Kingston Health 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

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 89 (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 very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

All leaders we spoke with demonstrated their commitment to achieving their vision and strategy. To achieve this the leadership had attended an external mentoring and leadership sessions. They used this to help shape and define their vision and purpose. Staff at all levels demonstrated understanding of the practice vision and commitment to the values. Values included taking ownership, having a person-centred approach and being team oriented. We saw multiple examples of staff displaying these values. We saw examples of how they considered the vision and values in their practice through their employment of new team members to how they appraised their staff.

All staff had contributed to the development of the practice vision and strategy, which was kept under review. All staff we spoke with confirmed that they knew the practice vision and strategy and were fully involved in implementing it.

There was a positive and compassionate listening culture that focused on learning and development. We reviewed staff feedback the practice had collected.

The practice was aware of the projected increase in the local population and was working to address future needs. They had processes in place to predict list size growth and recruited in advance of need. For example, they recruited additional GPs in the winter months where seasonal respiratory virus increased appointment demand. One had just started and two more were due to start in the new year. Leaders told us this approach was mirrored across all teams ensuring they had capacity to still function even if staff were unwell or took leave.

The service had exceptionally 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. The leadership team was very stable, and leaders had worked in the practice for many years. They had collectively worked together to increase the patient population from 6000 to 28500. Each leader had clearly defined roles and accountability aligned to their skillset.

Leaders led with integrity, openness and honesty. The leaders demonstrated they had created a strong staff culture through their leadership. One example we saw was that they completed additional training in specialist areas and encouraged and supported staff to do the same. Leaders told us that the encouragement for staff to develop, directly impacted on high retention rates. This resulted in low staff turnover, helping to provide long-term continuity of care for patients and demonstrated a strong staff culture.

Staff told us leaders in the practice was approachable and inclusive leaders who worked with their team to achieve the highest level of patient care. For example, staff valued the team meetings, informal coffee and lunch catch ups and weekly brunch sessions provided by the practice. Staff said they could discuss clinical queries and get advice to help them manage their decisions but also demonstrated inclusive leadership. During these sessions leaders listened to their viewpoints and showed “genuine interest” in team members well-being. The levels of engagement made staff feel a strong sense of belonging which boosted morale. Staff at all levels referred to the practice culture as a “family environment”, with support being provided by the whole team. All team members we spoke with felt they were given opportunities to contribute fully to decisions in the practice irrespective of their position.

Staff also told us leaders modelled the values of the practice. They described leaders as “exceptional”, “leading from the front” and as giving the “highest level of support”. All staff we spoke with at every level commented on the importance of the organisations values and stated that all staff they interacted with modelled these values.

The leaders in the practice presented as a united team, dedicated to providing compassionate and inclusive leadership. For example, they engaged well with the team and their views on what staff needed aligned with what staff told us. Each leader had clearly defined roles and their accountability aligned to their skillset. One leader told us that this helped to ensure the vision was “realised”.

The GPs with management and leadership responsibilities had protected time for these, they valued this time as it gave them an opportunity to reflect and focus on administration side of their role This ensured that they had “timeout” that was not patient facing. GPs told us they valued this time as it gave them an opportunity to reflect and focus on administration side of their role.

We saw the leadership team worked with other practices in the primary care network and were engaged in the development of primary care services within the local area.

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

The practice had established Freedom to Speak up arrangements with other practices in the GP federaton. The practice manager was the Freedom to speak up guardian. All staff we spoke with were aware of how they could raise concerns. They told us that they would feel confident to go to them with concerns. There was also an external guardian if staff wanted to raise concerns outside of the practice.

Staff we spoke with said that “managers have an open-door policy” and that colleagues were “supportive”, and they felt able to have difficult conversations if they were required.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Policies and procedures to promote diversity and equality were in place. The practice manager told us that they “celebrated diversity and championed inclusion”.

Leaders gave us an example of how they had identified that over a period of time all new GPs were trainees who had worked in the practice. They considered whether their workforce would be more diverse if they widened their recruitment drives.

To ensure this they strengthen their recruitment practices to ensure their adverts were circulated to a wider audience. They told us this eliminated structural bias and ensured equality of opportunity.

