Walkden Medical Practice

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 rating has changed.

The service was in breach of legal regulation in relation to Good Governance.

This service scored 61 (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 vision and shared 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. However, strategies in place did not support their ambitions to provide an excellent service long term.

Information from staff had not contributed to the development of the practice vision. Staff, however, explained that the practice aimed to provide excellent care and treatment, treat people with respect and respond to information from patients.

The practice worked with partner agencies, including other local practices, to address current and future challenges.

Not all leaders understood the context in which the service delivered care, treatment and support.

Leaders did not all demonstrate the skills, knowledge, experience and credibility to lead effectively, through processes that included sharing learning with and listening to all staff.

Administrative staff in particular were not kept sufficiently up to date where appropriate with learning from incidents and complaints or the results of audits.

Processes for sharing information were not inclusive because this relied almost exclusively on staff reading documents or emails.

Briefings records generally showed information provided by the leadership team to staff. Roles and responsibilities evolved instead of being developed.

There was evidence that the leadership team worked in a compassionate, enabling manner with staff on an individual basis. Staff told us they enjoyed working at the practice and that leaders in the practice were approachable and responded to some concerns raised.

We saw the leadership team worked with other practices in the primary care network and were engaged in the development of primary care services within the local area.

Leaders demonstrated openness and honesty.

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

The practice had established Freedom to Speak up arrangements with other practices in the primary care network. Staff were aware of how to raise concerns.

The service valued diversity in their workforce.

Policies and procedures to promote diversity and equality were in place. We saw senior leaders made adjustments to facilitate staff retention and demonstrated that staff were valued.

A list of roles and responsibilities was available.

They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.There was insufficient formal monitoring to provide assurance that potential for high-risk incidents are identified and mitigated.

Audits were conducted but evidence of learning was not always available and information in final reports or the analysis of findings were incomplete. There was insufficient formal monitoring to provide assurance that potential for high-risk incidents are identified and mitigated.

Meeting minutes failed to show proactive questioning or follow-up when patient outcomes were missing. This meant the provider was unable to ensure that patient outcomes were driving service improvements.

Leaders and managers did not always support staff through clear and documented processes. Many staff, particularly administration and allied health care professionals, identified that their roles evolved and had changed over time, however, there was no evidence of completed planned supervision or appraisal to support staff through these changes or assess effectiveness or quality.

Managers met with staff regularly but did not complete appraisals and performance reviews.

From reports of investigation we reviewed we found many lacked detail and transparency because, for instance: abbreviations and acronyms were used throughout documents; the role or responsibility of staff involved in incidents, or what was expected to carry forward changes, was not always clear; actions needed to mitigate risk or initiate an activity were unclear and there was little evidence of shared learning or discussion with the wider team when a conclusion was reached.

Meeting records were also generally incomplete and did not support improvement because action logs to allocate responsible staff and timescales were rarely completed.

Staff took patient confidentiality and information security seriously.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement. The provider worked with other practices within their primary care network to offer extended access, and flu and other immunisation programmes.

The service aimed to focus effectively on continuous learning, innovation and improvement across the organisation. They were successful in responding to local system pressures at a practice level, for example their childhood immunisation programme was very successful.

They encouraged and participated in creative ways of delivering equality of experience, outcome and quality of life for people. They contributed to safe, effective practice and research.

However, oversight and monitoring systems needed to be developed and introduced to ensure consistency in performance and quality.

Service level quality improvement plans, and risk assessments including succession planning had recently been introduced.