The Village Green 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

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities. Managers worked with the local community to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas.At our last assessment, we rated this key question as outstanding. At this assessment, the rating has changed to good.

This service scored 82 (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. 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. All staff had contributed to the development of the practice vision and strategy, which was kept under review. The vision of the practice was displayed online and in the waiting room. New staff and trainee doctors were expected to be part of the vision of the practice. The service continuously looked for ways to improve outcomes for patients and staff. Leaders took the time to ensure staff received an induction which was developed to their individual needs, which incorporated the culture of the practice. We reviewed a clear long- term plan for the practice. The manager and partners were all able to provide examples of where they hoped the practice would be in the future, this focused on increasing services offered to patients. The extension to the premises had allowed for more treatment rooms which at the time of our site visit was nearing completion, this extension was built to ensure nurses were all in the same part of the building to improve patient care and peer support. Leaders were able to clearly demonstrate improvements made by the practice since our last inspection such as implementation of continuity of care, the lung screening processand building an extension on site which provided 3 new treatment rooms for clinical staff to work from. Leaders demonstrated a passion for education and the development of staff.

The service 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. We saw evidence of leaders also considering the gender pay gap.

Staff told us leaders in the practice were approachable and responded to any concerns raised. Staff 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. We saw evidence of leaders making amendments to support staff where required. Leaders were willing to listen to feedback from all staff members.

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 told us they felt comfortable approaching leaders within the practice but also knew where to go externally if they needed support. We saw evidence of freedom to speak up posters being on display, the practice also had a suggestion box and regular team meetings where staff could bring suggestions or concerns if they needed to.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Policies and procedures to promote diversity and equality were in place. All staff were up to date around training on equality and diversity. We saw senior leaders had addressed concerns related to discrimination. Adjustments had been made to ensure all staff were valued, for example we saw adjustments to support disabled staff were in place.

We reviewed an effective process which had been implemented to protect staff and patients who may be a victim of racist abuse, the practice had a clear set of guidelines which they expected staff to follow. Leaders pledged to investigate any allegations of racism within 48 hours. Any patient who was seen to be racist toward a staff member would also be contacted within 48 hours; leaders would agree a course of action together.

Leaders annually reviewed staff pay, and incorporated gender pay gap, and age discrimination in relation to staff pay. Leaders were able to demonstrate an awareness of how these two things affected their own staff directly.

Staff who wished to celebrate various religious festivals were given the opportunity to do so.

The service 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 act on the best information about risk, performance and outcomes, and share 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. At the time of our assessment staff were offered an appraisal but did not have to have one, leaders told us this was something they were in the process of implementing. The provider had established governance processes that were appropriate for their service.

Staff could access all required policies and procedures online via TeamNet which is an online administrative system used by the practice. 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 service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always shared 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, including through established weekly meetings centred on the care of those at higher risk of hospital admission. We saw evidence of a vulnerable patients register which staff maintained oversight of, this enabled staff to track patient contact with external services such as Out of Hours. The care navigator was invaluable to ensuring these patients were signposted and monitored effectively.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and individual practice. They always encouraged creative ways of delivering equality of experience, outcomes and quality of life for people.

Staff told us they felt that they could be part of learning within the practice. Practice leaders were able to provide many examples of improvements that had been made as a direct result of feedback or incidents. For example, a PCN wide led incentive that was introduced by the care home lead in response to bowel screening for care home patients not being managed appropriately. A new protocol was introduced to improve patient outcomes.

Audit and quality improvement were embedded throughout practice, and staff were able to provide examples to us of improvements they had seen in the practice, for example changes to a workflow for secretaries who were concerned about workload increase. We reviewed evidence which indicated leaders continuously reviewed audits to ensure patient outcomes remained positive, for example and audit initially implemented in 2015 which looked at patients at risk of malnutrition, this had been reviewed annually.

Leaders consistently engaged with stakeholders and showed willing to implement new processes, which were fed back to local and national levels. For example, the project regarding lipids which was shared across the PCN and presented to national practices. We also reviewed evidence which demonstrated that the practice was intending to share the process of implementing the ‘continuity of care’ with other surgeries locally and nationally.

The practice, is a training practice, providing placement opportunities to medical students and doctors at registrar level, the practice has a strong level of staff retention, many of the staff worked as trainees at the practice and have progressed to senior roles during their career, and all GP's employed had worked at the practice as a trainee. Trainee doctors were supported to produce an audit.

Leaders at the time of our assessment were looking to Artificial Intelligence software as a potential improvement in the practice. Again, we reviewed evidence which demonstrated a practice-based approach to this, all staff were to be involved in any decision to make changes to current systems. The hope was that the time reading and coding letters could be reduced, freeing up appointment slots for patients.