Gough Walk 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. This is the first assessment for this service since its registration with CQC. This key question has been rated as Good. This meant we found leaders and managers generally had effective oversight of systems and processes to promote safe service provision. However, we found that oversight of some systems needed strengthening.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The leaders and staff 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 people and their communities. Staff we spoke with shared the provider’s desire to deliver high quality patient-centred care and foster a strong partnership with patients to achieve the best possible health outcomes.

Leaders and staff understood their patient population, their cultural needs and challenges. Staff told us they felt well supported by their leaders. All staff had contributed to the development of the service’s vision and strategy, which was kept under review. The service had developed values that would help them achieve this vision. The values included delivering an effective healthcare service and encouraging health promotion to meet the medical needs of patients. Staff demonstrated a well-developed understanding of equality and diversity, and how to prioritise safe, high-quality care.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support. Leaders demonstrated they had the skills, knowledge, and experience to lead effectively. There was constructive engagement with staff and a high level of staff satisfaction. Staff told us they were happy working at the service and that leaders were approachable and responded to any concerns raised. Staff used words such as “supportive”, “approachable” and “open” when they described leaders who they worked with. Leaders told us they worked to foster a culture of staff wellbeing.

The leaders told us they operated a no-blame learning culture which would provide all staff with an open and equal working relationship. Leaders we spoke with understood the importance of protecting individuals from discrimination and promoting equality in the workplace.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. Staff said there were no barriers to speaking up and their views were listened to and acted upon. This aligned with the management approach of being actively engaged with staff to seek their views. The service had a freedom to speak up (FTSU) policy with the contact details of the service’s FTSU guardian and there was information available for staff to approach external organisations, should staff not be confident to raise concerns internally. Staff we spoke with were aware of how to raise concerns. Processes ensured that when things went wrong, people received an apology and were told about action that would be taken to prevent the situation happening again.

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. We saw adjustments had been made to ensure all staff were valued. Leaders provided training and resources to ensure staff were aware of their rights, including those related to equality, dignity, and respect in the workplace. The leaders held regular meetings where staff could raise concerns. Staff reported being supported if they were struggling at work. Staff members told us they felt encouraged to contribute their ideas. Leaders told us they valued and supported all team members.

Staff had clear roles, responsibilities, and governance systems to deliver good quality sustainable care, treatment and support. They mostly acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. Governance processes were mostly well-established, with accessible policies and procedures. Leaders used reliable data on risk, performance, and outcomes. Leaders held regular meetings to discuss risk, performance and operational management of the practice.

Regular searches of the clinical record system were being run to identify patient needs and ensure these were being met. However, our review of clinical records showed that this was not always effective. Oversight of some safety netting processes needed strengthening.

Staff we spoke with knew who the relevant lead person was for areas such as safeguarding, infection control and significant events monitoring. Staff took patient confidentiality and information security seriously. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. We reviewed a sample of minutes from clinical meetings for the previous 3 months. Managers clearly recorded any learning and actions arising from these meetings and ensured they shared these with staff. Managers met with staff regularly to complete appraisals and performance reviews.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborate for improvement. Staff understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Leaders told us they collaborated with stakeholders and had integrated care meetings with district nurses, care agencies, mental health services, care coordinators and palliative care services. They had multidisciplinary team meetings monthly to discuss and improve outcomes for people with complex needs and a bi-monthly meeting with the health visitors to discuss child safeguarding.

The service was actively involved in their local primary network, where they worked with other services to improve the local health inequalities. Staff worked with other practices within their primary care network to offer extended access, referral to rapid response, domiciliary phlebotomy for housebound patients and flu, shingles and covid vaccination programmes. Staff had made adjustments to improve coordination of their service with community healthcare services. We received feedback from the PPG. they found the service to be open and honest and listened to concerns raised by PPG members.

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 people. They actively contribute to safe, effective practice and research. There were established processes to ensure that learning happened when things went wrong, and from examples of good practice. However, we found inconsistency in medicines management systems which were not routinely picking up issues. Action had not always been taken to implement changes to these systems, to address the shortfalls in best practice we identified.

The service had a quality improvement plan in place to help drive improvements in services. They also had an action plan which reviewed data from the national GP patient survey, this focussed on staff and the appointment system. All staff were encouraged to put forward and test out new ways of working. They actively contributed to safe, effective practice research and training. Leaders actively invested time to listen and engage with staff at all levels. We received positive comments from staff who felt leaders welcomed their feedback. Staff told us they felt proud to be a training service. We were provided with feedback from a GP, working at the service, who felt positive about the leadership and support for their professional development. The service had supported one of the GPs to become a community dermatologist and adjustments were made at the service to enable them to complete the training.Staff told us they felt proud to be a training service. We were provided with feedback from a GP, working at the service, who felt positive about the leadership and support for their professional development. The service had supported one of the GPs to become a community dermatologist and adjustments were made at the service to enable them to complete the training.Leaders told us they had supported 2 members of the pharmacy team to become independent prescribers.