The Quarter Jack 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 rating remains the same.

This service scored 79 (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.

All staff had contributed to the development of the service’s vision and strategy, which was kept under regular review. The service was aware of the projected increase in the local population and was working with partner agencies to plan for future challenges.

The service had previously received funding through the GP Improvement Programme, which they reported had been beneficial. They subsequently chose to self‑fund continued support and development.

The service was keen to continue upskilling and developing its staff and had invested in nurse development. Two nurses had been supported to become women’s health specialists, and another had developed expertise in heart failure care. This approach ensured nurses were trained in specialist areas, enabling the introduction of dedicated chronic disease clinics.

The service had also rebranded and upskilled its reception team, recognising their enhanced role in individual care. They were renamed as ‘care navigators’ and received training to support their involvement in care and triage, with dedicated tools created by the GP partners to support this transition. The triage tool created had improved timely access to care and strengthened support for people using the service.

In addition, the service had a dedicated in‑house frailty team, which had a positive impact on GP workload and helped streamline care pathways by ensuring people were booked in to be seen or reviewed by the relevant team or clinician.

All GPs at the service were supported by GP assistants, which enhanced capacity to complete administrative tasks and undertake some basic clinical duties, such as managing referrals and assessing the appropriateness of triage. This allowed GPs to focus more on direct patient care while ensuring administrative and routine clinical processes were efficiently managed.

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 in the service were approachable and responsive to any concerns raised, and they consistently modelled the service’s values. Leaders demonstrated the skills, knowledge, and experience necessary to lead effectively and were highly regarded for their credibility. They maintained an open‑door approach, ensuring they were easily accessible to staff.

People using the service were placed at the centre of its work. Leaders valued staff wellbeing and supported them to achieve positive outcomes for those they cared for. We saw that the leadership team worked collaboratively with other services in the local primary care network and was actively involved in the development of primary care services within the local area.

There was a clear staffing structure, and staff understood their roles and responsibilities. They had access to line managers and senior leaders and told us they felt confident seeking advice and guidance when needed. Staff spoke highly of the provider and management team, describing the culture to be open, supportive, and caring. Leaders took time to support staff with both professional and personal matters, fostering an environment where staff felt valued and listened to, and where action was taken when issues were raised. The service actively sought staff feedback and demonstrated how this had contributed to positive changes.

An annual staff survey was completed, and findings were shared openly with staff. The survey allowed leaders to identify themes and incorporate these into future improvement planning. Surveys were carried out both within the service and across the wider Dorset General Alliance. The Dorset General Alliance is a collaborative group representing all general practiced in Dorset aligned with primary care networks.

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 with other services in the local primary care network. Staff were aware of how to raise concerns, and we saw examples where staff had used the arrangements to positive effect.

Staff told us there was an ‘open door’ policy and leaders welcomed feedback for service improvements. The service had a zero-tolerance policy in relation to the abuse of staff with systems in place to protect people and minimise the likelihood of reoccurrence.

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.

The service had policies and procedures to promote diversity and equality, and we saw senior leaders had addressed concerns related to discrimination. Adjustments had been made to ensure all staff were valued and supported; for example, reasonable adjustments were in place for disabled staff.

The service provides mandatory equality, diversity, and inclusion training to all staff to ensure they understand how to work respectfully with people from different backgrounds. The leadership team maintains a zero‑tolerance approach to discrimination, addressing any issues promptly, whether occurring between staff members or involving people using the service.

Health and safety risk assessments, including Display Screen Equipment (DSE) assessments, were regularly carried out in line with the Health and Safety (Display Screen Equipment) Regulations 1992. These assessments ensured workstations were ergonomically designed to support staff wellbeing, with adjustments such as screen adaptors, ergonomic chairs, or standing desks provided where needed. Flexible working arrangements, including varied shift patterns, were also offered, with signed agreements in place to support reasonable adjustments.

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 and managers supported staff, and all staff we spoke with were clear about their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. The provider had established governance processes appropriate for the service, and staff were able to access all required policies and procedures. Managers held regular service meetings during which clinical concerns and emerging risks were discussed. Any actions arising from these meetings were clearly recorded and shared with staff. Staff took people’s confidentiality and information security seriously.

A business continuity plan was in place, providing staff with clear guidance to follow in the event of system failures. This included detailed actions for managing emergencies such as power outages, environmental hazards, severe weather and staff sickness.

The service carried out routine infection prevention and control (IPC) audits, including assessments of the premises. The service had plans to expand its existing hand hygiene audits to include all clinical staff and not just nurses and health care assistants. This was in response to our findings on the day.

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.

In 2023, the service merged with The Old Dispensary, another GP practice in Wimborne. The Old Dispensary, now the branch site had been at risk of closure following concerns raised by the CQC and the removal of the GP partner. To sustain the service, The Quarter Jack Surgery took on the contract.