Adjustments were made for individual staff to ensure they were able to carry out their role, for example, saw adjustments to support disabled staff were in place.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The practice manager demonstrated excellent oversight of governance arrangements. This included having systems and processes for monitoring maintenance checks, staff training, recruitment and general risk management. There was a large staff team with over 40 members of staff. We reviewed a large sample of staff files, and all documents were available in line with their regulatory requirement. As were all documents relating to maintenance and risk which were also readily available and up to date.

Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. There were clear structure charts. All staff we spoke with were aware of the lines of responsibility. Managers had regular management meetings to ensure they maintained delivery of high-quality care. We reviewed minutes from these meetings and saw that risks and performance were discussed and planned for.

There was a management and accountability structure in place. Staff described it as a structure that allowed the leadership team to work “harmoniously”. It clearly defined roles such as staff responsible for monitoring targets, clinical and non- clinical areas, education and training, marketing, operations and prescribing.

Managers met with staff regularly to complete appraisals and performance reviews. We reviewed records and all staff consistently had annual appraisals. In addition, all GPs had regular mentoring sessions with managers.

The provider had established governance processes that were appropriate for their service. Staff could access all required policies and procedures.

There was a range of meetings with staff, during which they discussed clinical, non-clinical concerns and emerging risks. This included general practice meetings, GP meetings, clinical staff meetings, reception meetings and managers meetings. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Staff confirmed that they found meetings “valuable” and that minutes were circulated in the event they missed a meeting.

Staff took patient confidentiality and information security seriously.

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

The provider worked with other practices within their primary care network to offer extended access, and flu and covid vaccination programmes. They hosted enhanced access on behalf of the PCN at the weekend. This helped to ensure all patients in the PCN received a seamless service.

Staff had made adjustments to improve coordination of their service with community healthcare services, including through recently established weekly meetings centred on the care of those at higher risk of hospital admission. They had multidisciplinary meetings every two weeks with community providers such social workers and other specialists relevant to the patients being discussed. These meetings were instrumental in ensuring seamless service for patients through the various care pathways and systems. For example, staff told us that when they discussed patients’ needs in these meetings this helped to identify timely movement from general practice care to palliative care team.

The practice had worked with community partners on an outreach project. This involved doing a joint visit with outreach workers in the most deprived areas of their catchment area to access patients and identify and respond to any unmet needs.

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 and research.

We saw numerous examples of how the practice encouraged learning and development amongst all staff groups. For example, most staff at the practice had experienced some form of internal career progression due to the support and development opportunities available. For example, some staff had started in non-clinical roles and developed to progress to the clinical team having completed necessary training. Others had progressed from administration into management roles.

All GPs were part of a mentoring programme, which sought to help them specialise in a particular area or build confidence. For example, a GP was supported to develop their interest in women’s health and lead in this area.

We saw examples of innovation in the practice. One area of innovation was the development of a podcast, “Whalepod” dedicated to learning and development. Two GPs were supported to develop the podcast which served as an educational tool for the whole team. Staff contributed to recording podcasts on their area of specialism or interest. They also had guest speakers record podcasts, for example a consultant cardiologist and a psychiatrist on topics of interest. All staff we spoke with commented on how beneficial the podcast was in supporting not only their learning stating it was also beneficial for their well-being. They felt it was innovative for learning. One member of staff said, “it’s great I can listen to the podcasts when I am out walking or exercising”.

The practice had a quality improvement plan in place to help drive improvements in services. This document outlined how they planned to improve care for patients and ensure staff were well supported. We saw patients were consulted and had contributed through surveys relating to dementia, carers needs and improvements to the diabetes process. The practice reviewed the results of the Friends and Family Test (FFT)

The practice had many initiatives relating to sustainability. This included converting to LED lighting, signing up to the cycle to work scheme (and supplying bike storage facilities) and encouraging staff to take public transport. They had an in-house “Green Team” lead by a member of the team. This included robust recycling systems, including a project to move towards exclusive use of rechargeable batteries. They had worked to improve green prescribing by switching to dry powder inhalers and low carbon salbutamol inhalers. This change has seen them move from the 95th to 15th percentile on the environmental impact of inhalers scale.