Rothwell and Desborough Healthcare Group

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 practice’s leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. There were many effective, well embedded governance systems that aimed to manage risks and keep people safe. Leaders had a clear business plan and gathered feedback and information about risks, performance and outcomes which they used effectively to make decisions about future developments. There was evidence of innovative approaches to clinical safety and quality improvement. However, staff feedback on culture, visibility of leaders, whether they felt supported and treated equally and their confidence to raise concerns was primarily negative. Some staff advised they faced excessive workloads and despite raising concerns, timely action had not been taken to support them. They described a difficult working environment, with conflicts between staff teams and disparities in leadership decisions amongst the partners and senior management teams.This key question has been rated as requires improvement.

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.

Practice leaders had a clear shared vision and strategy. However, not all staff we spoke with understood this and feedback on the culture was mixed. Whilst some staff commented favourably; describing a supportive and enjoyable working environment, most staff who provided feedback reflected on difficult working conditions. They described conflicts between teams and a lack of cohesion in the response of leaders when concerns were raised. Some staff described disparities in how they were treated, whilst others commented on unmanageable workloads. Leaders were aware of existing conflicts between staff teams and advised they had made efforts to support staff and improve. This included the use of external mediation and team building events. However, leaders advised staff had been reluctant to engage in these initiatives. Nonetheless, leaders appeared committed to improving working conditions for all staff.

We saw the leadership team worked with other practices in the Primary Care Network (PCN) and were engaged in the development of primary care services within the local area. Leaders understood the context in which they delivered care, treatment and support. However, staff we spoke with did not consistently describe the leadership team as effective leaders. Not all staff felt they could raise concerns in confidence. Some staff reported they had raised concerns but no action had been taken to support them. Some staff felt they would be disadvantaged if they did raise concerns. All staff reported that clinical support was available when required. Many staff felt that effective communication was lacking, particularly from senior leaders, often resulting in confusion and increased stress for staff. Practice leaders took a proactive response to feedback provided during the assessment. They submitted a comprehensive action plan to support their commitment to improve. This detailed various measures they planned to implement. For example, the introduction of an ongoing anonymous staff survey to gather direct feedback from the staff team.

Whilst some staff were aware of who the freedom to speak up (FTSU) guardian was, others were not. Not all staff felt able to speak up and raise concerns or felt confident they would be listened to. Some staff were not confident their request for anonymity would be respected. There was a FTSU policy in place. Leaders advised they would review FSTU processes and improve communication to staff of appointed internal and external leads.

Practice leaders told us they valued diversity in their workforce. There were policies and procedures to promote diversity and equality. We saw evidence of robust, fair and transparent recruitment policies and procedures. All but one member of staff had completed equality and diversity training. However, staff feedback was mixed and not all staff felt they were treated equitably. Some staff informed us they were expected to complete mandatory training at home as they were not given sufficient time at work to complete modules assigned to them. There was evidence that annual appraisals were undertaken and formal clinical supervision was provided. Some staff told us that adjustments had been made to support changes in their health.

The practice did not always have clear responsibilities, roles, systems of accountability and good governance. For example, an infection prevention and control (IPC) audit had been undertaken, and we saw action plans had been established. However, multiple actions had not been completed in the time specified. Although there were effective systems to manage and deliver high-quality, sustainable care, treatment and support to patients. Systems to effectively manage the staff team needed strengthening. Whilst some staff felt well supported, others reflected on the need for further training and improved leadership. Some staff were clear on the leadership structure whilst others were not. We discussed concerns raised with the leadership team who demonstrated a commitment to take further action to try and support staff and improve. Immediately following our assessment, we were informed leaders had spoken to all staff to encourage them to raise concerns both directly and through an anonymous staff feedback form.

The provider had established many effective governance processes that were appropriate for their service, including systems to support effective medicines optimisation and review of patients with long term conditions. Staff could access all required policies and procedures. Staff took patient confidentiality and information security seriously.

The practice clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The provider worked with other practices within their Primary Care Network (PCN) to offer extended access, develop improved ways of working and share resources to support the local population. Staff worked with community healthcare services, including through established meetings centred on the care of people who were housebound or had long term conditions.

There was a well-established patient participation group (PPG), which was supportive of the practice in driving improvements. The PPG acted as a channel for communication between the local community and the practice. We spoke with a member of the PPG who gave positive feedback about the practice. They advised they were working towards becoming more active and establishing more frequent formal meetings.

The practice 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. For example, they had invested significant resource in digital technologies to improve service delivery through the automation of patient recalls, capacity and demand planning to improve access and general management systems. The provider shared examples of quality improvement projects and audits they had carried out to improve care and treatment. Leaders reflected on difficulties in the recruitment and retention of reception staff. They discussed planned changes to staff roles to improve staff capabilities and reduce the risk of staff shortages in future. However, we also found that opportunities to learn and improve were not always fully embraced by the staff team.

There was evidence of a commitment to supporting learning and development in others. We saw staff had been supported with career development opportunities. Learning from significant events and complaints supported continuous improvement across the service.

The practice had invested in significant improvement work to the location in Desborough, with a conversion of the basement to provide 3 further clinical rooms. Leaders advised they were facing significant ongoing expansion in the locality through housing developments and were keen to maintain a sustainable service.