Dr Hutchings and Partners

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 practice’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 has changed to requires improvement.

As concerns remain regarding oversight, we found the practice 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 dignity, equality and human rights. Staff and leaders understood the challenges and the needs of people and their communities.

Staff were aware of the practice’s vision and strategy, which was kept under review. Leaders monitored and reviewed progress against the delivery of their strategy. The practice was aware of local challenges which affected their service, such as the projected increase in the local population over the coming years and explained their desire to increase capacity by planning strategic recruitment accordingly. 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.

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 did not have clear systems of accountability and good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. However, the practice had clear roles and responsibilities.

There was a lack of oversight of governance processes to consistently and effectively manage risk to keep people safe. For example, leaders had not ensured that all necessary actions from risk assessments of the premises had been completed. Our site visit took place 10 months after the original risk assessments, and risks identified as requiring immediate action, or action within 3 months, remained outstanding. One risk assessment contained information that the previous year’s actions had also not been completed by leaders. Risks identified by an audit of infection prevention and control had also not been addressed in a timely manner. These delays in mitigating known risks meant that leaders were unable to assure themselves that premises and equipment were safe for patients and staff. Following the assessment, the provider submitted a plan for actions it intended to take, and the timescales for completion, to address the outstanding risks identified.

Governance processes were not fully established or working as leaders intended. The practice did not have a robust system for recruitment to ensure that people were employed appropriately and able to fulfil their intended roles. Employment records contained gaps including criminal records checks for staff members who had already been employed for several months, despite the practice policy requiring these to be in place before employment commenced. Evidence was provided to show applications had been made for these at the time of employment, but administrative issues had not been followed up to allow completion of these checks. Systems to ensure staff were up to date with necessary training were also not effective and gaps were found in training records for a clinician. Since our visit, evidence of actions taken to address these concerns has been received.

Processes to ensure all staff were appropriately immunised for their roles were also not appropriate for the service provided or in line with national guidance. Records reviewed for clinical staff were incomplete and leaders were therefore unable to assure themselves that those staff were protected from the risk of infection or from spreading infection to others. The immunisation status of non-clinical staff was not routinely sought, which meant that their infection risk could not be assessed or mitigated. The practice leaders have since provided assurances and a plan of work to promptly address this concern.

Staff could access required policies and procedures to support their roles. However, systems to ensure effective oversight and management of policies were not always effective. For example, duplicate policies for Infection Prevention and Control were stored by the practice and one contained outdated guidance. This was addressed during our visit to ensure usage of the correct policy by staff.

These findings demonstrated that governance systems and processes were not operating effectively, to provide leaders with assurance that risks were identified, monitored and mitigated.

However, 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.

Leaders held regular 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.

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.