West Rainton Surgery

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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 Good. At this assessment, the rating has changed to Outstanding.

This service scored 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found there was an inclusive, positive learning and improvement culture well-established within the practice. This drove improvements in outcomes for people who used the service. There were consistent examples of how inclusive the practice were in driving improvements those who were most at risk of inequality and poor outcomes. There was a culture of continuous improvement with staff given time and resources to try new ideas. For example, they had increased the number of medicine reviews carried out by the practice, to improve the safety and effectiveness of medicines. They had a focus on ensuring often-marginalised communities were offered checks on their health to promote early intervention and healthier lifestyles, with staff contributing to identify and establish these initiatives. For example, they had increased the number of people with learning disabilities accessing annual health checks. They had increased patients from the Gypsy, Roma and Traveller community receiving NHS Health checks. They had implemented the PCN wide initiative to provide annual health checks for housebound patients with long term conditions.

We found the practice had an ethos of investing in staff to support good continuity of care and developing and maintaining a sustainable service.

All staff had contributed to the development of the practice vision and strategy, which was kept under review. The practice was aware of the projected increase in the local population and was working with partner agencies to address future challenges, including the local Integrated Care Board and other healthcare partners. Members of the Patient Participation Group (PPG) spoke positively about the culture and strategy within the practice and told us they felt involved, and their views respected in terms of future planning within the practice. Staff told us they felt their views were highly respected and they were enabled to lead areas of innovation within the practice and also influence developments across the locality.

We found there was strong, highly regarded leadership within the practice. Staff reported very strongly of being valued, and the family feeling of the practice. Staff told us leaders supported them during a bereavement related to someone known to the practice. This was highly valued by staff and reflective of the approach taken in the practice more generally.

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.

Staff told us leaders in the practice were approachable and responded to any concerns raised. We found leaders embedded psychological safety and empowerment to speak up and raise concerns to help learn and improve. Staff also told us leaders modelled the values of the practice. There was positive feedback about leaders in the practice from other healthcare professionals that worked in partnership with the practice. We saw the leadership team worked with other practices in the Primary Care Network (PCN) and were engaged in the development of primary care services within the local area. Equality and human rights approaches were embedded in everything the practice did and were understood by all staff.

The service was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard. Staff spoke to us passionately about how the practice valued their contributions and listened and responded to feedback. Staff were enabled to lead on innovation to improve the quality of care provided within the service. For example, there were innovative developments by the social prescribing service to meet the needs of marginalised groups. The practice pharmacist was enabled to support the improvement of medicines optimisation.

The practice had established Freedom to Speak up arrangements both internally and with other practices in the primary care network. Staff were aware of how to raise concerns, and we saw examples where staff had used the arrangements in place to positive effect.

We found the practice welcomed rigorous and constructive challenge from people who used the service, the public and stakeholders. Areas for improvement were identified and acted upon quickly.

The service valued diversity in their workforce. They 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. We saw senior leaders had addressed concerns related to discrimination. Adjustments had been made to ensure all staff were valued, for example we saw adjustments to support disabled staff were in place.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. Governance systems were well established, embedded and effective at supporting the practice to identify any risks, issues or concerns and mitigate these.

In our review of the established and well embedded governance processes, alongside our discussions with leaders, we found they drove an awareness of positive accountability, support and sustainable improvement across the organisation. We found and leaders actively anticipated current and future performance and risks to the quality of the service. There was an informed approach to positive risk taking to support innovative ways of working.

We found data management systems consistently operated to a high standard. Information was analysed and used to drive significant improvements to care quality.

Leaders and managers supported staff, and all the staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. The provider had established effective governance processes that were appropriate for their service. Staff could access all required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Clinicians were supported by daily ‘huddles’ to give an informal opportunity for support, advice and guidance. Staff took patient confidentiality and information security seriously. We found there was a whole practice approach to governance, with staff clear on how they could contribute and support good governance processes.

Performance management processes were effective, reviewed regularly, and staff consistently performed their roles in line with best practice. Where performance was not at the expected level, this was identified, a plan put in place to address the areas of underperformance. This was reviewed and if the expected improvements were not made and maintained, appropriate action was taken to address this.

Staff were recognised and thanked for their contribution. There were staff recognition schemes to identify and reward staff, one of which was voted for by staff themselves.

The service understood their duty to collaborate and work in partnership, so services work 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 offer extended access. Staff had made adjustments to improve coordination of their service with community healthcare services. For example, patients are offered increased choice from an area phlebotomy service and support from mental health workers and health and wellbeing coaches. The practice was working with the local GP federation to review weekly the needs of patients who were frail to better identify and support their needs. (GP federations are groups of GP practices working together, sharing responsibility for the development of services closer to home for their local population).

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research. The practice told us they had a sustained commitment to primary care research, and a GP Partner had undertaken additional training in good clinical practice for conducting research. Research projects they were involved with included:

• Improving the Wellbeing of People with Opioid Treated Chronic pain (IWOTCH). The practice reported they had no patients on high dose opioids for chronic pain.
• Screening for atrial fibrillation (SAFER research), 20 patients joined this study and no extra diseases identified for these patients.
• They were a recruitment site for Genetic Links to Anxiety and Depression (GLAD) and the Immune Defence study

The practice took a proactive and staff led approach to safe innovation. For example, staff were encouraged to develop and innovate to improve the safety and quality of the service. The practice pharmacist had increased time dedicated for medicine review appointments to improve medicine optimisation and safety. We saw evidence of this in our analysis of clinical searches within the practice IT system., with a high number of medicines reviews carried out across the practice patient list and high number of patients who had received the recommended monitoring and review of their long term conditions and medicines.

Leaders and staff understood the importance of listening to the voice of people who use services and the local community. They incorporated these views to drive development, improvement, and innovation. We found leaders resourced the embedding of improvements within the service.

Staff delivered earlier vaccination against influenza to the vulnerable housebound community to provide proactive protection against ill health. There was partnership working with the social prescribing service to offer NHS health checks to the local Gypsy, Roma and Traveller Community and encourage uptake of health promotion initiatives, such as NHS health checks, cancer screening and immunisations.