Middlestown Medical Centre Also known as Dr Swan and Partners

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. The provider had good governance processes in place, and had a strong approach to learning and innovation.

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 practice had a very clear 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.

From the start of our interviews and discussions with staff, it was very clear that they wanted to ensure that patients received the best care possible, and that the care that patients received was delivered in a timely and safe manner. This desire and drive was reiterated when we discussed the ethos of the practice with partners and senior managers, who told us that they felt that a practice priority was to put their patients at the centre of all they do.

The provider had developed a practice plan 2025 to 2026 which outlined how it planned to deliver against its key aims. This included workforce planning, working at scale with partners and stakeholders, developing systems, processes, and monitoring of delivery, and through effective engagement and financial planning. Targets and milestones had been set within the practice plan.

The provider had a good understanding of the challenges faced in the delivery of their aims and vision for the practice. For example, they were fully aware of their increasing practice patient list, and the needs of specific patient groups such as service veterans. In response, they had put in measures to tackle these including increasing appointment access, raising awareness of veterans, and continuing to use data to guide them in the development and improvement of services.

Staff told us that the practice had a supportive and positive culture, and that teams within the practice all worked closely together. This view was supported by leaders and managers who told us that they felt that staff were part of a wider work family, and that they all strived to give support and treat others with care at all times. The provider had numerous examples of how they sought to develop an ethos of team working and fun which included social events and activities both inside and outside the workplace.

We found that the practice had inclusive leaders and managers at all levels who clearly understood the context in which they delivered care and treatment. We saw that leaders and managers had the skills, knowledge, experience, and credibility to lead effectively, and we saw they did so with integrity, openness, and honesty.

As part of our assessment, we discussed with staff their experiences of working with leaders and managers at the practice. Staff told us that leaders, senior managers and line managers were supportive, approachable, and inclusive. Staff also informed us that they would have no hesitation in contacting a leader or manager if they had a concern they wished to raise with them. Feeback from GP registrars showed that leaders and managers at the practice had supported them during their placement.

We saw the management team worked closely with the other practices in their primary care network (PCN) and wider stakeholders, and were engaged in the development and delivery of primary care services within the local area.

The practice recognised and effectively planned for the loss and retirement of key staff and partners, and we saw that succession planning measures were in place. This included forward financial planning, and the identification of staff for future development to act as possible replacements for those leaving the practice.

We found that the provider fostered a positive culture where staff and patients felt they could speak up, and their voice would be heard.

The practice had put into place freedom to speak up arrangements, and staff we spoke with fully understood who to contact if they had a concern that they needed to raise. Freedom to speak up and other related topics such as grievance and whistleblowing processes were also outlined in the practice’s governance handbook. Managers told us that they had an open-door approach which allowed staff to raise concerns with them directly, and this was corroborated by feedback we received from staff. Staff told us that they felt that leaders and managers were approachable, and friendly, and they felt any issues they raised would be listened to and investigated fully.

The providers approach to complaints handling supported patients to raise concerns about the care or treatment they had received. We found that complaints had been thoroughly investigated and responded to, and learning from issues raised used to improve services.

We saw evidence which showed that the practice valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

There were key policies and procedures in place to promote diversity, equality, and the protection of staff. This included a lone worker policy, zero tolerance policy and grievance and whistleblowing/speaking up policies and procedures.

We reviewed training records as part of our assessment, and these showed that staff had all undertaken training regarding equality and inclusion. We heard from both the provider and staff how adjustments had been made to ensure staff were valued and supported. Staff feedback to us was positive regarding how they were treated by the provider, and how they had been supported to develop their careers within the practice.

The practice had defined clear responsibilities, roles, systems of accountability, and good governance. They used these to manage and deliver high-quality, sustainable care, treatment, and support. The practice acted on the best information about risk, performance, and outcomes, and shared this securely with others when appropriate.

The provider had in place a comprehensive management structure which covered all areas of service delivery. In addition to clinical duties, partners had lead roles across the organisation such as safeguarding, prescribing, data and performance, and oversight of the dispensary. Governance was supported by a practice business plan which mapped out the direction priorities for the practice in the short/medium term. The provider oversight of performance and compliance was achieved by detailed performance monitoring, data analysis, and quality assurance processes.

