The Nile 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

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 legal regulation in relation to effective systems and processes to ensure good governance.

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. 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 had not contributed to the development of the practice vision and strategy however, most staff were aware of it. The practice’s vision was displayed within the practice and highlighted the need to provide safe, caring, kind and supportive care for people using the service.

The new leaders were aware of the areas that needed to be addressed and responded to them as they identified them. The service worked closely with partner agencies such as the Primary Care Network to address future challenges.

Staff were extremely positive about the culture within the practice and described it as open, caring, professional and supportive. Staff felt they were encouraged to raise concerns, they were listened to and action was taken to address them.

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. Staff were extremely positive about the new leadership structure and the support it provided for staff. Staff told us that leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff told us leaders in the practice were visible, very approachable and responded to any concerns raised. Staff also told us leaders modelled the values of the practice. 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 very positive culture where people felt they could speak up and their voice would be heard.

The practice had established Freedom to Speak up arrangements both internally and externally to the practice. There was a poster in the practice to make staff aware of the support and details of who to contact were in the whistleblowing policy.

The service valued diversity in their workforce. They worked 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. Adjustments had been made to ensure all staff were valued. For example, a member of staff told us that due to personal reasons they requested a change to their working rota and this was accommodated.

Staff described an open and positive working environment where staff felt everyone was valued and supported. They told us there was a friendly, inclusive team atmosphere. Staff also told us there was a no-blame culture at the service.

The service had clear responsibilities, roles and systems of accountability however, governance processes needed to be strengthened to address the issues the provider had identified within the practice and to deliver good quality, sustainable care, treatment and support. Risks within the practice were not always assessed or action plans, to mitigate risks, had not always been put in place.

The service had not fully established effective governance processes that were appropriate for their service. During discussions with leaders, it was clear they were aware of the gaps in the service however, an overarching action plan was not in place to capture this or identify how changes were going to be made and the effectiveness of the changes monitored. For example, action plans to mitigate issues identified in the infection prevention and control (IPC) audit did not address all the issues. In particular, cleaning of carpets, non-wipeable seats and overflows in sinks. There was no action plan for the Cannock practice. Documentation to support the analysis of significant events and complaints lacked detail and trends in significant events had not been completed. Systems to identify people with previously undiagnosed conditions such as chronic kidney disease were not effective because coding had not always been correctly added to people’s records to ensure they did not miss essential monitoring.

A risk log was not in place to record risk and ensure risk assessments were completed and acted on. For example, legionella risk assessments. There was no evidence the provider had checked the fire risk assessment at the Hednesford practice. Service wide Control of Substances Hazardous to Health (COSHH) risk assessments were not available. A complete list of staff immunisations against potential healthcare acquired infections was not available for all members of staff and risk assessments to mitigate potential risks had not been completed.

The required documentation to demonstrate when safety procedures had been carried was not always available. For example, audits of the prescribing of non-medical prescribers, clinical supervision and fire safety drill records.

However, leaders and managers supported staff, and staff we spoke with were clear on their individual roles and responsibilities. Lead roles were displayed throughout the practice, and staff referred to these when required.

Managers met with staff regularly through clinical and staff meetings. Staff could access all required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Staff took patient confidentiality and information security seriously.

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

The provider worked with other practices within their primary care network to offer extended access. Staff had made adjustments to improve coordination of their service with the palliative care team, care co-ordinator and social prescriber.

The service worked closely with the Patient Participation Group (PPG) to work with the patient population. A representative from the PPG told us the practice listened to their concerns and acted on them.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to effective practice. For example, a practice nurse had developed a leaflet for people with diabetes to make them aware of the importance of attending for their diabetic foot check. A GP had provided a learning session for staff in the identification of rashes. A blood pressure machine was available in the wating rooms for people to monitor their own blood pressure. The results were monitored and coded by the practice nurses.

The practice used significant events and complaints to drive improvements within the practice. Learning was shared with staff at regular team meetings. They used clinical audits to drive improvements in patient care. For example, management of medicines, palliative care and referrals for cancer.