Brune Medical Centre

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

Well-led - 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 Good. At this assessment, the rating has remained Good.

This service scored 75 (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 and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The practice worked in partnership with the Hampshire and Isle of Wight Healthcare NHS Foundation Trust to provide support with the strategic ambitions and evaluation of performance as a group.

Staff told us there was a positive team culture within the practice and that they felt supported by GPs and senior leaders. They told us they were able to contribute to discussions about service improvements, incidents and complaints. All staff we spoke with were proud to work for the service and had a vision to deliver high quality patient care.

There were established and effective systems in place to promote a positive culture of learning, collective best practice and performance. There was a practice mission statement developed by staff during annual practice TARGET training sessions. TARGET is a scheme aimed at improving patient care by learning new skills, sharing best practice and incorporates quality improvement activities. The practice mission statement and values were available and accessible to staff. Positive learning culture was demonstrated through meeting minutes which showed that performance, incidents, patient feedback and complaints were routinely discussed.

There were established and effective processes and systems in place for leaders to share their vision, practical experience and support with colleagues. This was achieved formally through supervisions processes, monthly governance meetings and clinical discussions. This was also achieved informally through being accessible to clinical and non-clinical staff if they had queries and required support.

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.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they were confident to raise concerns either via their management or the Speak up guardian. They reported that they felt able to raise concerns with leaders without fear of retribution and they knew how to access the whistleblowing policy. We received staff feedback as part of the inspection process which highlighted there was an ‘open door’ policy and leaders welcomed feedback for service improvements.

There were established and effective processes in place for staff to speak up without fear of reprisals. Staff could raise concerns internally and externally to safeguard the safety of people. There were opportunities for staff to raise feedback about the service through the annual staff feedback survey. Actions had been taken in the last feedback survey and were raised during governance meetings. Staff were offered an employee assistance program (EAP) and the practice had access to occupational health services to support staff with their job roles.

There was a zero-tolerance policy in relation to the abuse of staff with mechanisms in place to protect people and minimise the likelihood of reoccurrence.

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 demonstrated clear responsibilities and accountability, with established systems in place to support decision-making, risk management and improvement planning. Risks were effectively identified, assessed, and mitigated in most key areas, including business continuity, staff training and recruitment, and information governance. However, practice processes did not always identify or rectify instances where patients were either not appropriately reviewed or monitored in accordance with guidelines for safe prescribing, particularly involving high risk medicines. As a result, people’s care and treatment were not consistently monitored to ensure the continued safety of their prescribed medicines. In addition, the management of patients with diabetes was not always aligned with evidence-based guidelines. For example, annual diabetic reviews were sometimes overlooked and confirmed diagnoses were not always correctly coded. The service had implemented plans and begun addressing these shortfalls. The service held monthly governance meetings to monitor prescribing of medicines, performance of clinical searches and discussed viable improvements to internal processes. The service has also met with patients and their families, undertaken investigations, including after-action reviews (AARs) and this included the practice risk register for oversight. There are also quarterly governance meetings to review themes and trends.

Staff told us that leaders were receptive to feedback and wanted to improve services to people. They had access to policies and procedures to support them within their role and attended regular meetings about the practice, where complaints and significant events were discussed. Leaders told us about the ways in which they monitored and mitigated risks, through risk registers, assessments and improvement planning. The practice held monthly governance meetings to address service performance. This included, audit activity, risk management and health and safety.

Information was stored securely in line with digital security standards with relevant information was made available for patients to access in line with privacy, consent notices and general data protection regulations.

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.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice, research and a project to test new ways of running clinical trials in conjunction with Hampshire and Isle of Wight Healthcare NHS Foundation Trust. For example, the practice contributed to ongoing research into memory disorders including Mild Cognitive Impairment, Alzheimer’s Disease and Dementia with the aim to better prevent, diagnose and treat these diseases.

Staff and leaders told us they had strong relationships with healthcare professionals within the local community to support care provision and joined-up care. Staff spoke positively about the work that was happening in the local community, and were proud to have made an impact. Feedback from community providers highlighted positive experience working with the practice, including a collaborated approach to monitoring and providing care and treatment for patient’s needs, such as patients with poor mental health and for end-of-life care.

Leaders demonstrated examples of quality improvement activity. For example, the practice implemented dedicated frailty clinics, which provided a specialised service managing patients with mental health conditions. Its purpose was to assess patients' progress, treatment plan reviews, ensuring medication efficacy, and addressing any challenges or concerns in patient care. During frailty health review appointments, safety alerts and monitoring processes, including quality outcomes framework (QOF) parameters were actioned, such as blood tests, blood pressure checks, annual electrocardiograms (ECGs), adjustments to medication, outstanding vaccinations, anthropometrics (such as height and weight) were recorded and reviewed. As a learning point for future clinics, the practice considered clinical staff arrangements and ways to reduce did not attend (DNA) rates. Staff told us patients found these clinics provided positive outcomes for long-term management, and maintaining mental well-being.

The practice incorporated the GP Improvement Programme (GPIP) as a strategic tool to review the existing access appointment model into a ‘Continuity Care Teams’. GPIP is a 20-session programme, run over 6 months, with an NHS England’s contracted delivery partner. The practice was assigned an experienced Quality Improvement (QI) practitioner/facilitator. GPIP looks at a variety of practice areas including access, capacity management, clinical and back-office functions and the processes around how a practice operates.

The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. For example, there was a clear plan for conducting clinical and non-clinical audits, with dedicated leads for each audit area. Outcomes and learning were shared with staff to ensure future best practice was applied.

The pharmacy team leads were interviewed as part of a series of podcasts by an external healthcare provider about supporting innovation in general practice. The interview discussed how the Willow Group pharmacy team used strategic staff deployment to ensure comprehensive care, while specialisation and ongoing training enhanced service offerings. It has stimulated more than ten GP practices/PCNs to contact the team to discuss how this work can be applied to their practices.

The provider was listed as a training practice which helped support and mentor GP registrars, advanced clinical practitioners and trainee pharmacists. There were 2 GP trainers assigned as mentors and the practice worked with the University of Portsmouth regarding tutorial support for medical students. This helped to improve the local health economy by developing clinicians with ambitions to retain staff for the long-term resiliency planning.