Norton Medical Centre

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• 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 Requires Improvement. At this assessment, the rating has changed and is now inadequate.

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

This service scored 29 (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 did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. Some leaders did not provide an environment where staff felt included or valued beyond team lead level. Leaders had carried out staff surveys prior to our assessment; it was unclear what changes had occurred based on these.

Leaders were out of touch with what was happening in the service and what staff think. There were examples provided to us by staff in relation to non clinical management of workforce bullying, harassment, discrimination towards certain staff and certain groups of people. The provider was not taking adequate action to reduce or investigate this promptly. Leaders told us there were challenges with conflict between management and staff, and they were unsure how this could be resolved. We note that whilst this is a series of allegations, leaders had not taken them seriously.

At the time of our assessment, we informed partners that staff feedback was overarchingly negative. There were concerns from staff about the professionalism of management, including attitudes towards staff members, breaches of staff confidentiality and allegations of foul language being used. Staff told us they felt threatened by redundancies. Since our site visit, clinical leaders have told us they intend to address this feedback. This will be reviewed at our next assessment.

The service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills to lead effectively, and they did not do so with integrity, openness and honesty.

Staff told us some leaders in the practice were approachable but were not responsive to any concerns raised. They told us leaders would listen, but no actions followed.

Not all leaders communicated in accessible ways that demonstrated integrity, openness or honesty. Management told us they used Team Net to update staff on changes to policies and procedures. Staff told us they felt this excluded them. Partners were aware of a breakdown in communication between staff and management.

A number of staff were de-motivated and felt excluded. Staff spoke highly of their own team leaders and felt within their own teams they worked well together. Staff recognised the limitations of a team lead, once they had escalated concerns to management.

We saw examples of management making significant changes to polices. for example, staff were only made aware of changes to the sickness policy after it had been implemented. This was disclosed to staff via an email informing them of a new policy on Team Net. Staff told us communication from management was ineffective. They had suggested other forms of communication to management; however, they did not feel this was working well. Leaders told us they felt staff remained unhappy with communication and they were not sure how this could be resolved.

Communication from leaders could be defensive or lack transparency. Staff told us that they had felt threatened by the tone of communication from management.

Leaders had not always delivered the organisational vision effectively. Risks were not always professionally managed, and we have found examples of leaders failing to report incidents accurately.

Leaders were often not visible and had not taken steps to ensure they always set examples of inclusive behaviours.

We reviewed evidence which indicated that leaders were not following their own policies, specifically in relation to recruitment and grievances.

We reviewed evidence which indicated that patients do not feel concerned by leaders’ attitudes. Patient feedback indicated that staff were caring and communicated politely during consultations.

People did not feel they could speak up and that their voice would be heard.

The culture of the service was not open and transparent. Some leaders did not always communicate with honesty or act with integrity. These behaviours created mistrust between staff partners and external stakeholders.

Engagement with people, staff, the public and community was minimal. The Patient Participation Group told us they did not feel valued or listened to and were not informed at the time of the last CQC assessment of ratings. Members of the PPG told us they found out the rating of our last inspection via the news.

People and staff who raised concerns, including whistle blowers, were not supported. The issues they raised had not been acted on in a timely manner, in line with practice policy.

Concerns were not dealt with in an open and objective way. Staff and leaders were insensitive and did not respect people’s confidentiality. Lessons were not always identified, shared or acted on. Staff were not offered apologies when things had gone wrong. Lessons were not always learned which may lead to patterns of similar incidents over time.

We saw that at the time of our assessment staff had engaged with the freedom to speak up guardian. Following our site visit we were informed the practice had removed this person from the role. We asked for a process and rationale around this decision, given leaders knew that staff had spoken up. Practice leaders were unable to demonstrate they had considered the impact this would have on staff. We were made aware by an external stakeholder that they had suggested a different person for the role of freedom to speak up guardian. The practice then changed the name of the guardian on their policy before informing this person. At the time of writing the practice does not have a freedom to speak up guardian in place.

The service did not value diversity in their workforce. They did not 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. Staff had all completed their equality and diversity training, however we noted numerous examples of leaders not acting in a way which promoted the inclusivity of all staff. These actions were not in line with training, and policies. Staff told us within their own teams they felt included however this had broken down at leadership level.

Staff told us that a member of non clinical management had displayed behaviours which were inappropriate. This had been aimed at other members of staff. This was reported in both our staff surveys, and by external parties with an involvement in the practice. We were told that not all staff were not offered appropriate exit interviews when leaving the service.

Staff told us that there was a closed culture, and that unprofessional behaviour had been overlooked. This included comments relating to certain staff members, religious beliefs and certain demographics. We note that while the comments relating to non-clinical management are allegations, partners did not address these comments in a timely manner. We are aware that partners had been made aware of these concerns approximately 2 months prior to our assessment and had not actioned or begun investigations.

At the time of writing we are aware that partners have contacted external stakeholders in relation to mediation, however they have not informed us of any further steps. This will be reviewed at our next assessment.

The service did not have effective clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Leaders and managers supported some staff. Staff felt clear on their responsibilities but felt excluded from changes made to policies and processes. We were told of conflicts between managers and staff in relation to how tasks should be completed. Partners told us they did not have a way in which this could be rectified.

Team leads carried out appraisals. Leaders told us they were considering changing this to a more senior person. Staff could access all required policies and procedures via TeamNet.

Managers did not hold regular practice meetings with staff, whilst partners were aligned to different parts of the practice, for example one partner took responsibility for reception staff, another took responsibility for the prescribing team. They acknowledged that aligned partners did not all regularly attend these meetings. Prior to our assessment, there was not a meeting where partners and non-clinical management met. This has since been implemented.

The practice currently have no registered manager with CQC and were unaware of this until it was highlighted to them. Leaders at the practice told us that this had been processed in 2024, however we have no evidence of this process being completed.

Legal requirements about data submissions and notifications were consistently not understood or met. Quality of information shared was poor, and not accurate. Leaders were unaware of a potential risk of harm to 78 patients, who were vaccinated without the appropriate safeguards in place, until it was highlighted by CQC. This information was not shared appropriately with the required external partners.

The practice did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider worked with other practices within their primary care network to offer extended access, and flu and covid vaccination programmes. Staff had made adjustments to improve coordination of their service with community healthcare services, including through increasing the frequency of palliative care meetings and improving communication with care homes. The practice were not always collaborative in working with external stakeholders and did not always provide information to them in a timely or accurate manner. Management did not accurately report a safety issue relating to 78 patients. We spoke with stakeholders who told us that while communication and engagement with the practice had improved there was space for this to improve.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

However, in relation to non-clinical improvement, leaders were unsure on how this could be improved. Leaders did not encourage staff to speak up with ideas for improvement and innovation or actively invest time to listen and engage. Some staff mistrusted innovation or improvement initiatives because of this, which had an impact on their effectiveness. Leaders were unable to provide an effective action plan to resolve these issues, aside from advising us that they were considering mediation. We will review any action taken at our next assessment.

The practice had a quality improvement plan in place for some aspects of care. For example, we noted improvements in palliative care systems and processes. We also reviewed evidence of a long-term conditions appointment overhaul which was about to be implemented and will be reviewed at our next inspection.