The Fairfields 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 good. At this assessment, the rating has changed to outstanding. This meant the service had exceptionally 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 always did so with integrity, openness and honesty.

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 very clear shared vision, strategy and culture. This was based on candour, respect, innovation, safety, being a pro-active service, and remaining patient focused. There were 5 long standing GP partners providing primary care in a diverse, inner-city area of Nottingham which had a young population and high turnover of patients. There was a clear mission statement, and their aims and objectives included reducing health inequalities, optimising care and acting as patient advocates. The practice initiated and hosted the ‘Deep End Notts’ group of practices in Nottinghamshire who are in highly deprived populations who are committed to provide equitable services to people living in areas where traditional general practice initiatives do not suit their patients. The Group worked with the National trailblazer scheme, and the phoenix team in the setting up of a Nottingham Trailblazer fellowship, this is a fellowship for recently qualified GPs to work in practices in areas of socio-economic deprivation; participation in the Care Quality Commission’s report on the impact of regulation on ethnic minority-led GP practices and co-production work with NHS England.

Staff were positive about the culture within the service and described it as open and transparent. This was supported by the leaders’ views of a democratic approach to decision making. Health and wellbeing were a priority, encouraging lifestyle changes and preventative care to improve long-term health outcomes. Activities to promote it were planned as part of the practice strategy. For example, the practice team held a walking challenge to achieve 4 million steps in July 2024 to encourage exercise both in and out of the workplace.

We saw evidence of strategic planning in the form of meeting minutes and action plans developed by the practice. We saw evidence that these action plans had been implemented. Leaders also told us about future plans for the practice, and the work that had already been done in the planning of this strategy.

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 were acutely aware of the differences in life expectancy, with their population having a 15-year age gap between themselves and areas of lower deprivation levels in the Nottinghamshire area. This was evidenced by the average of 72.9 years of people registered with the practice who died in the last year. Leaders responded to this by proactively tailoring services to suit their population and continually analysing information accessible to them to meet needs.

The practice manager was awarded a certificate as ambassador of the NHS England initiative to tackle health inequalities and promote equity called the Core20PLUS5. This was awarded to people who undertake specific training and demonstrate a commitment to achieving optimal outcomes for all, including people living in areas of high deprivation, ethnic minority communities and inclusion health groups.

There had been recent promotions within the team and upskilling of staff to support progression and build resilience within the management team. 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 service were approachable and responded to any concerns raised. 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 held regular management and staff meetings to ensure all staff members were aware of changes to service delivery. The practice has an equality and diversity policy and promoted equity to all people, including staff, with diverse needs and protected characteristics, such as sexuality (LGBTQIA+) age, religious, disability and race.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. There were systems in place to support staff to whistle blow or to speak with a Freedom to Speak Up Guardian if they had any concerns. Staff were aware of how to whistle blow and who the Freedom to Speak Up Guardian was and what their role was in supporting staff. Most staff felt that they could speak up and most felt that their voice would be heard and acted upon.

The service had clear responsibilities, roles, systems of accountability and governance which they used to manage and deliver good quality, sustainable care, treatment and support. They acted on information about risk, performance and outcomes. Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Processes were in place for appraisals and performance reviews for all staff. Staff knew how to access all required policies and procedures. Regular meetings were held with staff, during which clinical concerns and emerging risks were discussed. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Staff took patient confidentiality and information security seriously. External human resources support was used by the practice for employment contracts and some staff policies.

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 (PCN) to gather people’s views on enhanced access appointments. There were processes in place to work in partnership with key organisations and agencies to support the provision of care and joined up working. For example, Live Well with Diabetes 2 project which is a lifestyle intervention-based project for patients with high blood sugar which involved a GP Fellow initiating a walking group for this cohort of patients to reduce their blood sugar. The practice manager and practice staff participated in an NHS England podcasts to share learning about innovative ways on working in partnership with people and communities to improve support for people with Type 2 Diabetes in Nottingham. This involved a research project with neighbour practices and co-production with an external consultancy company, gathering information from 20 patients about their experience. The results showed people preferred a personalised approach to education with open discussions about their condition. Following successful engagement in this way, the practice replicated this approach with cervical cancer screening, resulting in higher uptake in smear tests.

The service were early adopters of the Complex Cancer Care Pathway which supported people who were likely to not attend their cancer care appointments. Staff told us they regularly went over and above for people by referring them to services within the community such as a health and wellbeing coach to support them to live healthier lives. The service worked with the local community to improve cervical cytology uptake by educating women in the importance of early screening. The project was funded through Women’s Health Hub and was to investigate the reasoning behind low cytology uptake and develop solutions to address the barriers experienced by women and girls. The practice hosts medical students and registrar doctors to obtain experience, training and skills in general practice, this also includes training on heath inequalities.. To enable the practice to be a training practice a comprehensive audit of systems and processes was reviewed by system partners to ensure safe practice and effective well-led training.

The service focused on continuous learning, innovation and improvement across the organisation and local system and had an inclusive culture regarding learning from incidents and training. Leaders demonstrated a commitment to reducing health inequalities for their population through their involvement in various local and national groups which aimed at improving services in deprived areas. They advocated for patients by engaging with commissioners for accessible services closer to home. Data on deaths was used to look at ways to improve life expectancy age and better health outcomes.

Leaders had engaged with other practices to discuss health innovation projects. For example, they used funding available to them to co-produce innovative ways to engage with people with Type 2 Diabetes, recognising that their population did not engage with methods used traditionally in general practice. Learning from the project was replicated in other areas such as cervical cancer screening, resulting in increased uptake rates.

The service was a training practice for doctors training to become GPs and were a research active practice with over 5 studies conducted annually. The service used learning from significant events and complaints to continually improve the service they provided, and changes were made within the practice if needed. The telephone system had also been upgraded to cloud telephony to improve access on the telephone with call back functions enabled. The service also used an online platform to send monitoring information and communicate virtually with patients.