The Grange Practice

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 has changed to requires improvement.

The service was in breach of legal regulation in relation to good governance.

This service scored 62 (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 patients and their communities.

Staff had contributed to the development of the practice vision and strategy, which was kept under review.

The practice recognised changes in service demand and patient demographics and had outlined plans to adapt accordingly.

Some staff spoke positively about the working environment highlighting a positive team culture, feeling valued, respected and listened to. However, others highlighted concerns regarding communication and support. We saw efforts by practice leaders to understand staff perspectives. Leaders conducted regular anonymous staff surveys, with the most recent carried out in September 2025, and described a range of initiatives aimed at improving communication and staff engagement. These included plans to introduce staff newsletters and to organise workshops focused on strengthening communication with the practice and across different teams.

The practice had established systems and processes to encourage and support staff to speak up. The practice had designated Freedom to Speak Up Champions, offering staff a confidential route to raise concerns internally or externally. All concerns raised were recorded, investigated, and addressed, with learning shared to support improvement. Staff reported that they knew how to raise concerns and were aware of the different options available to them for speaking up.

The provider had systems to promote equality, diversity and inclusion in the workplace. Some staff told us they had received support and developmental opportunities as well as reasonable adjustments to accommodate individual needs. The provider also described a range of initiatives to support staff development and inclusion, including training pathways, apprenticeships and work experience opportunities.

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

There were not effective systems to identify and act on environmental risk, monitoring of fire warden training, management of new patient information and processing of incoming documents. Improvements were needed in the oversight of patients prescribed some high-risk medicines, long-term condition reviews, documentation of medicine reviews and the tracking of urgent cancer referrals.

However, managers told us they met with all staff to complete appraisals and performance reviews. Staff told us could access all required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Staff took patient confidentiality and information security seriously.

The practice met with staff to assess and review performance. Lessons were learned from significant events and complaints, to help prevent similar incidents from reoccurring.

The practice understood their duty to collaborate and work in partnership, so services work seamlessly for patients. They shared information and learning with partners and collaborate for improvement.

There was an established Patient Participation Group (PPG) that held regular, well-structured meetings with good engagement and regular attendance. Feedback from some members indicated a positive relationship with the practice.

Staff told us patients welcomed the availability of the drop-in sessions with a social prescriber that were held twice a week. This provided patients with the opportunity to gain advice about a range of topics including housing related queries, carer support and financial advice.

The provider also highlighted a range of wider community and partnership activities, including supporting the PCN, hosting trainees, contributing to local charitable initiatives and offering additional clinics to improve access for the local population.

The practice focused on continuous learning, innovation and improvement across the organisation and local system. Leaders demonstrated a clear understanding of the needs of the practice’s local population, including its demographics and the challenges faced.

The practice had systems and processes in place to support learning, continuous improvement and innovation.

Staff told us that patients benefited from the in-house diagnostic ultrasound service, which made it easier and faster for patients to access diagnostic care locally. They told us it resulted in shorter waiting times, quicker results, and more convenient appointments.

The practice also shared further examples of innovation and service development, including interventional ultrasound procedures, dedicated women’s health clinics, and their involvement in wider system outreach activities.

Significant events and complaints were used to make improvements. The provider told us learning was shared with staff; documents we viewed and staff we spoke with confirmed this.