Tottenham 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 assessed all quality statements for this key question and rated the practice requires improvement for providing well-led services. This was because the practice did not always have effective governance processes for identifying and managing all risks, issues and performance. We recognised that there had been improvements to the practice since our inspection, and staff feedback was positive about working at the practice. However, as some of these changes were recent or yet to be made, the provider was unable to evidence improvements were embedded or sustained. 

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff we spoke with were able to describe how they responded to patient needs in a holistic manner. Some staff showed knowledge of the practice’s vision and values, whilst others’ knowledge was very limited. Senior leaders demonstrated awareness of the local demographics and adapted access needs accordingly.

There were processes to plan for the changing demands of the local population. For example, a new appointment system was implemented in September 2024. The GP partner recognised that at times they were unable to cope with their managerial responsibilities, and the practice required more senior clinical staff. To address this the practice had applied for a merger with a neighbouring practice.

Staff told us there was compassionate, inclusive and effective leadership at all levels. They told us they were mostly happy with the communication at the practice. However, some staff were concerned that the future leadership of the practice was unclear and unsustainable. Not all staff were aware that there was an application to merge with another practice.

There was a business continuity plan in place which was reviewed in the past 12 months. Records showed staff had received an annual appraisal or had a date scheduled. The practice had put in place job descriptions for all staff and had ensured staff were aware of their roles and responsibilities. A review of a sample of staff files found the practice was following an improved recruitment process. Staff had access to training and development.

The practice had a whistleblowing policy in place and all staff we spoke with knew how to access this. All staff members spoken with reported they felt able to raise concerns to senior leaders without fear of retribution. Staff we spoke with did not know who the Freedom To Speak Up Guardian was.

Practice policies did not contain the name of a Freedom to Speak Up Guardian. Guidance from NHS England (Freedom to speak up in Primary Care, 2016) states that primary care providers should name an individual as the Freedom to Speak Up Guardian who is independent of the line management chain. Without this information, staff may not know how to raise concerns, or where to seek advice and support, particularly if their concern is about someone senior in the practice or their direct employer. If concerns about patient care are not addressed, there is a potential risk of harm to patients.

Staff spoken with reported they felt respected within the practice and stated that colleagues would support one another. Staff explained that each colleague offered different skills and experience (both from current and previous employments), and individual input was valued amongst the team.

All staff had completed recent training on equality, diversity and inclusion. Staff had access to continual professional development, support and mentorship. Equality, diversity and inclusion was discussed during practice meetings.

Staff told us about the governance processes used to monitor the care provided, the quality of the service and also safety of the service. They informed us about processes to monitor long term conditions management, medicine reviews, infection control and medicine management including emergency medicines and equipment.

The practice did not always have clear responsibilities, roles, systems of accountability and good governance. The provider’s quality assurance processes had failed to identify shortfalls with; medicines management; review of patient’s long term health conditions; patient specific directions; health and safety risk assessments; fire risk assessments; and the monitoring and allocation of blank prescriptions. Prompt action was taken after the assessment to address all risk to patients, staff and premises. These changes need to be monitored and become embedded in practice.

Staff spoken with during the assessment had knowledge of local services and were able to describe where they would signpost patients to for further support. The practice worked in collaboration to meet the needs of their patients. For example, staff were able to describe how they would discuss complex cases at multi-disciplinary team meetings. The practice adopted a multi-disciplinary approach in attempts to engage with non-responding patients. For example, enlisting the support of the administrative staff.

Leaders explained they held multidisciplinary team meetings to discuss and improve outcomes for people with complex needs. Leaders told us they collaborated with stakeholders and held meetings engaging with district nursing, palliative care and health visitors. Leaders explained how they collaborated monthly within their Primary Care Network (PCN) by holding PCN meetings and sharing information.

The practice had processes to manage people’s care in co-ordination with NHS 111, care homes, GP out of hours and other external services. The practice worked closely with other practices to identify and improve local health inequalities. The practice had an active Patient Participation Group (PPG) who met with the practice management team on a quarterly basis. We spoke to one member of the PPG, who spoke positively about the practice team and stated clinical and non-clinical staff listened to and involved patients.

Staff told us leaders supported them in their development and encouraged them to take up learning opportunities. Staff were given allocated time to complete mandatory training, were offered additional training and were encouraged to suggest improvement ideas. Leaders told us they sought staff views through meetings and individual conversations. They were passionate about implementing innovative ways to manage and address the challenges in primary care.

There was evidence of systems and processes for learning, continuous improvement and innovation. Significant events and complaints were used for learning and improvement at a practice and provider level. The practice also used patient views to improve services, including through the friends and family test, the local practice network patient participation group, complaints and compliments.