The Vale Surgery

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 good. At this assessment, the rating has changed to requires improvement.

The service was in breach of Regulation 17 (good governance) in relation to governance procedures.

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 service had a shared vision, strategy and culture. Staff reported that the practice had been thriving, friendly and patient‑centred. Staff explained that they worked closely together, valued one another’s strengths.

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. Staff understood the direction and culture of the service to be patient-focussed and high-quality care.

The service had 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, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff told us leaders in the practice were approachable and responded to any concerns raised. Staff told us that managers had “open door policies” and that they felt able to approach them for support at any time without hesitation. Staff described a leadership team that supported their wellbeing and professional development and promoted an open and learning‑focused culture where learning was encouraged when relevant to their role.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. Staff were aware of how to raise concerns, and reported leaders actively promoted a culture of openness and empowerment, encouraging staff to speak up and valuing their contributions. Staff told us they felt valued and confident to share concerns, and that these would be handled sensitively and confidentially. Staff were clear about who held the Freedom to Speak Up guardian role locally; however, this did not align with the details set out in the policy. Despite these inconsistencies, staff did not express hesitation in raising concerns and felt supported to do so.

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 were in place to support equality and diversity, and staff reported that leaders took steps to ensure they felt supported and able to perform their roles effectively. They also said the organisation was responsive to individual needs and made reasonable adjustments where required. These included adapting workspaces, providing tailored adjustments, and ensuring staff with health conditions had the appropriate tools to carry out their duties safely.

The service did not always have clear responsibilities systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes. During the onsite visit, we identified concerns with administrative oversight of daily practice schedules. These included some gaps in the system to monitor staff training, safe recruitment procedures and building maintenance such as completion of action plans recommended from risk assessments. Recruitment records were incomplete, and there were some instances where required training, such as fire warden training, had not been completed. Further gaps were identified through clinical searches, including some inconsistent application of patient safety alerts. In a small number of cases, we found that appropriate Medicines and Healthcare Regulatory Agency (MHRA) medicine safety information had not been provided. Immediate action was taken to contact these patients, and additional audit activity was undertaken following the inspection. We also identified gaps in protocols for managing patients who did not attend or respond to appointment invitations, which were not always followed in practice, including for vulnerable patients. Managers met with staff regularly to complete appraisals and performance reviews.Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. However, where minutes were available, they were incomplete, with discussions and outcomes inconsistently recorded. We raised these issues with the practice during the inspection. Shortly afterwards the practice informed us of improvements they planned to make in response to our findings.

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 practice engaged with patients through the patient participation group (PPG) and community sessions to support health education and prevention. Engagement was adapted to meet the needs of different groups, with targeted support for long-term conditions and immunisations. Patients were also supported through collaboration with the Primary Care Networks (PCNs) and social prescribers, including workshops and signposting to community activities to promote wellbeing.

Leaders focused on continuous learning and improvement across the organisation and local system. Leaders told us they had focused on making improvements to their systems and processes so they could provide better and safer care. However, this meant they had not engaged fully in innovation projects. The service provided evidence of clinical and non-clinical audits. All staff were encouraged to put forward and test out new ways of working. For example, they supported the nursing team to complete specialist clinical training, and they were supporting further development in this area.