Annual meetings were arranged with aligned care homes to ensure smooth collaboration for people supported by both services, in addition to ad‑hoc meetings when required to discuss individual cases.

To support the boarding schools aligned with the service, a bypass telephone number and a GP on site each morning from Monday to Friday were provided. They also have access to instant messaging and a task‑based system, which allows school nurses to raise specific tasks relating to pupils for the GP’s next visit and to request prescriptions.

The service had also taken a proactive role in addressing gaps in local healthcare provision. When the previous on-site pharmacy closed, the service supported the establishment of a new pharmacy on the premises, recognising the lack of accessible local pharmacies and providing space to meet community needs.

The service also supports three local boarding schools, which together accommodate approximately 1,200 children. Dedicated GPs provide support to these schools Monday to Friday, holding clinics on-site to assist the school nurses and ensure that children receive appropriate care and treatment. These clinics are available for NHS-registered people.

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 contribute to safe, effective practice and research.

The service had a quality improvement plan in place to help drive improvements in service delivery, with a particular focus on the appointment system. All staff were encouraged to suggest and test new ways of working, and we saw examples of this within the nursing team.

The service showed a strong commitment to staff learning. As part of a nurses training, they had to review their own 50 most recent prescriptions, noting what they prescribed, why, any errors, and how they could improve. Their trainer then reviewed this and provided feedback. Staff also had to complete a full audit of emergency medicines and the emergency bag as a quality improvement activity. This made emergency response more efficient, as the bag was colour‑coded into clear sections for easy use.

When safeguarding incidents or concerns occurred, GPs completed case studies. This allowed the event to be reviewed, ensured correct procedure had been followed, assessed outcomes, and identified any learning. Evidence within the case studies showed policies were updated in response to lessons learned. It also demonstrated partnership working with the local authority and children’s community mental health teams, with appropriate referrals and safety‑netting measures put in place for people.

The senior leadership team also conducted audits on triage toolkit activity by reviewing 10 randomly selected e‑consults each month. They ensured staff received refresher training twice yearly as standard. The audits helped confirm that staff were safely triaging e‑consults and allocating people the most appropriate appointment type, with the correct clinician or by signposting to an alternative service. These were then discussed in staff meetings, allowing lessons to be learned and supporting continuous improvement and learning.

The service conducted regular quality improvement audits. One such audit focused on people who were taking proton pump inhibitor (PPI) medicines such as Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole or Rabeprazole. These medicines are used to treat indigestion and reduce stomach acid. The audit was undertaken because the service had identified many PPI prescriptions were being updated remotely, or people were having in‑person reviews with a GP when this was not always necessary.

The aim of the audit was to introduce a standardised review process across the service by inviting people prescribed PPIs to consider reducing or stopping the medicine if appropriate to their individual needs. A questionnaire was initially sent to people taking these medicines; however, feedback indicated people did not like this method of providing information. As a result, the process was redesigned into an information leaflet and sent to people on these medicines. This included safety‑netting information and invited people to contact the service if they wished to discuss reducing or stopping their medicine. It also asked people to contact the service if they experienced uncontrolled symptoms or adverse effects, with links provided for each medicine type.

Another quality improvement audit was carried out after an MHRA alert about Sodium Valproate. The updated guidance states that all men taking this medicine should be advised about the increased risk of fathering a child with a neurodevelopmental disorder while taking it and for up to three months afterwards. Evidence shows this risk is 4–5.6% for men taking valproate, compared with 2.3–3% for those taking lamotrigine or levetiracetam. Although the guidance said counselling could wait until a person’s next medicine review, the service chose to act immediately. The audit would be considered complete once all men taking valproate had contraception advice coded in their records. To start, the service searched for all men who had requested a repeat prescription for valproate in the past 12 months. They identified 21 people, none of whom had been given contraception advice by either the service or secondary care. To ensure the advice was age‑appropriate, all men aged 13 and over were contacted.

Two months later, a repeat audit was completed. Of the remaining 19 people, 100% had a prescription note added to highlight the need for contraception advice, and all had the correct clinical coding. The service worked with the Primary Care Network (PCN) to complete the audit, and the PCN will continue to run it every three months, notifying the person’s GP of any newly identified patients.

All affected patients received a letter explaining the MHRA guidance and including the patient information leaflet. The findings were also shared at the next GP meeting to support staff education and ensure correct coding going forward.

The service conducted a quality improvement project to ensure compliance with the latest asthma guidelines published in January 2025. As part of this initiative, arrangements were made for all GPs and respiratory nurses to attend education sessions delivered by specialist respiratory nurses. This enabled the service to introduce in-house guidance to support safe and effective prescribing in line with national standards. Prescribing regimes were developed for adults and people aged 12 and over, accompanied by detailed prescribing guides.