Holbrook 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 key question has been rated as requires improvement.

Governance and accountability systems were ineffective, with failures to identify and act on risks and shortfalls. Where issues had been recognised, actions were not consistently followed through or embedded. Staff were encouraged to give feedback; however, some staff told us they did not feel supported or listened to by all the GP Partners and despite raising these issues, they remained unresolved.

However,leaders understood the needs of people and their communities and worked in partnership with other services. Staff were treated equally, free from bullying or harassment.

The service was in breach of legal regulation in relation to good governance.

This service scored 57 (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 mission based on putting people first, working together, acting with integrity and striving for excellence. Staff described a supportive, people and team focused culture within their teams and from the Practice Manager, however some staff felt this approach was not consistently demonstrated by all GP Partners.

Leaders were aware of the challenges of delivering safe, sustainable high-quality care. For example, they had made changes to staffing for improved capacity in the medical secretary and nursing team. Leaders were aware of the projected increase in the local population and had discussed possible solutions to address future challenges. However, the service did not have a formal business plan or strategy to provide leaders with clear direction aligned to agreed priorities, to effectively address risks, and operate safely and efficiently. The GP Partners held regular partnership meetings and were working to strengthen their functioning as an equal partnership, with shared responsibility and collaborative decision-making.

Not all leaders understood the context in which the service delivered care, treatment and support. Leaders had specific roles and responsibilities, and most staff knew who the designated leads were. However, we found some areas where leaders did not have effective oversight of their area of responsibility.

Not all GP Partners led with integrity, openness and honesty. Some staff told us they did not feel supported by all the GP Partners and would wait to discuss routine clinical and non-clinical queries with 1 of the GP Partners or the Practice Manager who they found supportive. Other examples were shared.

The service had recently appointed a salaried GP with a view to partnership.

People felt they could speak up; however, some staff we spoke with told us their voice was not always heard.

The service had established Freedom to Speak up arrangements. Processes were in place for staff to speak up, which included Freedom to Speak up arrangements with internal and external Freedom to Speak Up Guardians. Staff had completed Freedom to Speak Up training.

Staff we spoke with were aware of how to raise concerns and felt supported by their team leaders who were visible, approachable and listened. However, some staff reported that they did not feel consistently supported by all GP Partners. They stated that concerns had already been raised regarding the inconsistent level of support provided by different GP Partners, but these issues had not been effectively addressed or resolved. Some staff told us this was affecting staff morale.

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. The service had an equality and diversity policy, and all staff had completed training in equality, diversity, inclusion and human rights.

The service had processes in place to support workforce equality, diversity and inclusion. Adjustments had been made to ensure all staff were valued and able to undertake their roles. Staff gave examples of reasonable adjustments which were in place for staff. For example, some staff had 2 screens and other staff had adjustable desks.

The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk. The provider’s governance systems for identifying, capturing and managing organisational risks and issues were not effective. They had failed to take appropriate action where risks had been identified, including implementing immediate actions to address fire safety and premises risks, ensuring effective communication arrangements within the service, and completing staff appraisals.

In addition, they had not identified or acted on shortfalls we found in the oversight of significant events, legionella management, checks of emergency medicines, safe storage of medicines, and cleaning arrangements in the dispensary. Further gaps were identified in recruitment records, induction documentation, and some role-specific training.

Staff told us they were able to access a range of policies and procedures to undertake their roles, but some staff told us they did not receive information and updates. Leaders acknowledged that staff meetings had not been consistently held or minutes recorded. They recognised current staff communication systems were not always effective, for example notifications sent to staff were not always read. In response, GP Partners confirmed a schedule of meetings had been agreed and minutes would be documented and available on the service’s computer system. These arrangements needed to be embedded into practice.

The provider was unable to evidence improvements made in response to some of the concerns we identified were sustained or embedded, as some actions were recent and others had yet to be implemented.

The service understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people.

The service was a member of the South Rural Primary Care Network (PCN). (PCNs are groups of GP services who work together to improve primary care services). The leadership team engaged well with their local PCN and met regularly for support and collaborated for improvement. People benefited from the additional staff members they employed. For example, the PCN Clinical Pharmacist and Pharmacy Technician supported the identification, monitoring and review of people to support the safe management of medicines.

Leaders worked in partnership with the Patient Participation Group (PPG) to share updates and obtain feedback from people, and act on this to improve the service.

The service could demonstrate support for continuous learning, innovation and improvement across the organisation and local system. The service is an approved training practice for medical students and GP Registrars (qualified doctors training to become GPs). They had 2 GP trainers, and 2 GP Registrars were currently working at the service. The service also supported Dispensary Apprentices and was currently supporting a Trainee Advanced Clinical Practitioner to complete master’s level training.

Leaders encouraged creative ways of delivering equality of experience, outcomes and quality of life for people. Staff gave examples of improvements made. For example, 1 initiative supported more effective management of constipation for people, including those who lived in a care home.

The service completed clinical audits to ensure the quality and safety of people’s care and treatment was effectively monitored.