Rectory Meadow 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 inspection, we rated this key question as Good. At this inspection, the rating remains the same and continues to be rated Good.

This service scored 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders within the practice told us there was a balanced vision and ambition to both modernise the practice whilst keeping the traditional, family ethos in 2025 and beyond. The findings from our inspection and repeated high levels of patient and staff feedback indicated the practice was delivering their vision and the culture was embedded. The direction of the practice was under constant review, shared with staff and documented within the practice’s 5-year (2022 to 2027) plan and strategy. Leaders highlighted the importance of reviewing the plan as changes continued within primary care, the NHS and the local communities.

The 5-year plan included 6 strategic priorities and leaders spoke of the importance of staff wellbeing to support them in achieving the ambitions and maintaining good outcomes for patients. Leaders invested in learning and development for all staff and developed tools to assist staff to achieve best practice. We saw leaders continually assessed the current workforce, evaluated their skills, experience, and potential of staff members. This included succession planning. We saw the practice had identified those who had the potential to take on more responsibility or move into key roles in the future. This in turn had created a pipeline of talent by recruiting and retaining skilled individuals who could be developed into future leaders within the practice.

Staff told us the improved culture and recent changes within the practice had transformed the way in which the practice worked. Leaders told us, this has not only been well received by the patients but had been instrumental in attracting staff both administrative and clinical, who had a desire to modernise the service and make the practice resilient and agile for the future.

Staff listened to patients’ needs, complaints and suggestions and showed an understanding of equality, diversity and human rights in providing safe, compassionate care for the patient population. Feedback we received from staff regarding the culture within the practice was positive. They told us it was a positive and friendly environment to work in, the culture was open, transparent, blame free and non-discriminatory.

The practice had exceptionally 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. Staff told us leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty. Staff feedback also highlighted leadership changes had brought new energy, new ideas and created a ‘togetherness’.

Furthermore, staff told us leaders were approachable and responded to any concerns raised in a compassionate, inclusive and timely manner. There were regular management and staff meetings to ensure all staff members were aware of changes to service delivery. Staff also told us leaders modelled the values of the practice. We saw the leadership team, both clinical and non-clinical leaders worked with other practices in the primary care network (PCN) and were engaged in the development of primary care services within the local area.

The practice had an equality and diversity policy and promoted equity to all people – including staff, patients and visitors to the practice. Leaders demonstrated a clear understanding and embedded commitment to equality, diversity and inclusion (EDI). Leaders went beyond statutory requirements to create a culture where individuality was genuinely valued, and differences were seen as a source of strength. For example, the creation of a safe, quiet space for reflection, prayer and sanctuary.

Staff were able to request adjustments to working at any time and were reminded during appraisals, and in supervision meetings to keep adjustments accurate and up to date. Examples included, flexible working hours and rotas to support family or caring responsibilities, home working arrangements where possible, and sit–stand desks provided for musculoskeletal needs.

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 and staff were aware of how to raise concerns.

There was an open culture where staff felt confident to speak up if they had concerns or ideas for improvement. Staff told us they were listened to and felt safe raising issues without fear of negative consequences. Leaders promoted honesty and transparency, encouraging staff to share concerns early so they could be addressed quickly. There were clear policies in place, and staff knew how to access them if they wanted to raise a concern formally. Regular team meetings and supervision sessions gave further opportunities for staff to talk openly about their experiences.

The practice valued diversity in their workforce. They worked 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. Adjustments had been made policies, processes, work patterns and furnishings within the practice to ensure all staff were valued and included. For example, a quiet area for prayer and reflection and also the introduction of gender-neutral toilets.

Staff we spoke with told us about career development and opportunities for learning. For example, staff progressing to senior roles, with leadership training supported for internal candidates.

Staff had completed training in equality, diversity, and inclusion and were aware of supporting people with protected characteristics such as age, gender, sexual orientation, religion and disability.

The practice had clear responsibilities, roles, systems of accountability and good governance. Staff told us, following changes within the leadership of the practice, communication and systems to promote governance had greatly improved. Staff said they used the new systems to monitor, manage and deliver good quality, sustainable care, treatment and support. We saw staff acted on information about risk, performance and outcomes, and shared this securely with others when appropriate.

Leaders supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Leaders met with staff regularly to complete appraisals and performance reviews. The provider had established governance processes that were appropriate for their service. Staff could access all required policies and procedures. Staff took patient confidentiality and information security seriously.

The practice monitored all elements of performance and analysed data to ensure any potential risks were assessed. For example, dashboards and live reporting reviewed all aspects of patients’ access, including routine access, urgent access, telephone access and online access. In terms of clinical performance, this was monitored by the clinical team and support staff.

The practice clearly understood and carried out their duty to collaborate and work in partnership with other services within the local health economy. This included open and transparent collaboration with relevant external stakeholders and agencies when investigating multi organisation learning events.

The practice worked with 4 other practices within their PCN to provide additional and extended services.

Feedback about Rectory Meadow Surgery from the local PCN was extremely positive and highlighted how the practice hosted and embraced ideas, pilots and projects to identify new and innovative ideas to improve the health outcomes of practice patients and the wider Amersham, south Buckinghamshire community.

There was an active PPG, with regular meetings and 2-way communication. Representatives from the PPG reported that the practice was supportive and receptive to the patient voice, actively involving them in initiatives such as health promotion and enhancements to the practice.

Staff and leaders engaged with partners to share learning that resulted in strengthened joined up care and continuous improvements to the service and across local communities.

The practice focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Over the last 18 months, innovation and change had transformed many aspects in the practice. This included changes to the telephony system, appointment system, communication tools, online channels including the website and general improvements to the systems to manage administration and practice workflow.

Staff across the practice had key roles in monitoring and improving outcomes for patients. Staff spoke positively about the culture in the practice regarding the Quality Improvement Plan for 2026. This included further work to improve child immunisations in light of measle outbreaks and recent deaths and work to improve the management of medicines within female health.

There was an effective clinical audit programme to drive improvement. Audits and improvement projects were monitored and re-audited to measure impact. To promote shared governance and continuous quality improvement, results were discussed to all relevant staff. We also saw the practice used national reporting systems to benchmark clinical performance such as childhood immunisation data and cancer screening data.