Gravel Hill 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 82 (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 told us they understood the vision and how to apply it to their roles. For example the reception team had a set of standards developed into their handbook.

The staff showed confidence in completing their tasks, with the use of clear processes, handbooks to refer to and leaders who understood how each role contributed. There were mini daily huddles to allow hand over of information and regular staff wellbeing check in. Staff felt included in the future planning of the service, with their own development plans discussed at appraisals and included as part of the business plan.

The service had an open culture around patient feedback – there was an active and well attended Patient Participation Group (PPG), Friends and Family Test (FFT) results were shared with patients and staff including any themes identified through regular reviews. Patient compliments, relevant updates and focus areas were also shared through a weekly bulletin, which also included staff celebrations such as birthdays.

The PPG members told us that leaders were open and honest, listening to patient views, and shared information that was appropriate with the group.

The service aims and vision were shared visually in staff areas and staff were able to describe the aims and the benefit to service users to us. There was a business plan in place which included areas such as patient care, staff wellbeing and business planning. The plan had expected completion dates for focus and included future aspirations beyond the next 12 months.

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.

The leadership had a clear delegation of responsibilities known to all staff. Skills and specialist areas were developed, as well as a documented and reviewed business plan for the year as well as 3 and 5 year plans, which also included staff aspirations for the same time period to include all. Leaders understood each other’s skills and knowledge as well as those of the staff, these were developed and sharing of experiences and ideas was documented throughout meeting minutes and encouraged via various methods.

Leaders demonstrated a good understanding of training, responsibilities and development empowered the team by knowing the individual and including the service visions and aims across the team.

Staff notice boards had a good level of clear information, such as wellbeing support and celebrating positive feedback as well as actions from learning.

Staff described working at Gravel Hill Surgery like being part of a family, this was evident from many examples given, including staff development, all ideas and opinions taken into account and shared breaktimes.

The service demonstrated a leadership built on respect and support, able to manage processes and staff without hierarchy. Social events were a large part of building on this relationship, including quiz nights.

Patient feedback was that the service provided a high level of care, irrespective of who they were, the treatment and service was consistent.

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 another practice 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.

Staff fed back that they were confident and comfortable to raise concerns with any leaders at Gravel Hill Surgery. We saw evidence of a proactive, learning and safe culture where people felt free to speak up, with leaders treating information confidentially and an opportunity to develop and build on the strength within the team.

The service strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who work for them.

Policies and procedures to promote diversity and equality were in place. Staff told us that they all felt involved in the service planning and were able to voice their ideas and thoughts openly. There was evidence of adjustments made to the work environment or processes for staff, there was the opportunity to request flexible working arrangements which were treated in a fair and consistent manner.

Staff feedback was that there was an inclusive culture and everyone was given the same opportunities and treated the same, an example of staff feedback regarding workload was shared with an open and honest approach from leaders and staff able to express their views, resulting in agreed actions and understanding of decisions made. Staff shared that they felt equal within the team with fair treatment and understanding.

Staff had been encouraged to develop, with opportunities for promotions and additional qualifications. Appraisals had been completed in a fair, equal way with time given to the staff before appraisal meetings to consider their own thoughts and a standard appraisal process across all staff. Outcomes of appraisals were considered and acted upon, including staff aspirations for development or additional qualifications for change in role. All staff aspirations were taken into account as part of the business planning process and opportunities for training and development was shared across the whole team. Staff were able to suggest training opportunities themselves and these were considered and acted on for the whole team of staff.

The leaders ensured positive feedback was shared amongst the team and celebrated. This was done within meetings, weekly bulletins and emails. Leaders ensured that feedback was captured in many ways from patient comments, the friends and family test (FFT) and written communications.

The leaders encouraged staff inclusion by putting on regular social activities and including fun quizzes as part of introducing new projects such as the online triage system.

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 act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

During our assessment we saw evidence which demonstrated well thought out management in all areas, which took into account legislation and guidance as well as processes. Legal documentation, personal information and confidential information was stored securely with risks taken into account and measures in place to protect them.

All staff had a clear understanding of their own role and the responsibilities of others, they could demonstrate who held responsibility for all aspects of the service, for example, the safeguarding lead, fire marshals and the Infection Control lead. They could also confidently tell us who deputies were and who they would go to if the area lead was not available.

Remote clinical searches found safety alerts were recorded and actioned appropriately within the patient records, we also saw evidence these were discussed in meeting structures and referred back to in relevant programmes of work, such as audits, clinical supervision and training.

The service was aware of legal requirements and had clear processes and schedule of work relating to required checks and reports, they also had considered the service environmental impact- working through an environmental self-audit aiming to reduce the impact the service had on the local and general environment.

There was building work at the planning stage for an extension, for which there was documentation relating to the expected impact to the service, risks and considered measures to reduce these.

The service had a clear well written business plan which contained details of the identified areas which affected the service in both negative and positive ways, expected completion dates, actions and outcomes. The plan covers areas of opportunity to improve patient experiences as well as make the workflow more efficient.

The service had implemented a technology function to reduce secretarial workload while ensuring a safe and secure transfer of medical notes when required through clear and agreed processes.

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 service had a well-established patient participation group (PPG) with regular meetings, members from the group actively worked with the service and the meetings regularly had speakers to enhance patient experiences, such as the cancer champion.

The service engaged well within the Primary Care Network (PCN) attending meetings and actively developing roles within the PCN such as a GP assistant. The service took part in various community projects through the PCN, for example the warmer homes project working with the local council and energy supplier to ensure eligible homes have access to first time central heating system funding.

The service worked well with other local community services, such as the local hospice and the district nursing team, we saw evidence of regular communications and meetings that included various roles, from other services, to ensure continuity of care.

The service leaders had attended a Practice in Management conference where they were able to share best practice and learn about systems that could benefit the service, they had identified software that would support automated clinical letter coding and had met with other GP services to learn from each other.

There was collaboration with other services to ensure the outcome for patients was effective with a holistic approach. For example care home visits were completed with input from the community learning disability, and mental health team where appropriate.

Patients were signposted to other health services, where appropriate, such as community pharmacies using the pharmacy first service and minor eye conditions service (MECS) at community opticians.

The service focused 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 was host to a variety of training and improvement areas, such as a research nurse and training hub supporting 3 GP registrars at the time of the assessment. The service was routinely involved in research studies, and showed how actively participating in studies had a positive impact on their own service users, staff knowledge and the wider health service, for example research into osteoporosis in older women, a condition that weakens bones and increases the risk of fractures. The study aimed to identify what was important to the older women and health care professionals caring for them with a desired outcome of improved care and better understanding of guidelines.

There was a clear ethos of development and learning through staff meetings where learning from when things had gone wrong had been openly discussed and actioned.

Staff training was completed in an engaging and effective way, for example during the launch of the online triage system they held quizzes which engaged the staff and identified key areas where more information was needed. The service developed detailed handbooks and bespoke training support based on the quiz results

The service worked with the pharmacy team and the Primary Care Network (PCN) digital transformation lead to develop and launch an electronic drug chart for palliative end-of -life patients to reduce the risk of human errors and reduce the time taken to complete the forms.

The use of online self-booking links for clinics such as influenza and covid vaccinations allowed the phone lines and reception staff to be freed up to support service users who were unable to use the self-booking system and provide more valuable time to service users who require additional support.

The service leaders were hoping to adopt AI (artificial Intelligence) scribing tools, which would reduce the amount of time clinical staff used for note writing and admin tasks, they were exploring funding for this.