Peartree 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 practice 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 is Requires Improvement.

The practice was in breach of legal regulation in relation to good governance.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice 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 practice vision and strategy, which was kept under review. Staff told us there was a positive team culture within the practice and that they felt supported by GPs and senior leaders. They told us they were able to contribute to discussions about service improvements, incidents and complaints. All staff we spoke with were proud to work for the service and had a vision to deliver high quality patient care.

The practice 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 practice was approachable and responded to any concerns raised. Staff also told us leaders modelled the values of the practice and staff really enjoyed working at the practice and a testament to this was the length of time staff had worked at the practice. We saw the leadership team worked with other practices in the primary care network.

The practice 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 told us they were confident to raise concerns either via their management or the Speak up guardian. They reported that they felt able to raise concerns with leaders without fear of retribution and they knew how to access the whistleblowing policy. We received staff feedback as part of the inspection process which highlighted there was an ‘open door’ policy and leaders welcomed feedback for service improvements.

The practice valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them. Policies and procedures to promote diversity and equality were in place such as a zero tolerance policy. All staff we either spoke with or received questionnaires from reported high levels of job satisfaction. Staff had completed training in equality, diversity, and inclusion and were aware of supporting people with protected characteristics such as age, gender, religion and disability.

The provider had not established effective governance processes appropriate for the service.. For example, the review of policies to reflect the complaints process within the practice was not effective; there was a lack of oversight of recruitment records; Patient Group Directives; a lack of evidence of learning from events and incidents to improve the service and prevent recurrence. We found improvements were required in relation to management of risks with staff immunisation records. The practice had also not notified the Care Quality Commission about notifiable events for example Police attendance at the practice. Managers held regular practice meetings with staff, however clinical concerns and emerging risks were not discussed, nor was learning from complaints shared to reduce the risk of recurrence. Managers did not clearly record any actions arising from these meetings and ensure these were shared with staff. Staff could access all required policies and procedures. Staff took patient confidentiality and information security seriously. The provider’s own quality assurance processes failed to identify these concerns prior to our inspection visit.

The practice understood their duty to collaborate and work in partnership, so practices 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 covid vaccination programmes. Staff had adjusted to improve coordination of their practice with community healthcare practices, including through recently established weekly meetings centred on the care of those at higher risk of hospital admission. Feedback from care homes was positive about their working relationship with the practice and considered the practice very responsive and available when needed.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They actively contribute to safe, effective practice and research. Thepractice had a quality improvement plan which was in progress to help drive improvements in practices for example to be an approved learning centre, and the practice is working towards becoming a dementia friendly practice. Staff were encouraged to suggest and trial new ways of working, and we saw examples of the practice carrying out learning needs analyses to identify individual strengths and areas for future development.