Roundwood 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

At our last assessment we rated this key question as outstanding. At this assessment, the rating remains the same.This meant the service was consistently managed and well-led. Leaders were very compassionate and inclusive, and staff felt supported and valued. The culture they created promoted high-quality, person-centred care.

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.

The service had a shared vision, strategy and culture, with leaders who actively lead and worked with other practices in the Primary Care Network (PCN) and were engaged in the development of primary care services within the local area. Roundwood Surgery is an integral part of Rosewood PCN, working in partnership with four other Practices as well as collaborating with other local services such as hospitals and community services and Nottingham and Nottinghamshire ICB (Integrated Care Board).For example, the provider put forward a business case to purchase an ear irrigation machine to the Nottingham City Integrated Care Board (ICB) to provide the service to Roundwood people and to people within the PCN locality, saving the NHS and hospitals costs. In addition, through their PCN, the service initiated an NHS travel vaccination clinic for registered patients with vaccinations being administered by practice nurses and oversight of the service led by one of the GP partners, and latterly administered by the practice pharmacist.

Roundwood practice were the initiators within the PCN for the provision and delivery of the Beacon Project for homeless people. The PCN employed a salaried doctor to provide additional GP appointments for the Roundwood Surgery and neighbouring practices within the PCN, with appointments bookable in advance or on-the-day or follow-up appointments, allowing people to have continuity of their care.

The executive partner at Roundwood Surgery had a dual role as Clinical Director of the PCN. Under his leadership, the PCN employed a wide range of additional roles who worked across GP practices within the network to support the provision of care in primary care settings for the local population. These included a clinical psychiatry nurse to support people with mental health problems, three mental health occupational therapists, one of which supported people with dementia in their own home or care home, three nurse associates to support house bound people and those with learning disabilities, five social prescriber link workers to review people’s holistic needs and a first contact physiotherapist to review people with musculoskeletal conditions, ensuring that people were seen by the most appropriate person. A PSA nurse was employed to manage people with prostate cancer, with access to a consultant through the PCN pathway.

There was a clear mission statement, and their vision showed aspirations to provide the highest possible standard of professional interaction to people, staff and wider community and deliver high quality care innovatively. Staff were positive about the culture within the service and described it as open and transparent.

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, and they did so with integrity, openness, and honesty. The senior partner had a wealth of strategic and clinical knowledge, to include dentistry, palliative care and was passionate to deliver health care services that were close to home enabling people to be seen in the right place, by the right person with the right skills and at the right time. To support the strategy the senior partner was instrumental in the employment of the wider health care team within the PCN to enable the delivery of high-quality safe care. The practice were at the forefront of providing virtual consultations to people and were early adopters in the employment of an in-house prescribing pharmacist to promote safe prescribing, improve capacity in the healthcare system and improve people’s outcomes. The experienced practice manager ensured that governance systems and processes were effective to safeguard people from harm and had clear oversight of the management of the practice, and utilised external professional stakeholders for specialist and complex responsibilities, for example, health and safety legislation.

Within the PCN the practice were also leaders in the initiation and prescribing of Inclisiran, which is a six-monthly injectable cholesterol busting medication to prevent heart attack and stroke for people who were unable to tolerate the standard tablet form. Nottinghamshire Integrated Care Board had not commissioned the administration of the medicine, however, Roundwood Surgery and the wider PCN agreed that evidence based best practice was to provide the medication to suitable patients, thus incurring costs by the practice which are not reimbursable.

Staff told us leaders in the service were approachable and responded to any concerns raised. The service held regular management and staff meetings to ensure all staff members were aware of changes to service delivery. This was supported by notice boards communicating changes to all staff members. The practice had an equality and diversity policy and promoted equity to all people, including staff, with diverse needs and protected characteristics, such as sexuality (LGBTQIA+) age, religions, disability, race. Staff told us that leaders cared about their wellbeing and provided mindfulness sessions for their mental health, had yoga sessions at the practice, and provided a table tennis table for staff to play to de-stress and improve mental wellbeing. During in house training sessions the practice hosted an external yoga instructor for staff and the PCN mental health practitioner offered a 30-minute mindfulness session at the start of all training sessions. Leaders conducted staff surveys to identify areas of improvement, with one concern being staff salaries. Subsequently, leaders increased pay when governmental budget increases were applied to the service and Christmas bonuses were paid to the practice team commensurate to working hours and length of service to reflect leaders’ gratitude for team members continued commitment to the practice and people. Staff turnover was low, with several staff members being in post for more than 20 years.

Leaders celebrated staff weddings, birthdays and held social events for the whole practice team when the practice was closed held team building away days as part of professional learning and development. An employment assistant program was provided free of charge for staff to access if they had personal problems, for example, housing or debt problems.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. There were systems in place to support staff to whistle blow or to speak with a Freedom to Speak Up Guardian if they had any concerns. Staff were aware of how to whistle blow and who the Freedom to Speak Up Guardian was and what their role was in supporting staff. Most staff felt that they could speak up and most felt that their voice would be heard and acted upon.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service had clear responsibilities, roles, systems of accountability and governance which they used to manage and deliver good quality, sustainable care, treatment, and support. They acted on information about risk, performance, and outcomes. Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Processes were in place for appraisals and performance reviews for all staff. Staff knew how to access all required policies and procedures. Regular meetings were held with staff, during which clinical concerns and emerging risks were discussed. Managers clearly recorded any actions from these meetings and ensured they shared these with staff. Staff took patient confidentiality and information security seriously.

