The Mill Medical 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 practice leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

There were clear and effective governance, management and accountability arrangements. Staff understood their role and responsibilities. Managers and leaders could account for the actions, behaviours and performance of staff. Information was used effectively to monitor and improve the quality of care. Leaders implemented quality frameworks to improve equity in experience and outcomes for people using services and tackle known inequalities.

Staff feedback during the assessment was positive, with staff stating there was a supportive, team-based culture and all staff we spoke to were passionate about delivering a high-quality service.

At this inspection, the rating has changed from outstanding to good. Whilst the provider had maintained excellent practice, the threshold to achieve an outstanding rating had not been reached.

This service scored 82 (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.

There was an active patient participation group, (PPG). Members of the group told us that the PPG felt valued and had been invited to work with the practice to make improvements and assist with the implementation of new developments. Trust and respect had been built over a number of years, and a working relationship had been developed based on mutual trust.

Leaders demonstrated the importance of staff wellbeing to support them in maintaining good outcomes for patients. Leaders invested in learning and development for all staff and developed tools to assist staff to achieve best practice.

Feedback we received from staff regarding the culture within the practice was very positive. They told us it was a friendly environment to work in and there was an open, blame free culture and they enjoyed working there.

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. 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.

Staff we spoke with told us leaders were approachable and responded to any concerns raised. There were regular management and staff meetings to ensure all staff members were aware of changes to service delivery.

Leaders engaged with patients, staff, and partners to gather feedback and acted on it, demonstrating improvements they had made in response during the assessment.

Staff told us that leaders cared about their wellbeing and provided initiatives such as peer support across all levels and organised social events.

The practice fostered a positive culture where patients felt they could speak up and their voice would be heard and responded to.

The practice had established Freedom to Speak up arrangements with other practices in the primary care network. Staff were aware of how to raise concerns, and we saw examples where staff had used the arrangements in place to positive effect.

The practice had an open culture where staff felt confident to speak up if they had concerns. Staff told us they were listened to and felt safe raising issues without fear of negative consequences. Leaders promoted honesty and transparency, encouraging staff to share concerns. There were clear policies in place. All staff spoken with told us they knew how to access them if they wanted to raise a concern formally. The practice had an external freedom to speak up guardian.

The practice valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Policies and procedures to promote diversity and equality were in place. Adjustments had been made to ensure all staff were valued. Staff had received training in equality, diversity and inclusion and were aware of supporting people with protected characteristics. There was a zero tolerance to bullying and harassment and leaders were committed to providing an inclusive and supportive working environment.

Staff we spoke with reported high levels of job satisfaction. They told us they felt valued and career development and opportunities for learning were encouraged. A number of staff had longstanding employment with the practice.

The practice had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-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.

Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. GPs were each assigned clinical areas to oversee, and staff informed us that they knew who to contact if they had any queries or concerns. Staff we spoke with told us the leaders had an “open-door” policy and were always responsive and available to provide support.

Managers met with staff regularly to complete appraisals and performance reviews. The provider had established governance processes that were appropriate for their service. Staff knew where to access all required policies and procedures and understood the importance of patient confidentiality and information security.

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.

The practice had comprehensive assurance systems that underwent regular review and improvement. These systems effectively managed risks to both patients and staff, covering areas such as fire safety and the learning from complaints, safety alerts and significant events. We saw evidence of clear action plans which were monitored to ensure identified risks were mitigated, actions completed and sustained over time.

Recruitment processes were effective, with appropriate checks carried out for new staff. Staff were aware of their training requirements, and all had completed their mandatory training.

The practice operated a robust clinical audit programme. Audits and improvement projects were monitored and re-audited and results were discussed with all relevant staff.

The practice website was designed and managed by Surrey Integrated Care Board. This meant that the practice had little control over the contents. In response the practice had created their own website ‘The Mill Patient Portal’. The website included links to websites for support, information, about the practice and links to how to book appointments and order medicines.

The practice clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for patients. They always shared information and learning with partners and collaborated for improvement.

The provider worked with other practices within their primary care network to offer extended access, and flu and covid vaccination programmes.

The practice worked with stakeholders to build a shared view of challenges and of the needs of the population. The practice worked with a range of external partners, for example, other health and social care professionals, mental health services to support patients with a range of needs. There were many clear examples of how partnership working had improved patient outcomes and how best practice had been shared across the wider organisation.

The practice had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome, and quality of life for people. They actively contributed to safe, effective practice and research.

Leaders showed strong commitment by regularly listening to patient and community feedback, which directly influenced the design and assessment of new working practices. They also invested significant time and resources to support staff.

The practice was participating in a pilot which provided 14-day continuous ECG monitoring in the community. Measurable targets had been set including reducing referral-to-result turnaround time from 6–8 months to less than 3 weeks, improving arrhythmia detection rate and enhancing patient experience and satisfaction. The practice had identified 68 patients to take part in the pilot. The pilot was ongoing, with a project duration of no longer than 12 months, to allow for the collection of sufficient data. As such detection rates and outcomes had only been partially evaluated but initial results had shown improvements, with waiting time from referral to diagnostic result falling and feedback of positive patient experiences. The project had been nominated for the Health Service Journal Primary and Community care Project of the Year.

The practice had been involved in the development of Ockford Ridge Community Project, a community initiative focused on children, young people, and families in Godalming. A partner had contributed to project development discussions from a healthcare perspective, focusing on the health needs that resident may have. This included common childhood presentations seen in general practice that often do not need GP contact but would benefit from early social support or intervention by the health visitors/local children’s teams.

The practice used learning from significant events and complaints to continually improve the service they provided, and changes were made within the practice if needed.

We saw examples where staff had requested and been offered the opportunity to progress in their roles and/or add to their skills. These included clinical and non-clinical roles.

We saw evidence of a range of audits and quality improvement projects. Projects were designed to improved performance, outcomes, and patient experience. For example, audits for complaints, clinical audits and infection control. All staff were encouraged to put forward and test out new ways of working.