St Martin's Gate 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 75 (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. Staff had contributed to the development of the practice vision and strategy, which was kept under review.

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 were approachable and responded to any concerns raised. Several staff spoke about compassionate management when they had personal issues that had affected them at work.

The practice fostered a positive culture where people felt they could speak up and their voice would be heard. The practice had an internal Freedom to Speak up Guardian and an external Freedom to Speak up Guardian who was part of the primary care network. Staff were aware of how to raise concerns. Staff we spoke with felt comfortable in speaking up and told us the leadership team were approachable. Leaders recognised that not all staff members would feel comfortable speaking up during meetings, so they used an anonymous comments box to ensure everyone got heard.

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 to ensure all staff were valued.

The practice had clear responsibilities and roles. Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. Staff could access all required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Staff took patient confidentiality and information security seriously.

The practice understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement. They told us how they worked collaboratively alongside the primary care network (PCN) and organisations such as Healthwatch. For example, they worked with Healthwatch to support their project on understanding patient experience of accessing community mental health services for low level mental health support via a GP referral.

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. All staff were encouraged to put forward and test out new ways of working. They actively contributed to safe, effective practice and research. Leaders were aware of the challenges the practice faced. They met regularly to enable them to address these in a timely manner.