Wrenbury 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

The practice had a well-established, inclusive, and positive learning culture that consistently drove improvements in outcomes for patients and the wider community. Learning was both shared with and gathered from partners to support this.

There were clear examples of how a supportive and collaborative leadership style had led to better safety, more integrated care, greater sustainability, and a stronger focus on meeting people’s needs and addressing inequalities—both for staff and for patients. Governance and management systems helped leaders keep track of risks, performance, and outcomes. Leaders made ongoing efforts to improve how services were delivered, using feedback from staff and patients to reduce risks and enhance care. They also clearly understood and demonstrated their responsibility for maintaining a strong safety culture, which was evident in day-to-day practice.

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 shared vision, strategy and culture which was based on transparency, inclusion and engagement. The provider and leaders understood the challenges and needs of people and their communities and worked strongly with partner agencies to support people effectively. Feedback from those organisations was extremely positive.

Staff demonstrated a shared vision to provide a high quality, patient centred service that was responsive to people’s needs. All staff we spoke to, without exception, felt positive about working at the practice and feedback from staff questionnaires was consistently positive about their working environment and about their leaders. They described good teamwork and a service that was clear on its function to work in the interests of patients, providing the best patient experience they could.

Patient learning time (PLT) was consistent every month for all staff. In particular we saw evidence of clinical learning events for existing and trainee staff which was organised by the partners weekly over a three year period. We spoke with staff who were highly motivated and consistently felt well-supported by leaders.

The service had inclusive leaders at all levels, specifically the providers, who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. They had high levels of credibility and consistently demonstrated during the assessment how they achieved what they set out to do. It was evident that patients were at the heart of everything the practice did and leaders demonstrated the importance of staff wellbeing to support them in maintaining good outcomes for patients.

Friends and Family data was consistently high with less than 1% negative feedback in 12 months. More than 650 Give Feedback on Care (GFOC) responses were consistently positive about the entire service.

Leaders worked with patients, staff, and partner organisations to gather feedback on their management and communication and responded to it. They demonstrated during the assessment how they made changes for the better wherever they could. Responses, from patients, staff and partners both to the practice and directly to CQC, were consistently and extremely positive. Leaders invested (both financially and with time) in learning and development for all staff and developed tools to assist staff to achieve best practice on a daily basis.

All staff without exception spoke of an open, blame free, inclusive environment and everyone without exception said they felt happy to speak up if and when required. There was a Freedom to Speak up (FTSU) Guardian within the Primary Care Network (PCN) and all staff said they were aware who that person was. Staff knew how to raise issues, said they felt confident to do so and felt their concerns would be acted upon. Leaders demonstrated how they encouraged staff to raise concerns and promoted the value of doing so. They referred to staff speaking up as “a gift to help them identify opportunities for improvement that they might not otherwise know about.” We saw FTSU posters displayed around the physical environment.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by supporting equality and diversity for people who worked for them.

Reasonable adjustments were made to support staff to carry out their roles. Staff with caring responsibilities were actively supported with a flexible approach and changes to schedules to accommodate their needs. Staff had completed training in equality, diversity, and inclusion and were aware of supporting people with protected characteristics such as age, gender, religion, or disability. We saw and heard of no concerns with regards to workforce equality at any level including the recruitment of staff. The practice had an equality, diversity, and inclusion policy.

Governance was extremely well-embedded into the running of the service. Information about risk and performance was shared proactively and there were robust systems for capturing data. These systems demonstrated the ability to provide excellent quality information for relevant data or submission requirements such as the practice’s CQC assessment.

The provider used data to monitor performance and quality, which was discussed monthly during protected learning time with all staff. Topics included incidents, near misses, patient feedback, complaints, inherent risks, patient care and treatment, and best practice. Most sessions included an external speaker to inform, share experiences, or present learning the practice could use to improve outcomes.

A regular suite of searches of the clinal record system were being run to identify patient needs and ensure these were being met and our review of clinical records showed that this was effective.

Staff knew where to access all required policies and procedures and understood the importance of patient confidentiality and information security. There were arrangements for identifying, managing, and mitigating risks and a major incident plan was in place. The provider had established governance processes that were appropriate for the service.

All staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. Staff and leaders actively monitored and anticipated current and future risks to delivering the strategy, including relevant local factors. All staff understood and were actively engaged in action plans to prevent and manage risks. Members of the team told us that communication not only encouraged learning and development but was effective in increasing production and positive outcomes for the patients and the whole community.

Leaders offered competitive employment packages, including bonuses, to retain staff and demonstrate their appreciation.

The provider fully understood their duty to collaborate and work in partnership, ensuring services ran smoothly for patients. They regularly shared information and learning with partners and worked together to drive improvements. Leaders consistently collaborated with other practices in their Primary Care Network to deliver extended access and ran flu and COVID vaccination programmes. There were many clear examples of how partnership working had improved patient outcomes and how best practice had been shared across the wider organisation.

They also worked closely with external stakeholders, commissioners, and partner agencies to develop and deliver effective services. Staff not directly employed by the practice consistently described an inclusive environment where they felt fully part of the team. The practice was also supported by a Patient Participation Group (PPG).

Their engagement with the Travelling Community and best practice was also shared Cheshire-wide for others to learn from.

The practice had a strong and long-standing culture of continuous learning, improvement, and innovation, shaped by evidence and local need. This led to better outcomes, fairer access, and a better experience for patients.

Leaders and staff were proactive in sharing ideas, taking part in research, and using good practice to improve care. They regularly listened to feedback from patients and the community, using it to shape and assess new ways of working. Leaders also invested time and resources to support staff and encourage collaboration with patients. The practice undertook a project with the PCN musculoskeletal (MSK) therapist to educate staff and increase the number of first contact referrals. They successfully increased the number of patients referred directly to MSK via reception from 40% to 69% (9% higher than the required target). They identified that this education of staff and direct referral system significantly reduced the pressure on GP appointments. The project was shared PCN-wide.

Wrenbury Medical Practice demonstrated a strong commitment to research, recognising its value in driving innovation, enhancing effectiveness, engaging both patients and staff, improving data quality, and supporting financial oversight. The practice appointed a Clinical Research Lead and actively participated in three research studies, including the prevention of depression in high-risk adolescents, the impact of movement on glycaemic control in sedentary individuals with type 1 diabetes, and patient-led completion of electronic data for those living with and beyond cancer. The team had well-established processes to reflect on both successes and concerns, ensuring that actions were taken and meaningful changes implemented to prevent recurrence and continually improve patient care.

Their quality improvement projects with the nursing home demonstrated enhanced care planning and more coordinated care for patients. The initiatives resulted in fewer calls between ward rounds, more proactive patient management with appropriate escalation plans, and improved processes around end-of-life care.

Staff had time and support to build their skills in improvement and innovation, and there was clear evidence of this being put into practice. Everyone was encouraged to come forward with ideas and take ownership of change, with innovation seen as part of everyday work.

They also built strong links with outside organisations and took part in technical research to bring in fresh ideas. What they learned was put into action, helping the practice keep improving and stay up to date with best practice.

The leaders developed the Wrenbury Medical Practice Intranet and Digital Information Portal, a robust document management system designed to support clinicians with up-to-date resources on topics including medicines management, referrals, and end-of-life care. This system proved especially valuable for GP registrars, trainees, and locum staff.

Monthly PLT sessions were used to discuss learning opportunities to enhance patient outcomes. For example, 2 members of the learning disability team were invited to share their experiences, helping staff improve their understanding and approach to treating patients with learning disabilities. All learning was consistently documented, stored, and made accessible for ongoing reflection. The quality and depth of this documentation demonstrated a clear commitment to meaningful and sustained learning across the practice.

The PCN had secured funding and the practice had applied to embark on an initiative to demonstrate the value of proactive case management and case finding for those who were frequent attenders to accident and emergency or high risk of hospital admission. By proactively identifying those individuals and providing a holistic case management approach, there was a vision to radically reduce the use of urgent care and emergency admissions. Once undertaken this will be monitored and reviewed over a period to determine its efficacy.