Toddington Medical Centre

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• 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 the service’s leadership, management and governance assured high-quality, person-centred care and promoted an open and fair culture. At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 71 (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 shared vision, strategy and culture. This was based on transparency, equity, equality, human rights, diversity, inclusion and engagement. Staff and leaders understood the challenges and the needs of people and their communities.

Leaders monitored and reviewed progress against the delivery of their strategy. The service was aware of local challenges that affected delivery, including a projected increase in the local population over the coming years and wider workforce pressures, and worked with partner agencies to address these challenges.

Staff and leaders actively promoted equality and diversity and worked to identify the causes of any workforce inequalities. They demonstrated a positive and compassionate listening culture that focused on learning and development. Staff were positive about the culture within the service and told us it was open and transparent. Staff told us they felt supported to raise concerns and were confident these would be listened to and acted upon. Staff also described improvements in team culture and communication over time and felt that leaders had created a more supportive environment where staff could contribute ideas and discuss concerns openly.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service had clear responsibilities, roles, and systems of accountability. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on information about risk, performance and outcomes, and shared this securely with others when appropriate.

All staff we spoke with were clear on their individual roles and responsibilities. Leaders supported staff and met with them to complete appraisals and performance reviews. Managers ensured staff could access all required policies and procedures, which were kept up-to-date and reflected the latest guidance.

The service had governance processes in relation to the quality statements we reviewed during this assessment, although we identified some areas where oversight and monitoring required strengthening. Leaders held regular formal practice meetings with staff, during which they discussed practice information, clinical concerns, emerging risks and learning from events. Actions arising from these meetings were recorded and shared with staff. Staff described an open-door culture where they could approach leaders and clinicians for support and advice when needed. The service had systems in place to ensure staff worked in line with policies, national guidelines and within their competencies, for example through structured clinical supervision.

We identified some gaps in the service’s governance arrangements. For example, records demonstrated occasions where fridge temperature monitoring had not been completed. Whilst there was no evidence that temperatures had fallen outside the required range, these gaps meant the practice could not provide assurance that monitoring had been completed consistently. We also identified gaps in workforce records. Our review of training records did not provide assurance that autism awareness training was being effectively monitored across the workforce, and we found some recruitment records did not contain all required information. For example, we did not see evidence that a clinical member of staff had a DBS check. Leaders took action to address the recruitment record gaps following our assessment and provided assurances that all staff had the required checks in place. Leaders identified this as an area in need of improvement in relation to the storage and oversight of staff files and developed an action plan as a result.

The service demonstrated effective oversight of complaints and incidents. During the 12-month period preceding our assessment, 42 complaints and 10 incidents were recorded. These were investigated and reviewed to identify learning and opportunities for improvement. Leaders identified themes and trends, shared learning with staff and implemented actions to help reduce the risk of recurrence and improve the quality of care provided.

Leaders described plans to support succession, workforce continuity and the sustainability of the service. The service was a training practice for medical students and GP trainees, supporting workforce development and staff retention.

Staff understood the importance of confidentiality and information security. The service submitted data and notifications to external agencies as required.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.