East Harling & Kenninghall 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

This means we looked for evidence the practice was led effectively and in a way that was inclusive, supported improvement and innovation and made sure patients received care that was safe and effective.

At our last inspection we rated this key question Good.

At this inspection, the rating has changed to Requires Improvement.

Not all leaders were visible and this meant that there was not a clear vision for the practice. Staff did not feel supported by senior clinical leaders. Staff worked hard to provide care for patients but without the consistent leadership they required.

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.

Staff told us that they were not aware of a vision for the practice and that they had not been included in discussions regarding the development of the sites.

Most staff described feeling well supported by the management team of the practice but spoke of a lack of support and visibility by the clinical leaders. This was a recurring theme from the staff we spoke to who described the challenges of working with too few staff and limited clinical direction.

Leaders told us that they had plans for both sites to address the capacity issues.

The practice had a Statement of Purpose which included a mission statement, their purpose and their values. This did not align with feedback we received from staff and patients.

There was no business continuity plan provided to us by the practice.

Equality and diversity training had been completed by all staff.

Staff told us that they tried to support each other and we saw examples of this during our visit. They also shared that members of the management team were trying to resolve concerns around the working environment and staffing.

Leaders told us that they had awareness of the current challenges facing the practice. Some plans had started to be put in place to address concerns raised regarding access, but these were not yet fully embedded.

The lack of visibility of clinical leaders had a negative impact on staff perception of the support available to them. Staff told us a lack of consistent supervision impacted on their confidence and wellbeing. This had been exacerbated by absences and the use of locum staff.

Staff had access to protected time for training and development.

Regular staff appraisals and surveys were not in place.

Leaders had assigned areas of responsibility.

There were external Right to Speak Up contacts in place but staff who were aware of this were unsure that concerns raised regarding staffing and capacity would be addressed. Some staff were not aware that this was in place.

Staff told us that when they spoke with managers they felt listened to. Staff also said they had seen changes made in response to feedback and they felt they were able to raise concerns to the management team if needed.

Staff said that they did not feel confident that concerns raised to the clinical leaders would be addressed.

The practice had a Being Open policy which incorporated whistleblowing, Duty of Candour and Blame Free Culture. Contact details for the Right to Speak Up guardian was also included in this document.

Leaders told us that they accommodated reasonable adjustments for staff where required.

Staff told us that if they required a reasonable adjustment that they would feel confident that they would receive support from their direct line manager.

Staff were granted an additional day of annual leave in the month of their birthday.

There were policies in place to support Equality and Diversity and Equal Opportunities.

Training for staff included disability awareness, LGBTQ awareness and equality and diversity which all staff had completed.

Leaders told us that they did not have a risk register or a formal process to document and track risk. Although some risks were identified and discussed, we did not see evidence that these were being closely monitored. They had identified that actions assigned to staff members required tracking more closely.

Staff and leaders told us that there was a lack of consistent clinical cover. They were in the process of recruiting some additional roles. Most of the clinical work was covered by locums with minimal time provided by the partners. Staff told us that this made appropriate supervision and support of those carrying out extended roles difficult.

Staff described their working environment as challenging and that they were ‘trying to keep their heads above water’

During the inspection we saw that governance processes were not always in place or adhered to. We saw evidence that managers were in the process of ensuring these were reviewed and updated where necessary but that a great deal remained to be done. Any changes that had been implemented were not yet fully embedded but there had been some early positive feedback.

The practice had in place policies or protocols covering areas such as Confidentiality and Information Sharing, Information Governance and Environmental Sustainability Waste Disposal. These were very detailed and described clear pathways.

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.

Leaders told us that significant events and complaints were reviewed and discussed at practice meetings to learn lessons and make improvements and adjustments to care. Some staff told us that they were unable to view the minutes of meetings that they did not attend so missed information regarding improvements or learning from incidents. Staff we spoke to told us they were not always aware of incidents that had taken place.

Staff told us that they were given time for learning and development.

Staff told us that they did not have access to consistent clinical supervision by the partners which meant that opportunities for learning were limited. In the dispensary we saw good clinical supervision in place which staff valued.

Protected learning time was in place and mandatory face to face Basic Life Support training had taken place in the last 6 months.

There was oversight of the staff training records which was recorded electronically. Not all staff were trained in autism and learning disability awareness and there was no policy in place to determine what training each staff group required.

Learning was not always clearly or correctly identified in those incidents that we reviewed. We saw some events where the outcome was recorded as patient error when there had been a failure in process. This meant that steps to prevent recurrence were not taken.