The service identified the need to ensure clinical sustainability and recruited a salaried GP who had previously completed their GP specialism training at the practice. The service encouraged staff to develop additional skills within their role. For example, the service had recently appointed a nurse and had provided funding for the nurse to enrol in a university course to gain other practice nursing skills, such as management of long-term conditions.

The service was an early adopter of the inhouse pharmacist role to support GPs with the management of prescriptions and prescription queries. The pharmacist appointed had been with the practice for six years and was training to be an advanced clinical prescribing pharmacist to consult with people who had minor health conditions. The pharmacist engaged in audits and quality improvement. For example, the review of medicine that people could become dependent upon, such as opioids, to identify people who ordered their medicine too frequently. An annual audit of the pharmacists prescribing had been completed and reviewed by leaders. The PCN recruited additional clinical pharmacist to support the practice in the day-to-day management of prescriptions.

The practice used a supported internet document repository platform for their internal intranet, which enabled the sharing of information, stored policies and protocols and was a resource for the practice team to access information and guidance. All staff were able to access the platform for clinical and administrative guidance which was regularly updated by external sources. For example, National Institute for Health and Care Excellence, NICE who provided evidence-based guidance, advice and quality standards for practitioners. Practitioners were also able to access key safeguarding details for the local safeguarding team for the efficient processing of urgent safeguarding referrals. The practice manager had oversight of the platform and was able to circulate information with the facility to monitor that staff had read the messages. The manager used the platform to record staff training activity and set renewal diary dates for the training which alerted both the manager and staff member when training was outstanding.

The practice manager had robust systems and processes in place to ensure mandatory checks were carried out within the relevant timescales. For example, health and safety risk assessments and maintenance of equipment, such as fire extinguisher checks and calibration of clinical equipment. The service employed a caretaker to assist the practice manager in the completion of relevant maintenance tasks. The service had a clear management structure. We observed management and clinical oversight charts in all areas of the building communicating the responsibilities of the management team and the GPs. For example, the adult and children safeguarding lead, the infection prevention and control lead, the frailty and care home lead. GPs were each assigned clinical areas to oversee, and staff informed us that they knew who to contact if they had any queries or concerns. The staff told us that the leaders had an “open-door” policy and were always responsive and available to provide support. The in-house pharmacist and advanced nurse practitioner confirmed that the GPs were always available to support them with clinical queries.

The practice manager was supported by the GPs and held a weekly management meeting with the senior executive partner. The manager confirmed that the GPs were always available if they needed to discuss any concerns outside of this meeting. The manager had a deputy manager, and department leads for delegation of tasks providing the manager with oversight of all departments within the practice.

The practice manager told us that following an error of communication a chalk board was installed within the reception to update staff members of important news including any changes to systems or process. Staff informed us communication from the manager and between the team was very good and the chalk board worked well. We saw minutes of practice meetings which were retained on the practice’s internet platform. Staff were instructed to read meeting minutes. For example, reception team meeting and nurse meetings, which were in addition to the weekly clinical meetings. The manager met with department leads on a weekly basis. For example, the reception supervisor, the nursing manager and medical secretaries and outcomes from these meetings were communicated with the relevant stakeholders. The manager provided a staff suggestion box and people were able to make recommendations for change or suggestions on an anonymous basis.

We were informed that since 2022 the service donated medical equipment to under privileged countries. The service explained, “it is a significant concern when out-of-date consumables and medical equipment contribute to waste, impacting the environment.” Equipment donated included, out-of-date swabs, dressings, gloves blood pressure machines and stethoscopes, blood glucose monitors and test strips for monitoring diabetes.

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 service demonstrated a high level of collaborative working with other local practices within their network. For example, patients who have been diagnosed prostate cancer and discharged from hospital were monitored by the practice and PCN collectively, and people were referred to the hospital for ongoing consultant monitoring. Care Coordinators were involved in the timely recall of these people for their regular in-house monitoring; two care coordinators were employed by the PCN which ensured continuity of the recall service during sickness and annual leave.

The PCN contracted and offered a sleep station programme which commenced January 2024, for patients who had poor sleep hygiene. Within the PCN 120 people were referred into the service. People were able to self-refer or could be referred by their GP or other healthcare professional, and the outcome of the sleep station remote programme had improved people’s sleep hygiene. This project had prevented unnecessary use of benzodiazepines (medicines used to help people sleep), reduced the number of GP appointments people were attending, as well as helping patients improve their sleep pattern. People were followed up at three and six month intervals.

The PCN launched a dementia pathway delivered by occupational therapists to provide short term intervention in the persons home environment for people with dementia and their carers. In total 71 people utilised the service between July 2024 to February 2025, with outcomes which included, follow up appointments, reviews of dementia care plans and referral for social services input. Feedback from people, family members and carers were positive.

The service worked in collaboration with other practices within their PCN to gather people’s views on enhanced access appointments. There were processes in place to work in partnership with key organisations and agencies to support the provision of care and joined up working.

Staff told us they regularly went over and above for people by referring them to services within the community such as a health and wellbeing coach to support them to live healthier lives. The practice also completes a weekly multidisciplinary comprehensive care home visiting service to review peoples holistic care needs, which is led by a GP partner, clinical pharmacist, and practice nurse.

The service focused on continuous learning, innovation and improvement across the organisation and local system and had an inclusive culture regarding learning from incidents and training. They were a training practice for doctors training to become GPs. The practice hosted doctors from training hospital to obtain experience of general practice and nursing students. To enable the practice to be a training practice a comprehensive audit of systems and processes was reviewed by system partners to ensure safe practice and effective well-led training. The service used learning from significant events and complaints to continually improve the service they provided, and changes were made within the practice if needed. The service also used an online platform to send monitoring information and communicate virtually with people.