Highlands Surgery

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

Leaders had established an inclusive, positive, learning and improvement culture and were driving improvements in outcomes for people who use services and wider communities. Learning was shared with and sought from partners.

There were consistent examples of how an inclusive, supportive, and collaborative leadership approach had driven improvements in safety, sustainability, care integration, meeting people’s needs and inequalities for staff and people who used services.

Governance and management systems enabled leaders to identify and act on information about risks, performance and outcomes.

Leaders drove continuous efforts to maintain and improve understanding of ways of working, including staff and people’s experience to proactively mitigate risk and improve care delivery. Leaders recognized their role as drivers of a strong safety culture, and this was visible in practice.

At our last inspection, we rated this key question as Good. At this assessment, the rating has changed to Outstanding.

This service scored 93 (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 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. They had high levels of credibility and consistently demonstrated during the assessment how they achieved what they set out to do. It was evident that patients were at the heart of everything the practice did and leaders demonstrated the importance of staff wellbeing to support them in maintaining good outcomes for patients. Leaders worked with patients, staff, and partner organisations to gather feedback on their management and communication and responded to it. They demonstrated during the assessment how they made changes for the better wherever they could. Responses, from patients, staff and partners both to the practice and directly to CQC, were consistently and extremely positive. Leaders invested (both financially and with time) in learning and development for all staff and developed tools to assist staff to achieve best practice on a daily basis.

Staff told us leaders in the practice were approachable and responded to any concerns raised. Staff also told us leaders modelled the values of the practice. We saw the leadership team worked exceptionally well with the other practice in the primary care network, (PCN), and were fully engaged in the development of primary care services within the local area.

The service 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. They had high levels of credibility and consistently demonstrated during the assessment how they achieved what they set out to do. It was evident that patients were at the heart of everything the practice did and leaders demonstrated the importance of staff wellbeing to support them in maintaining good outcomes for patients. Leaders worked with patients, staff, and partner organisations to gather feedback on their management and communication and responded to it. They demonstrated during the assessment how they made changes for the better wherever they could. Responses, from patients, staff and partners both to the practice and directly to CQC, were consistently and extremely positive. Leaders invested (both financially and with time) in learning and development for all staff and developed tools to assist staff to achieve best practice on a daily basis.

Staff told us leaders in the practice were approachable and responded to any concerns raised. Staff also told us leaders modelled the values of the practice. We saw the leadership team worked exceptionally well with the other practice in the primary care network, (PCN), and were fully engaged in the development of primary care services within the local area.

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

Policies and procedures to promote diversity and equality were in place. Adjustments had been made to ensure all staff were valued, for example, we saw evidence of flexible working arrangements being made to provide equal opportunities to staff, both on a temporary and permanent basis. We also saw fair and equitable treatment of staff in terms of opportunities for personal and professional development.

Staff at the practice included people from diverse communities and backgrounds and also included staff who were veterans and carers.

Staff had completed equality, diversity and inclusion training.

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

Policies and procedures to promote diversity and equality were in place. Adjustments had been made to ensure all staff were valued, for example, we saw evidence of flexible working arrangements being made to provide equal opportunities to staff, both on a temporary and permanent basis. We also saw fair and equitable treatment of staff in terms of opportunities for personal and professional development.

Staff at the practice included people from diverse communities and backgrounds and also included staff who were veterans and carers.

Staff had completed equality, diversity and inclusion training.

The service 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 always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Governance was extremely well-embedded into the running of the service. Information about risk and performance was shared proactively and there were robust systems for capturing data. These systems demonstrated the ability to provide excellent quality information for relevant data or submission requirements such as the practice’s CQC assessment.

The provider used data to monitor performance and quality, which was discussed monthly during time to learn (TTL) with all staff. Topics included incidents, near misses, patient feedback, complaints and compliments, inherent risks, patient care and treatment, and best practice. Some sessions included an external speaker to inform, share experiences, or present learning the practice could use to improve outcomes.

A regular suite of searches of the clinal record system were run to identify patient needs and ensure these were being met and our review of clinical records showed that this was effective.

Staff knew where to access all required policies and procedures and understood the importance of patient confidentiality and information security. There were arrangements for identifying, managing, and mitigating risks and a major incident plan was in place. The provider had established governance processes that were appropriate for the service.

All staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. Staff and leaders actively monitored and anticipated current and future risks to delivering the strategy, including relevant local factors. All staff understood and were actively engaged in action plans to prevent and manage risks. Members of the team told us that communication not only encouraged learning and development but was effective in increasing production and positive outcomes for the patients and the whole community.

There were effective processes in place for staff recruitment, and we saw evidence that the appropriate checks had been carried out for new staff. Repeat checks had also been carried out for existing staff to ensure ongoing suitability and competency for their roles.

Staff had completed all mandatory training and practice leaders had excellent oversight of what had been completed.

There was a comprehensive programme of clinical audits in place held which were held on a central database of all audits and improvement projects that were ongoing. These were monitored effectively and repeated in a timely manner and the results were shared with the relevant members of staff and partner agencies, including health and community services and the ICB for ongoing shared learning and improvement.

The practice had a strong and long-standing culture of continuous learning, improvement, and innovation, shaped by evidence and local need. This led to better outcomes, fairer access, and a better experience for patients.

Leaders and staff were proactive in sharing ideas, taking part in research, and using good practice to improve care. They regularly listened to feedback from patients and the community, using it to shape and assess new ways of working. Leaders also invested time and resources to support staff and encourage collaboration with patients

Learning from external work was applied and embedded so that ways of working were continually evolving to reflect evidence-based best-practice.

The practice had a quality improvement plan in place to help drive improvements in services. All staff were encouraged to suggest and/or test out new ways of working. Practice leaders were able to provide many examples of improvements that had been made as a direct result of feedback or incidents.

