Ringmead Medical Group

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

During the assessment we reviewed evidence remotely, spoke with staff, completed remote clinical searches of the practice's clinical system and undertook observations while on site.

We also reviewed feedback provided to CQC by people that had used the service. We found the following:

Our evidence identified governance shortfalls regarding IPC, training and recruitment that had not been identified by the provider's governance arrangements. For example, quality assurance of cleaning by external contractors had not identified an absence of compliance documentation and although training and recruitment systems had improved, they did not operate consistently. However, these shortfalls were not of sufficient seriousness to demonstrate a continued breach of HSCA 2008 Reg 17 Good governance.

We found staff could raise concerns both internally and externally and staff we spoke with now provided clear explanations about how to do this.

Staff told us leadership were approachable and supportive and they would not have concerns if they needed to raise an issue and were confident action would be taken.

We found roles and responsibilities were clear and known by staff.

We found the practice still had a clear vision for the future following a merger with another practice. Leaders told us that initiatives to become a single practice were having positive impact with staff.

Overall, we found the practice had made improvements to its governance, quality assurance and the management of risk within the practice.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Since our last assessment changes to the leadership had occurred, for example, a new practice operations manager had joined. Leaders continued to work across all the sites to ensure they were visible and accessible to staff and to continue embedding the vision of a single practice after the merger of the two practices.

At the last assessment resignations after a merger had been a concern for the provider because of the impact on staffing levels, morale and workloads. Leaders were alert to this and the impact of poor culture within the practice and had taken action to improve morale and teamworking. For example, a decision had been made to give staff a main site so that relationships could develop and we were told resignations had reduced and staffing levels had stabilised.

We heard from leaders how valued staff were and how social events for staff and families had been held to thank and recognise staffs' hard work and contributions as well as for teambuilding.

Leadership had been concerned about the impact of potentially abusive behaviour by patients on staff wellbeing. The provider had acted in support of staff by asking them to record incidents and had educated patients by sending 'zero tolerance' letters explaining that the behaviour was not acceptable. This had resulted in a positive outcome because the provider had monitored the number of zero tolerance letters sent to patients and this had reduced year on year.

Succession plans were in place to ensure the provider had planned for vacancies in key roles.

Roles and accountabilities were generally clear and known by staff. The provider operated a deputy system to ensure leads were supported and sufficient coverage throughout the practice. However, the findings of our assessment indicated that quality assurance was not always effective and new processes needed further improvement or more time to embed.

Overall, we found improvements had been made. Leaders were capable, now had oversight of the practice and were alert to the risk of poor culture. Vision meetings occurred to plan the future and staff we spoke with were proud to work for the service.

Leaders told us they encouraged and promoted a culture which empowered staff to raise concerns. Staff we spoke with reported they would be confident to raise a concern and that their concern would be listened to and acted upon where appropriate. Leaders told us they operated an open door policy and staff we spoke with explained they would be happy to approach any member of the leadership team or GP partners to report a concern without fear of detriment.

The practice had a Freedom to speak up (FTSU) policy and an external FTSU guardian meaning staff could contact someone outside of the practice if they needed to.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

At this assessment we found improvements had been made to the practice's governance systems and processes.

For example, the provider had improved processes to manage and maintain premises. There was now a programme of maintenance and monitoring was routine.

Processes existed to monitor the temperatures of fridges storing medicines requiring storage within a specific temperature range.

However, our evidence also identified governance shortfalls in other areas which appeared to stem from governance processes not operating effectively and a lack of oversight regarding staff roles and responsibilities.

For example, although the provider had considered the risks associated with hazardous substances in use in the practice, measures existed to further lower the risk. Specifically, we noted the absence of appropriate signage for a cupboard used to store COSHH products.

We also noted a programme of routine and regular cleaning of the premises was in operation. However, the records confirming cleaning for 1 site were either only partially completed or incomplete and the provider's own systems had failed to identify this governance oversight.

The provider had improved its systems and processes to ensure staff were recruited in accordance with the requirements of legislation and were compliant with training required by the practice. We found these operated effectively for 4 of 5 staff sampled and for the remaining the staff, the information was held by the provider but was not immediately available on site and the system had not operated as the provider intended. We were advised that governance processes would be strengthened in this regard.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.