The Old School 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 outstanding. At this assessment, the rating has changed to good.

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.

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 contributed to the development of the vision and strategy, which was kept under review. The service had developed values they called ‘cornerstones’ which were embedded in the appraisal process to contribute to the vision and culture of delivering the service.

The service was aware of the projected increase in the local population and was working with partner agencies to address future challenges.

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.

Staff told us leaders modelled the values of the service, they were visible and approachable. The staff felt well supported within the team they worked. However, some feedback from staff was mixed about the visibility, support and interaction they experienced from the GP partners.

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.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service had established Freedom to Speak up arrangements another local service. Staff were aware of how to raise concerns.

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. Most staff feedback was positive stating they felt valued.

Policies and procedures to promote diversity and equality were in place.

Reasonable adjustments had been made to ensure all staff were supported at work, for example, staff could request flexible working arrangements.

Staff feedback demonstrated there was a no-blame culture at the service and the staff team was non-hierarchical. However, some staff told us they felt teams were not treated or paid equally.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Leaders met with staff regularly to complete appraisals and performance reviews. Staff could access all required policies and procedures. Leaders held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Leaders recorded any actions arising from these meetings and ensured they shared these with staff. Staff took confidentiality and information security seriously.

The service had governance processes that were appropriate for their service. However, these were not consistently followed, as it was not clear there had been effective oversight and monitoring of all systems. For example, we found gaps in staff recruitment files and staff vaccination records, unsafe clinical waste storage and unnoticed gaps in the monitoring of fridge temperatures. Also, the service had consistently not met the uptake target for cervical screening for eligible people aged 25-49 years old.

The service had 2 sites and the differences between the sites and who attended each site had not been consistently considered in how the service operated. For example, the health and safety risk assessments had not considered the branch site was based in the middle of a university campus and the emergency medicines and equipment risk assessment did not thoroughly address what was not kept in stock in line with guidance.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. For example, there was an independent pharmacy based in the premises of the main site and they shared the waiting room. Staff told us when someone had been wrongly referred to pharmacy first, they could immediately be signposted back to the GP reception to request an appointment.

Feedback from partner organisations demonstrated the service had a good understanding of the people they support. Partner organisations told us they appreciated having easily accessed named staff who listened to concerns and respected their input.

The service worked with other practices within their primary care network to offer extended access, and flu and covid vaccination programmes. The service had well established links with local services in the community that could support people.

The service had a focus 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 contribute to safe, effective practice and research.

The service had a quality improvement plan in place to help drive improvements in service.

The service had participated in various projects to improve outcomes and experiences for people. For example, a local pilot project to increase GP confidence in identifying possible ADHD, making assessment referrals and managing the post-referral process to ensure a more informed, streamlined process for people.

Clinical staff were encouraged to participate in group supervision, and audits were promoted to support reflective practice and improve safety.

The service was an active participant in a local GP federation (a group of GP services working together to collaborate, share and develop new ways of working).