Tower House 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.

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 and engagement. Staff feedback referred to the culture of the service as friendly, inclusive, and supportive, with a strong emphasis on teamwork and mutual respect. Staff reported the service was an enjoyable place to work, where people supported one another and morale was generally good, although not without its challenges. Some comments reflected the emotional demands of the role, especially in the reception team, where difficult interactions with service users could affect mood. Staff said they felt supported from management during these incidents. Despite occasional pressure and dips in morale, the overall atmosphere was seen by staff as improving, with signs of growth and a commitment to maintaining a healthy, welcoming environment.

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, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. Some staff told us leaders in the service were approachable, however, some staff also told us they did not always feel able to enter the management office and did not consider the management team as always available. The provider was given feedback and confirmed it would consider how changes could be made so all staff felt they could approach leaders freely. However, staff also told us leaders modelled the values of the service. We saw the leadership team worked with other services in the primary care network and were engaged in the development of primary care services within the local area. Training was ongoing, with staff completing relevant e-learning and inductions, though some called for more training in managing difficult situations.

People did not always know who the Freedom to Speak Up person for the service was so their voice would be heard. Although the service had its own internal Freedom to Speak Up guarding, the service had not considered the lack of impartiality of this may mean. Staff therefore did not have access to an external Freedom to speak up contact should there be a need to speak to someone outside of the service. Staff did not raise any concerns about needing to raise concerns.

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. We saw examples of how adjustments had been made to enable staff to work effectively at the service, for example, adjustments were in place for staff who needed specific work equipment.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Leaders had not met with staff regularly to complete appraisals, clinical supervisions and performance reviews in line with their own policies. Whilst relevant national safety alerts were identified and shared with clinicians, the associated guidelines were not always being implemented consistently, for example there was a lack of oversight with medicine monitoring reviews and the ongoing management of safety alerts. In addition, oversight of staff recruitment records and fire safety processes had not identified the issues as found during this assessment.

However, staff could access all required policies and procedures. Leaders held regular service meetings with staff, during which they discussed clinical concerns and emerging risks. Leaders also recorded any actions arising from these meetings and ensured they shared these with staff. Staff took 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 services within their primary care network to offer extended access, and flu and covid vaccination programmes. Staff had improved co-ordination of their service with community healthcare services, through recently established weekly meetings centred on the care of those at higher risk of hospital admission. The service had access to a social prescriber who provided non-medical support in the local community, for example, helping people to access local support groups. The service had undertaken a joint community initiative focusing on supporting people recently released from prison It was identified recently released people faced poor health outcomes, including higher mental health needs, and by offering people an opportunity to register immediately, without the need for identification or an address, created a safe space to pursue support.

The service offered mental health practitioners who played a significant role in enhancing both access to and continuity of care for people across the local community via the primary care network it was part of. The service was also responsible for the assessment of local people who had contacted the national NHS111 service. The service offered a clinical assessment service for urgent, on the day, remote consultations, thereby helping to reduce unnecessary attendances at A&E and urgent treatment centres. This approach not only alleviated pressure on emergency services but also ensured people received timely support in the most appropriate setting for their needs.

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 safe, effective service and research. The service was involved in the education and training of doctors and recognised as a GP training service. The service had undertaken a refurbishment project to create a phlebotomy department within the service. This provided a more focused space and easier movement of people coming in for blood tests. Staff we spoke with shared they considered the service to be forward-thinking and open to innovation, with staff feeling valued and supported in their development.