Heathcot 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.

Staff understood the health needs of the patient population and worked to improve health outcomes for minority groups. However, the practice lacked assurance in governance around completion of delegated tasks. They had failed to establish effective oversight processes to ensure a high quality of care was provided.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating remains the same.

The service was in breach of legal regulation in relation to good governance.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

There was a positive culture within the practice and staff teams worked together to treat patients with dignity and respect. However, some staff reported that leadership could be more accessible and responsive to their needs.

Not all leaders understood the context in which the practice delivered care, treatment and support. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Feedback from staff about management was varied, with some reporting they felt well supported and listened to, whilst others stated that communication and leadership could be improved. The practice had many long-term employees but had experienced a recent high turnover in the management team.

Since the last inspection, changes to the leadership team included a new Practice Manager and a new deputy Practice Manager. There had also been changes within the GP partnership. This new leadership team had not yet established governance processes that were clear, effective or embedded. Leadership of the practice demonstrated a lack of understanding about how to manage and mitigate risk.

Staff told us that communication from leaders within the practice could be more effective, particularly around changes made to clinical and non-clinical areas which are applicable to staff.

The practice told us they fostered a positive culture where people felt they could speak up and their voice would be heard. Staff feedback about leadership visibility and approachability was mixed. Some staff told us that leaders in the practice were visible and approachable, while others said they did not feel this was consistently the case.

The practice had established Freedom to Speak up arrangements and staff understood why this was important. There were policies and processes to support speaking up. Staff were aware of how to raise concerns and understood there was the option to approach practice management. There was also an arrangement with a designated member speak up guardian through the local Integrated Care Board (ICB).

The practice valued diversity in their workforce, and told us that, across the staff team, more than 20 languages were spoken, which enabled them to support patients in an administrative capacity, such as assisting them to make appointments. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff had completed mandatory training around equality and diversity, and policies and procedures to promote diversity and equality were in place.

We saw examples of career progression being supported by the practice. For example, one person had started their employment as a receptionist and progressed to a management role.

The practice did not always have clear responsibilities, roles, systems of accountability or good governance. They were unable to act on information about risk, performance and outcomes because oversight processes were not clear, effective or embedded. Leaders demonstrated a lack of understanding about how to manage and mitigate risk using the clinical systems designed for this.

Delegated tasks were not effectively monitored to ensure they had been completed. While responsibilities for various processes were allocated to individuals, management were unable to provide assurance that these were being followed to maintain patient safety around referrals and follow-ups from secondary care. Following our inspection, the practice provided documentation detailing their plans to improve their oversight of these processes.

Managers, who were new in post, were working to create effective systems for governance around recruitment and training. We found these systems were not yet entirely effective or embedded. The process for storing recruitment records was not consistently maintained and gaps were found, for example, a disclosure and barring check for a new member of staff was missing, and some training records were incomplete.

We also found records of staff immunisation contained gaps. This meant management were unable to ensure safety around protecting patients and staff from preventable spread of infection. These issues had not been identified and highlighted lack of adherence to regulatory requirements. Leaders demonstrated awareness and insight regarding these risks when we brought them to their attention. They provided assurance they would take action to address and mitigate these risks.

At the time of inspection, the provider’s registration details were incorrect. Corrective action had been initiated, and the update process remained ongoing following our visit.

Practice and staff group meetings were held regularly, and systems were in place to review practice and individual performance. Significant events and complaints were investigated and logged appropriately, and lessons learned were shared with staff.

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

The practice had identified minority groups within their patient population and understood the health inequalities they faced. Staff had organised health and wellbeing events at local religious settings to provide education and promote health screening and vaccinations to these groups. They had also held an educational event for patients who struggled with technology, to help them better understand the NHS app and how to use it to access healthcare.

Relationships with various community services were maintained to ensure patients received co-ordinated care and staff regularly met with providers. For example, palliative care team meetings were held to discuss relevant care needs and improve outcomes for specific patient groups.

There was a small but active PPG (Patient Participation Group) that met with practice staff three times a year. Members told us that they felt able to raise concerns and make suggestions about the practice and its processes. They felt confident with the new leadership team’s commitment to improving the service for its patient population.

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.

Trainees were supported by the practice in several different areas including ANPs (Advanced Nurse Practitioners) and we saw examples of existing staff benefitting from career progression within the practice.

As early adopters of the total triage system for appointment access, the practice continued to monitor the effectiveness of this provision. (A total triage system is a way of managing patient requests where patients are first assessed so they are directed to the right care, at the right time, by the right professional). Review of the processes were ongoing to ensure patient experience was optimal.

A health and wellbeing coach role was created and funded by the practice to identify patients needing assistance with weight management within the diabetic patient group. Patients were able to take part in a structured health coaching programme. The health and wellbeing coach was able to tailor advice and support to take account of individual needs, such as observance of religious fasts. An audit of this activity demonstrated positive outcomes, including improved diabetic control, reduction in weight and blood pressure and increased patient engagement with services. The learning and patient impact was shared more widely with local commissioners and GP practices. The local commissioners were supportive of the role and funded an additional 3 health coaches in local practices, who were managed by the health and wellbeing coach from this practice.