We saw that good governance processes had been established across the practice. This included a comprehensive meeting structure which drove forward good communications, as well as supporting service delivery, development, and improvement. The provider held weekly management and clinical meetings. Minutes from meetings were detailed and carried the appropriate level of information. Standing agenda items for meetings included performance, safeguarding, significant incidents and learning opportunities. Minutes were stored on their digital management platform which was available to all staff. This platform also contained a suite of policies, processes documents, and standard operating procedures, and governance processes were detailed in their governance handbook.

As part of our assessment, we spoke with staff regarding information governance and security and found them to have a good understanding of confidentiality and security processes, and if they had concerns knew how to escalate these internally. Staff had received mandatory training in information governance and security. The provider was appropriately registered with the Information Commissioners Office.

The provider had a business continuity plan which had been reviewed in March 2025.

The medical centre had recently begun to work with the Royal College of General Practitioners Green Impact Toolkit and at the time of our assessment was starting to put in place actions to implement measures to improve their approach to environmental sustainability. Initial activities will be to engage with staff regarding the proposed programme.

The practice understood their need and duty to collaborate and work in partnership with others, so services worked seamlessly for people.

They shared information and learning with partners and collaborated to achieve improved services and outcomes for patients. For example, a partner from the practice acted as the education lead for the PCN and arranged network level learning sessions into musculo-skeletal medicine, and acted as the lead for the PCN menopause working group. Working as part of their PCN the practice had access to additional services for their patients including social prescribers and wellbeing coaches, as well as patients being able to attend PCN events such as a dementia tea group.

As a training practice the provider worked closely with both students and their placement bodies. Wider community co-working saw the practice support local authority and PCN staff in establishing walking groups.

Leaders and managers informed us that they looked to deepen their collaboration with community partners including their PCN and local pharmacies.

The practice had a strong focus on continuous learning, innovation, and quality improvement across all levels of the organisation and local health and care system. They frequently encouraged and implemented creative ways of delivering equality of experience, and improving outcomes and quality of life for patients. They actively contributed to safe and effective practice developments and supported research and wider learning amongst their staff and trainees they supported.

The practice had a programme of quality improvement activities which included clinical and non-clinical audits, clinical supervision, and regular searches of their clinical records system to ensure compliance with best practice principles. Quality improvement also benefitted from learning from significant events, near misses, and complaints. We saw for example, following a significant event how assessment, consultation and communication had led to changes in practice processes, and that staff had been made aware of these changes.

Learning, training, and teaching was a strength within the practice. The provider supported the training of GPs and medical and nursing students, as well as supporting individual staff within the practice to gain additional qualifications and to develop their careers. During our assessment we saw that the provider was supporting a member of the nursing team to become an advanced nurse practitioner, and staff told us how they had grown and developed within the organisation and taken on new roles. Weekly clinical meetings facilitated the sharing of learning and had included discussions regarding significant events, new guidance, learning, audits, and cases of interest.

The provider had a comprehensive approach to the monitoring of patient demand which supported effective staffing, capacity planning, and patient access. Reviews were made of patient appointment utilisation and population health needs. Results allowed the provider to ensure the right numbers and staff mix was available to meet this planned demand. This has allowed the provider to achieve a high level of patient appointment availability, and supports the delivery of patient-centred care as clinicians are able to spend more time with patients, leading to what the provider feels are better patient outcomes.

The provider embraced novel ways of working and the use of technology to improve health and care services for patients. We saw that the practice had adopted a software platform to improve medicines management and long-term conditions processes, and had installed a health pod in the main site waiting room which allowed patients to record weights, heights, and blood pressures. These measurements were transferred automatically to the patients record. The women’s health lead was looking to introduce innovative group consultations for menopause patients. Whilst other activities included the introduction of training clinics for registrars, and the use of digital scribes to reduce the administrative burden and save clinicians time on notetaking.

As an accredited training practice supported learning amongst those placed with them, and also took part in supporting research work. Recent support being given to a project examining transgender health. Feedback from GP registrars was very positive about the level of support they received from the practice including developing their consultation, examination and diagnostic, and treatment skills.

All staff were encouraged to put forward and test out new ways of working, and to make suggestions on how to improve services and we saw some examples when these had been put into practice, such as changes to clinical sample drop offs, and improvements to noticeboards in waiting areas.