Lapal 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 remains the same.

This service scored 68 (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 shared with us a vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. However, not all staff were aware of it.

Leaders fostered a culture of positivity, compassion, and active listening, with a strong emphasis on promoting equality and diversity. They showed awareness of the challenges and changing needs of the local population.

Staff listened to patients’ needs, complaints and suggestions and showed an understanding of equality, diversity and human rights in providing safe, compassionate care for the patient population. Staff reported a positive experience of working at the practice. They described strong teamwork and a shared commitment to delivering high-quality, patient-centred care.

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.

Leaders were generally knowledgeable about the service and the needs of the people it supported. Staff described leaders as approachable, fair, and supportive, and told us they felt comfortable seeking guidance or raising concerns. Leaders promoted inclusivity and respect, both for people using the service and for staff. They valued different perspectives and encouraged open discussion, ensuring that everyone felt listened to.

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

The practice had clear policies and procedures accessible to all staff, for example, there was a whistleblowing, equality and diversity and duty of candour policy in place.

The practice had established external freedom to speak up arrangements. Staff were aware of how to raise concerns and reported feeling confident to do so. They told us they felt listened to and safe when raising issues or sharing ideas for improvement, without fear of negative consequences.

Leaders promoted honesty and transparency, encouraging staff to share concerns early so they could be addressed quickly. There were clear policies in place, and staff knew how to access them if they wanted to raise a concern formally.

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 in place to promote diversity, equality, and safe recruitment practices. It actively valued diversity within its workforce and worked towards fostering an inclusive and fair culture by improving equality and equity for all staff.

Key policies included those relating to recruitment, equality and diversity, bullying and harassment, and grievance procedures. All staff had access to regular annual appraisals and plans were to implement performance reviews for new staff.

The service had clear responsibilities and systems of accountability, however governance processes needed strengthening to ensure risks were identified and actioned.

There were governance structures in place to support staff, and all staff we spoke with were clear about their individual roles and responsibilities. The practice had appointed designated leads, and deputy leads for both clinical and non-clinical areas, including prescribing, health and safety, fire safety, and safeguarding. However, these arrangements required strengthening, as we identified concerns in several areas.

For example, there were no alert systems in place to identify patients on the safeguarding register, which may impact the effectiveness of safeguarding processes. Although health and safety and fire risk assessments had been completed, the provider had not ensured that all identified actions were addressed, which may pose a risk to staff and patient safety. The provider also did not have effective systems in place to manage and respond to all relevant safety alerts, which could compromise the timely identification and mitigation of risks.

Clinical searches identified areas for improvement, including the monitoring of patients prescribed direct oral anticoagulants (DOACs), where appropriate follow-up and review processes were not consistently in place.

At the time of our assessment, the practice was undergoing a period of organisational transition. This shift in leadership roles had contributed to delays in implementing suggested improvements, which may have affected the sustainability and responsiveness of governance arrangements.

The service demonstrated an understanding of its duty to collaborate and work in partnership to ensure services operated seamlessly for people. Leaders told us they worked with stakeholders and the local community to improve outcomes for patients. The practice was part of a primary care network (PCN), which enabled access to enhanced services such as social prescribing, physiotherapy, and mental health support.

There was a patient participation group (PPG) in place, with regular meetings held. We spoke with a representative of the PPG who confirmed that the practice and its partners actively engaged with the group, listened to feedback, and implemented changes to improve the service.

The provider shared information and learning with partners and demonstrated a commitment to collaborative improvement.

Whilst we found gaps in training as well as no formal recorded process for clinical supervision. There was generally evidence that the service focused on continuous learning, innovation, and improvement across the organisation and local system. Staff were encouraged to explore creative approaches to delivering equitable experiences, outcomes, and quality of life for people. Quality improvement audits were carried out regularly, and clinical meetings were held to discuss patient needs and share best practice.

The practice recognised that access to appointments was a challenge and had introduced a new triage system to help address this. The system was under ongoing review and refinement to ensure it met the needs of the service. Additionally, a new salaried GP had been employed to support increased access for patients.

The service worked collaboratively with stakeholders, including the Primary Care Network (PCN) and the patient participation group (PPG), to improve the experience of people using the service and to support the wider needs of the local community.

At the time of our visit, the leadership team was undergoing a period of transition, with managers moving into newly defined roles as operations and finance leads. We were told that this had presented some challenges in consistently engaging the leadership team in improvement initiatives. Nonetheless, the provider remained committed to maintaining quality and fostering collaborative working to support ongoing service development.