Knoll 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 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 Good. At this assessment, the rating remains the same.

This service scored 86 (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 very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of patients and their communities.

All staff we spoke to were aware of the practice’s vision which was to be kind, mindful and proactive. Leaders at the practice told us staff had contributed to the development of the practice vision and strategy, which was kept under review. The practice worked with partner agencies to address future challenges.

We saw examples of the vision being implemented in the day-to-day work of the practice. We observed staff treating patients with kindness and respect and reviewed staff feedback which reflected this. Patients and staff were treated as individuals and steps were taken to ensure care was delivered in ways that met patients’ needs. Staff were respected and listened to. The practice took a proactive approach to healthcare by completing a number of quality improvement projects and exploring digital solutions to ensure equitable access.

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. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

Leaders had clearly defined roles and accountability aligned to their skills and expertise. The leadership team encouraged staff to develop in their roles which had contributed to high retention rates as well as encouraging a number of GP trainees to take up permanent roles in the practice once their training was complete.

Staff told us leaders in the practice were approachable and responded to any concerns raised. Leaders took staff wellbeing seriously and there was an employee assistance programme available to staff and their families which offered proactive tools for managing physical and mental health. Staff could access confidential guidance and support for significant life events. Leaders analysed reasons for staff absences and put processes in place to support staff. They worked with staff on their return to work to ensure this was managed effectively for the staff member and to prevent long-term absences. Data provided by the practice showed significantly lower sickness rates compared with national averages and averages within the NHS workforce. There was also a stable workforce with low rates of staff turnover. The practice told us they achieved this by creating an environment where staff could speak to management about any concerns they had about their work, health or personal circumstances.

Staff also told us leaders modelled the values of the practice and there was effective communication between leaders and staff. Staff valued daily huddles and regular meetings and were given the opportunity to raise concerns. 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.

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

The practice had established Freedom to Speak up arrangements with the Integrated Care Board and with an external organisation. Staff were aware of how to raise concerns and told us they felt comfortable speaking up.

We saw a number of examples of staff speaking up. The provider had taken action in response to concerns raised by staff and support was given to the staff members involved. Processes were in place to support non-clinical and less experienced member of staff to raise concerns about clinical matters involving more senior colleagues.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for patients 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. Leaders understood requirements to ensure reasonable adjustments were made for staff who needed them.

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 act on the best information about risk, performance and outcomes, and share 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. Managers met with staff regularly to complete appraisals and performance reviews.

The provider had established governance processes that were appropriate for their service. Staff could access all required policies and procedures. Staff took patient confidentiality and information security seriously.

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 manger had clear oversight to ensure staff who were unable to attend meetings were able to access important information discussed, for example safeguarding, or learning from significant events or complaints.

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

The provider worked with other practices in their primary care network to host a Wellbeing café in the local area. The café supported local residents to meet with each other and practices provided information and talks on health-related matters.

The practice had run sessions for the local Marathi community which has now become a sustained partnership to encourage healthy ageing. Talks for this group contained information relating to exercise, nutrition, bone health and lasting power of attorney.

Sessions were run to support patients to access digital services. Patients who attended described the sessions as very helpful and most attendees said their issues had been fully resolved.

The practice worked in collaboration with a local hospice and staff were involved in annual fundraising events to support the hospice’s work.

The service 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 patients. They actively contribute to safe, effective practice and research. The practice had a quality improvement plan in place to help drive improvements in services.

The practice had a virtual patient participation group (PPG). This had been changed from the traditional model of a PPG where patients would meet face to face in an attempt to encourage a more diverse group of patients to be involved in practice matters.

Themes were identified from complaints and significant events and discussed in operations meetings to identify areas for improvement.

All staff were encouraged to put forward and test out new ways of working. Two members of the management team had been supported to complete quality improvement training. Staff had implemented this training to improve outcomes for patients with diabetes.

There had been a strong focus on encouraging usage of the NHS app. The practice had recognised a need to increase usage as a way for patients to be empowered to access their health records and services at a time suitable to them, rather than relying on contact with the practice via telephone. A member of staff was appointed the NHS app ambassador and was responsible for training staff so they could promote the app and answer patient queries. The app was promoted during registration, on the practice website, through direct messaging and throughout day-to-day conversations with patients. The practice had recognised that some patient groups may need additional support and ran digital drop-in sessions to support patients. Over the last 12 months the practice saw a steady increase in the number of patients registered with the app and those using it to book and cancel appointments. There was also an even spread of users based on age.

We saw a number of audits and quality improvements projects the provider had been involved in. These included; patients with diabetes, discharge summaries, triage, reduction of recurrent attendance, and severe mental health reviews. Outcomes from these projects showed patients had experienced improved care as a result.