Bannockburn PMS

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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

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 requires improvement. At this assessment, the rating remains the same.

The service was in breach of legal regulation in regulation 17 (good governance) in relation to leadership at the practice and governance procedures. We have asked the provider for an action plan.

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 service had developed its shared vision, strategy and culture since the last inspection. 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 was aware of the projected increase in the local population and was working with partner agencies to address future challenges.

At our last inspection, we found that the service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. At this inspection we found there had been improvement. However, there had been significant management changes at the practice immediately prior to the inspection, and many of the changes implemented since the last inspection had been undertaken by temporary and consultancy staff. Therefore management structures remained unclear and could not demonstrate capable and sustainable leadership in the long term.

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.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

At our last inspection, we found that the service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. At this inspection we found that, although there was improvement in some areas, there remained elements of the practice’s governance processes which were either unclear or unfit for purpose. For example, we reviewed both the medicines management and safeguarding policies at the practice. Although clinical in nature, the policies had neither been drafted nor approved by a regulated clinical professional. At our last inspection, we had identified breaches of regulations relating to both areas and had identified that areas had been inappropriately delegated to non-clinically regulated staff. At this inspection we found that medicines management and safeguarding procedures had improved. However, the governance procedures supporting this were insufficiently clear and robust, as a regulated clinical member of staff had not reviewed them.

The service did not have formalised supervision arrangements for non-medical prescribers at the practice. On the basis of the clinical searches that we undertook, it appeared that these staff were working within the limits of their competence. However, there were no formalised meetings with these staff, or any other formal means by which their individual clinical work could be reviewed.

In other areas, the service had developed governance processes since the last inspection. Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Staff could access all required policies and procedures from a centralised database. 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.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service 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. They actively contribute to safe, effective practice and research.

The practice had a quality improvement plan in place to help drive improvements in services. This focussed on the appointment system. All staff were encouraged to put forward and test out new ways of working.