Norton Canes Health Centre Also known as Dr W Nilar and Partner

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 the service’s leadership, management and governance assured high-quality, person-centred care and promoted an open and 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 service had a shared vision, strategy and culture. This was based on transparency, equity, equality, human rights, diversity, inclusion and engagement. Staff and leaders understood the challenges and the needs of people and their communities.

The mission statement was displayed within the practice in both staff and patient areas. They aimed to provide patients with professional, continuous, confidential and personalised medical care in all aspects of medicine within a caring, friendly, professional environment.

Leaders monitored and reviewed progress against the delivery of their strategy. The service was aware of local challenges which affected their service. Staff and leaders actively promoted equality and diversity and worked to identify the causes of any workforce inequalities. They demonstrated a positive and compassionate listening culture that focused on learning and development.

Staff described the culture of the practice as open and transparent. They told us they felt supported to raise any concerns which they knew would be listened to and acted on. Staff told us the practice manager was very hands on and was always willing to assist them with their duties if they were short staffed. They told us they were very proud to work at the practice, and any complaints or significant events were used as learning to improve the service and patient experience.

Leaders told us they offered staff flexible working arrangements.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate

All staff we spoke with were clear on their individual roles and responsibilities. Leaders proactively supported staff and regularly met with them to complete appraisals and performance reviews. The provider had established governance processes in relation to the quality statements we reviewed during this assessment, which were appropriate for their service. Staff told us they could access all required policies and procedures, which were kept up to date. Leaders held weekly meetings with staff, during which they discussed emerging risks and potential improvements to the service. Leaders clearly recorded any actions that arose from these meetings and shared these with staff. Staff took confidentiality and information security seriously, which included verifying people’s identity during remote consultations. Staff submitted data and notifications to external agencies as required.

The service had a Patient Participation Group (PPG) to represent the views of people using the service. However, uptake in membership had not significantly increased since the last inspection, despite the efforts that had continued to be made. Representatives from the PPG described how leaders had made positive changes because of patient feedback. They spoke highly of the staff and of the practice.

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.

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