Parson Drove Surgery

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• 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

This means we looked for evidence the practice was led effectively and in a way that was inclusive, supported improvement and innovation and made sure patients received care that was safe and effective.

At our last inspection we rated this key question Inadequate. At this inspection, the rating has changed to Requires Improvement. This is because there were not always clear responsibilities for staff with systems of accountability.

We assessed a total of 7 quality statements from this key question. There were improvements in governance processes since the last inspection, for example the practice now had a vision and there was a positive culture where staff felt supported to speak up. Although leaders were engaged and had taken immediate action to improve when feedback was given during the assessment, systems and processes required further improvement and embedding.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At the last inspection, the practice did not have a clear vision and there was no credible strategy to provide high quality sustainable care. At this inspection we saw leaders had identified and taken some action to provide high quality sustainable care.

Leaders had created a Business Development Plan. This plan highlighted their future vision and goals over the next 3 years. The practice had a shared vision, strategy and culture but further work was required to embed it fully.

Most staff reported that communication and the culture at the practice had improved since our previous inspection.

The provider had identified improvements needed and these were discussed at practice meetings. For example, data through our clinical searches of the practice's system showed that the provider had made significant improvements in reducing opioid prescribing.

However, there were areas that still required improvement in the overall management of risk.

Leaders were self-aware and understood that they were undertaking an improvement journey and therefore keen to improve patient experience and safety at the practice. Some staff we spoke with told us that they had been given opportunities to take on additional responsibilities.

Leaders were mostly visible and accessible, and staff told us they felt supported by senior clinicians in the practice to deliver safe and effective care. Leaders were knowledgeable about some issues, challenges and priorities that the service may face and had a shared focus to strive improvements. However, leaders did not understand all risks to delivering safe and effective care as they were not aware of some of the issues we identified during the assessment.

Since the last inspection, the practice had developed processes for a capable, compassionate and inclusive leadership team, however this was still in the early stages and required further embedding.

Some staff and patients we spoke with onsite told us there had been improvements in the culture since the last inspection.

Staff told us that they had seen positive changes implemented as a result from their feedback to leaders. For example, the practice introduced a system to allow non-clinical staff to rotate between different roles throughout the day. Staff told us that this provided more variety in daily duties, helping to improve wellbeing and maintain a more balanced workload.

At the previous inspection the practice did not have a Freedom to Speak Up Guardian. At this assessment staff told us they felt able to raise concerns and be listened to and knew how and who to raise concerns with. The staff we spoke with throughout our assessment were able to identify who the freedom to speak up guardian was.

There was a Freedom to speak up policy in place which had been reviewed and updated since our previous inspection. There was an external freedom to speak up guardian from the Cambridgeshire ICB. All staff members we spoke to were aware of who the freedom to speak up guardian was and how to contact them.

The practice had a diverse workforce that was made up of permanent and long-term locum staff. Leaders told us they worked towards an inclusive and fair culture by improving equality and equity for people who work for them. Most staff told us they felt valued, listened to, and empowered to contribute to the practice’s success. We observed occasions when staff wellbeing was prioritised.

However, there were occasions where some staff reported that personal development that had been identified had not always been followed up.

All staff had completed their training for equality and diversity and there was a practice policy in place that staff were able to describe. Staff reported episodes of aggression from the public including racially motivated abuse. The practice did not have a clear process in place to manage these incidents and found it hard to identify how they could prevent further episodes.

There were leads for most clinical and non-clinical areas. However, staff we spoke with were not always clear on their individual roles and responsibilities and on who leads were. For example, some staff were unclear who the lead was for infection prevention and control and safeguarding.

Staff had opportunities to discuss incidents, complaints and safeguarding concerns as well as complex patients. However, there was limited formal monitoring to ensure that learning following complaints and incidents was embedded or that actions had been successful.

Although there had been improvements since our previous assessment, leaders did not always have clear oversight over all governance systems and processes. There were still some gaps in governance systems, for example, we identified issues with responding to complaints, staff recruitment files and monitoring of controlled medications.

The provider had implemented a business plan since the previous inspection. There were some effective arrangements for identifying risk, however there were areas for improvement in the overall management of risk and implementation and embedding of systems to monitor risk.

Since the previous inspection, the practice had developed a system for oversight and monitoring of staff training, however, records we viewed showed gaps in clinical supervision.

People were mostly able to access support at the practice. Some people told us that there had been issues in relation to referrals being made appropriately and that they did not always feel supported during waiting times to be seen by other services.

The PPG provided positive feedback regarding the practices ongoing engagement with the community. And we saw that the practice was working closely with the PPG to shape service enhancement. We saw minutes from meetings held where changes in service delivery and management were discussed, and views of the PPG members was sought. The provider was working closely with the PPG and had discussed within a recent meeting about involving younger people to include a greater variety of patient voice.

However, the practice’s website was not always kept updated to keep people well informed.

Staff described some systems in place to work with other organisations, however this was not always consistent.

There were links between the local Primary Care Network and the provider. The practice employed additional role reimbursement staff through the Primary Care Network to support collaboration and partnerships.

The practice also worked with commissioners, for example they engaged regularly with the ICB to monitor actions identified at the last inspection. Feedback from the ICB was that, although the practice was working hard to improve, there were times that responses were delayed.

The practice had started to hold regular multidisciplinary team meetings to keep oversight of patients receiving care and treatment from a range of services. These were becoming established, and the provider had not yet carried out any audits of the new process to evaluate effectiveness.

Leaders told us that learning needs were identified through annual appraisals, team feedback, and clinical audits, but we did not see any evidence that these had been embedded. Staff understood their duty to raise concerns, report incidents and near misses. Staff told us that they had received enough specific training for their role.

The provider had implemented new systems for monitoring significant events and complaints since our previous assessment. This was not consistently followed, for example, we saw a variance in the quality of learning from significant events.

There was evidence that learning from some incidents and complaints had resulted in changes, however, the provider could not demonstrate that actions had led to sustained improvements. There were 3 occasions where a significant event had been repeated with the same learning outcomes identified. This indicated that the learning outcomes and subsequent actions had not mitigated the risk.

We were not assured complaints had been dealt with effectively and lessons learned from them. The provider had systems and processes in place to investigate and report incidents; however, these were not routinely followed. We saw significant delays in responses to complaints which were not being handled in line with the policy.

The provider had produced a new significant events policy with actions and learning identified since our previous assessment. A new freedom to speak up policy had also been implemented. Some of the incidents we reviewed reflected that the practice had followed their duty of candour policy to involve and inform people when errors occurred.

We saw evidence of regular clinical governance meetings with learning shared. Since the previous inspection, the practice had developed a system for oversight and monitoring of staff training, however, records we viewed demonstrated gaps in clinical supervision.