The Old School 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 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 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. The practice was aware of the projected increase in the local population and was working with partner agencies to address future challenges. They had recently recruited a non-clinical partner to support with the project.

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.

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. We saw the leadership team worked with other practices in the primary care network and were engaged in the development of primary care services within the local area.

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 other practices 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.

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.

Policies and procedures to promote diversity and equality were in place. We saw senior leaders had addressed concerns related to discrimination. Adjustments had been made to ensure all staff were valued.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on information about risk, performance and outcomes.

Leaders and managers supported staff, and met with staff regularly to complete appraisals and performance reviews. The provider had some governance processes, however during the inspection we identified gaps within these, such as infection control, summarising oversight, MHRA, oversight of DBS for contracted staff, oversight of emergency medicines and equipment. The provider was responsive to feedback on the day of inspection and provided further evidence of actions taken to mitigate the risk. Staff could access all required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. However, some meeting minutes such as safeguarding did not always show details of actions arising from these meetings.

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 provider worked with other practices within their primary care network to offer extended access, and flu and Covid vaccination programmes. Staff had made adjustments to improve coordination of their service with community healthcare services. The PPG supported the provider by providing up to date feedback from the patient population so they could better understand their community.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. Whilst we did see some evidence of learning in the form of significant events and complaints, there was not a system to capture near misses and dispensing errors within the dispensary to drive improvements. Whilst we also found evidence of clinical audits the cycles were not always repeated to demonstrate improvements made and drive innovation.