In addition, leaders were aware of challenges being faced by primary care services and were working to improve. At the time of assessment, the practice was in the process of refurbishing 2 administration rooms in their branch surgery, situated across the road from the main site. They had worked with MSE ICB to convert the rooms into clinical rooms, to increase the number and type of appointments offered to people. This was in response to the challenge of increasing demand for clinical appointments.

Leaders had developed a bespoke suite of clinical and non-clinical tools for their clinical system, which included templates with links to guidance, pop-ups with essential information and requests for action and embedded protocols for care and treatment. This enabled staff to provide consistent, high-quality care and advice to people in line with national guidance and best practice.

Staff were able to provide anonymous feedback via a QR code and during the inspection we saw that this had been recently used by staff to suggest improvements to staff uniforms.

We saw many 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 and included a wide range of options including on the job coaching to professional development qualifications.

The practice was a registered training practice and at the time of assessment there were 3 trainee GPs (registrars) on placement. Feedback we received from them was that the standard of training, opportunities and clinical support they received was excellent. The practice was consistently oversubscribed in terms of the number of applicants for these positions. The practice worked collaboratively with the Royal College of General Practitioners (RGCP) and a local university to ensure that the training they provided remained at a high standard and met the current requirements.

The practice had recently advertised for a salaried GP and one of the GP registrars was successful in securing the position.

Leaders embraced innovation and digital tools to improve efficiency. They had recently commissioned and implemented an Artificial Intelligence (AI) process to improve efficiency to the document flow in the practice. This process was underpinned by the relevant safeguards to ensure safety and mitigate risk, and this included the relevant clinical risk assessment to comply with NHSE requirements. There was a human element involved in reviewing quality and safety, involving regular and frequent checks and recording any issues which could be addressed directly with the provider. This process had only been in place for a short time, but analysis had shown that there was a significant improvement in efficiency, meaning that staff time usually spent on this process could be diverted to other tasks.

The practice had purchased further AI applications, including the Heidi Health Tool, which is an advanced AI medical scribe tool, designed to transcribe patient visits, generate clinical notes, fill out documents, and dictate letters. This tool allows clinical staff to focus more on the patient consultation, rather than on typing and administrative tasks. In line with best practice guidance, they had planned a staggered implementation of the applications to ensure that any problems could be resolved without having a negative impact on patient care. They had carried out due diligence and extensive research into the use of AI. Although there were only a small number of practices nationally using AI, leaders worked with these GP practices to learn from them to mitigate any risks before implementing further applications.

The practice had a strong and long-standing culture of continuous learning, improvement, and innovation, shaped by evidence and local need. This led to better outcomes, fairer access, and a better experience for patients.

Leaders and staff were proactive in sharing ideas, taking part in research, and using good practice to improve care. They regularly listened to feedback from patients and the community, using it to shape and assess new ways of working. Leaders also invested time and resources to support staff and encourage collaboration with patients

Learning from external work was applied and embedded so that ways of working were continually evolving to reflect evidence-based best-practice.

The practice had a quality improvement plan in place to help drive improvements in services. All staff were encouraged to suggest and/or test out new ways of working. Practice leaders were able to provide many examples of improvements that had been made as a direct result of feedback or incidents.

In addition, leaders were aware of challenges being faced by primary care services and were working to improve. At the time of assessment, the practice was in the process of refurbishing 2 administration rooms in their branch surgery, situated across the road from the main site. They had worked with MSE ICB to convert the rooms into clinical rooms, to increase the number and type of appointments offered to people. This was in response to the challenge of increasing demand for clinical appointments.

Leaders had developed a bespoke suite of clinical and non-clinical tools for their clinical system, which included templates with links to guidance, pop-ups with essential information and requests for action and embedded protocols for care and treatment. This enabled staff to provide consistent, high-quality care and advice to people in line with national guidance and best practice.

Staff were able to provide anonymous feedback via a QR code and during the inspection we saw that this had been recently used by staff to suggest improvements to staff uniforms.

We saw many 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 and included a wide range of options including on the job coaching to professional development qualifications.

The practice was a registered training practice and at the time of assessment there were 3 trainee GPs (registrars) on placement. Feedback we received from them was that the standard of training, opportunities and clinical support they received was excellent. The practice was consistently oversubscribed in terms of the number of applicants for these positions. The practice worked collaboratively with the Royal College of General Practitioners (RGCP) and a local university to ensure that the training they provided remained at a high standard and met the current requirements.

The practice had recently advertised for a salaried GP and one of the GP registrars was successful in securing the position.

Leaders embraced innovation and digital tools to improve efficiency. They had recently commissioned and implemented an Artificial Intelligence (AI) process to improve efficiency to the document flow in the practice. This process was underpinned by the relevant safeguards to ensure safety and mitigate risk, and this included the relevant clinical risk assessment to comply with NHSE requirements. There was a human element involved in reviewing quality and safety, involving regular and frequent checks and recording any issues which could be addressed directly with the provider. This process had only been in place for a short time, but analysis had shown that there was a significant improvement in efficiency, meaning that staff time usually spent on this process could be diverted to other tasks.

The practice had purchased further AI applications, including the Heidi Health Tool, which is an advanced AI medical scribe tool, designed to transcribe patient visits, generate clinical notes, fill out documents, and dictate letters. This tool allows clinical staff to focus more on the patient consultation, rather than on typing and administrative tasks. In line with best practice guidance, they had planned a staggered implementation of the applications to ensure that any problems could be resolved without having a negative impact on patient care. They had carried out due diligence and extensive research into the use of AI. Although there were only a small number of practices nationally using AI, leaders worked with these GP practices to learn from them to mitigate any risks before implementing further applications.