Yarm 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 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 provider had a shared vision, strategy and culture, which staff showed a high awareness of. The provider was active in including staff, partners and people who use services in the vision, strategy and culture of the service, for instance when the practice building was first designed the PPG had an input.

Culture was based on transparency, equity, engagement, and understanding challenges and the needs of people and communities.Leaders understood the challenges and worked strongly with partner agencies to support people effectively. 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 deeply embedded in the organisation and understood by all staff.

The practice had a well-established, inclusive, and positive learning culture. Staff were heavily invested in the practice vision of ‘we do not provide services we provide care’. Staff demonstrated a shared vision to provide a high quality, patient centred service that was responsive to people’s needs. All staff we spoke to felt positive about working at the practice and feedback from staff questionnaires was consistently 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. All staff felt psychologically safe and empowered to speak up and raise concerns to help learn and improve. Staff were highly motivated and consistently felt well-supported by leaders. Protected learning time (PLT) was consistent every month for all staff, and was highly valued by staff, who were able to suggest and contribute to learning content.

The provider 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. Staff feedback was overwhelmingly positive about leadership, with staff members we spoke with saying they felt supported by leaders.

Staff told us of many inclusion initiatives including gender neutral toilets, equality, diversity and inclusion training, alternative communication methods for patients with hearing loss, and walk throughs of the surgery for patients with dementia or learning difficulties. The practice had invited charities and patient groups to give input and had made changes as a result such as a ‘dementia friendly’ lift. Equality was embedded into many practice policies, such as the patient registration and chaperone policies.

We saw there were internal and external Freedom to Speak Up Guardians in place and supportive mechanisms for staff to raise concerns.All staff without exception spoke of an open, blame free, inclusive environment in which everyone could speak up, in a variety of different ways. There was also an anonymous staff suggestion box. 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 detailed and supportive 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. Staff told us of how they had been supported through professional and personal challenges. 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, systems of accountability and well embedded governance and operating procedures. They 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.

The practice had achieved Silver and Gold Green Impact Awards, which encourage involvement in and awareness of sustainability in and around the practice. They also participated in Clean Air Day, advertising this to patients and undertaking a clean air audit.

Governance and management systems helped leaders proactively track risks, performance, and outcomes. There were clear and effective governance, management, and accountability arrangements. Staff understood their role and responsibilities.

Learning points were discussed at monthly governance meetings and cascaded to staff.

Leaders made ongoing efforts to improve how services were delivered, using feedback from staff and patients to reduce risks and enhance care. They also clearly understood and demonstrated their responsibility for maintaining a strong safety culture, which was evident in day-to-day practice.

All staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. Staff and leaders actively 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 detailed major incident plan was in place. The provider had established governance processes that were appropriate for the service.

The provider fully understood their duty to collaborate and work in partnership, ensuring services ran smoothly for patients, and this was embedded in the published vision and values of the practice.

We saw they often shared information and learning with partners and collaborated for improvement. Leaders consistently collaborated with other practices in their Primary Care Network, for instance to facilitate social prescribing, including dedicated social prescribing for under 16 years patients.

The practice actively sought to play an important part in their local community and had participated in many charitable initiatives including an Annual Christmas Jumper Day supported by staff to raise funds for a local children's Autism charity. They collected sanitary products for a local project helping to address period poverty in schools and had a charity book stall with the proceeds going to various local charities.

The practice facilitated a Domestic Violence Advisor clinic at the building, run by a local charity. They could be booked into directly by patients or by clinical or reception staff. The practice had joined a national ‘safe place’ register, where venues commit to offering help and support if someone is anxious, lost, scared, or believe they may be at risk. All staff showed a good awareness of this scheme. The practice invited local sixth form students on experience days, with some going onto medical school.

The practice also facilitated a DWP Patient Advice Service worker to be located in practice. Appointments could be requested by patient, clinician or receptionist, and patients could receive advice on subjects such as training, benefits, or getting back into work after sickness.

The practice was active in the local PCN and made use of additional roles schemes, allowing services such as Mental Health workers to be located within the practice, which could be booked straight into by reception or clinical staff.

Social Prescribing clinics were available through the day to increase ease of access and speed of assessment, with the option to be contacted by phone or face to face. This was an initiative developed within the practice by the Social Prescribing clinical lead and the Social Prescribing team.

There was an active Patient Participation Group (PPG), which met with leaders regularly and described the practice culture as open honest and engaged. Members felt involved with changes, such as to the new online consult system.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They were a research and training practice and actively contributed to research projects. One example was a new screening test for a type of throat cancer, where the practice hosted the clinicians and recruited the patients for testing. This project had identified positive patients who had shown no symptoms. These patients were therefore able to access the treatment they required earlier.

The practice had 3 registrars at the time of inspection. As far as possible lab results came back to the requesting clinician, including registrars and Nurse Practitioners, who were able to access regular clinical supervision and daily advice if needed to interpret these. There was a strong emphasis on learning and a comprehensive practice initiated clinical audit programme. We saw examples of completed audits which included improvements in care and outcomes for women with gestational diabetes, older patients taking anti-inflammatory medicines, the identification of bladder cancer, and diabetic patients using injectable insulin. Audit subjects were identified through a number of routes including incidents, both internal and external, and special interest areas.

We were given a number of examples of new initiatives the provider was bringing in to make improvements, such as a new online system to improve telephone access, and ‘health pods’ in reception.

Monthly PLT sessions were used to discuss learning opportunities to enhance patient outcomes and staff well-being, with a variety of internal and external speakers invited. These were highly valued by all staff.