilitating Saturday cervical screening clinics to encourage the uptake of screening by patients in this area.
Care home representatives also told us that the practice had set up a process by which they emailed each other on a weekly basis, in preparation for their weekly telephone ward rounds. This process worked well for residents and care home staff. This positive feedback was echoed by the practice.
Learning, improvement and innovation
The practice was a teaching and training practice for medical students training to become GPs, with 3 GP trainees at the practice, at the time of the inspection. This training aspect of the practice was well supported by GPs and an administrator, although the impact on GP availability due to their training responsibilities and other debriefing sessions for Primary Care Network (PCN) staff, was noted in staff feedback. This also affected staff in the performance of their duties, such as, receptionists, with reduced accessibility to GP appointments for patients.
However, the practice did not have an embedded focus on learning, innovation, and improvement for all staff. For example, while during the inspection, we found that the practice had a staff training programme in place, in their feedback not all staff had protected time to complete mandatory training, with some staff saying that they did not feel supported to undertake learning and development activities. The practice had recognised the completion of staff mandatory training generally, as an area for improvement.
Leaders shared with us examples of quality assurance and improvement activities undertaken for the period 2023/2024. This included, installing a cloud based telephony system in February 2024 and implementing a total triage model of care for patients in July 2024.
Various audits had also been carried out by the practice, such as, intrauterine device (IUD) or copper coil reviews and minor surgery and antibiotic prescribing for acute urinary tract infections audits.
While the practice provided us, during the inspection, with an overview on how they would be regularly reviewing and monitoring quality assurance and improvement activities, this would require more in-depth work, as they progressed with senior leadership team changes, to ensure the effectiveness of any changes made to further develop and improve the service and a quality improvement programme is fully embedded in the practice.