The Paradise Road 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 75 (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 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 told us that the vision focused on delivering personalised, holistic care, supporting patients’ physical, emotional and social needs, and promoting education and empowerment. There was a positive and compassionate listening culture, where staff reported feeling able to be open, ask questions and support one another. The environment promoted understanding and continuous learning. Staff were encouraged to listen with empathy, seek clarification when needed and learn from colleagues.

The service had inclusive leaders 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 was approachable and responded to any concerns raised. Staff referred to managers as all having “open door policies” and they felt able to go to them for support at any time, without hesitation. Staff also told us leaders modelled the values of the practice. Leaders showed their capability through understanding of patient needs and community challenges. Integrity was shown through open communication with staff and maintaining a culture where everyone’s voice mattered.

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

Staff told us that the practice had promoted an open and supportive environment where everyone felt comfortable speaking up and expressing their views. They said they had felt listened to, respected, and confident that any issues they raised would be taken seriously.

The practice had established Freedom to Speak up arrangements with other practices in the primary care network. They had an external Freedom to Speak up Guardian. In addition to this, staff were shown the whistleblowing policy and information relating to freedom to speak up during their induction. Staff were aware of how to raise concerns and told us that they had felt able to raise any concerns and were confident they would be listened to and that appropriate action would be taken.

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. The practice regularly assessed the working environment and made reasonable adjustments where needed. This included ergonomic assessments of desks and equipment, flexible working arrangements and being responsive to individual needs should any staff member require additional support.

The small team structure and frequent communication—through daily interactions, team meetings, the staff WhatsApp group, and the wellbeing noticeboard—had supported open discussions. They said they had felt listened to, respected, and confident that any issues they raised would be taken seriously.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good 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. Clinical audits were carried out to monitor quality, identify areas for improvement, and ensure that patient care remained evidence‑based. Findings were shared within the team, and learning was embedded into daily practice.

Managers met with staff regularly to complete appraisals and performance reviews.

All staff files we reviewed had recent appraisals and we saw previous years appraisals indicating that they were completed with staff on an annual basis. Staff we spoke with confirmed that they had regular appraisals and referred to the process as “very supportive.”

The provider had established governance processes that were appropriate for their service. Staff could access all required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. We saw meeting minutes confirming this. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Staff took patient confidentiality and information security seriously.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They engaged with patients, communities, and partner organisations to gather feedback, share learning, and drive continuous improvement.

Staff had made adjustments to improve coordination of their service with community healthcare services, including through recently established weekly meetings centred on the care of those at higher risk of hospital admission.

They had a Patient Participation Group (PPG) in place to engage with the patient population and gather views and suggestions. The PPG reported that they met when necessary and held at least one meeting each year. They explained that they had been actively seeking additional members and had been considering the option of holding remote meetings. The practice maintained regular communication with PPG members through periodic discussions, seeking their input on issues such as patient experience, accessibility, and environmental improvements. As a result of this engagement, the practice implemented changes including adding hooks in the bathroom, keeping the waiting room clean and tidy, and updating the patient timetable.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. The practice provided many opportunities for staff to develop and learn. They always encouraged creative ways of delivering equality of experience, outcome, and quality of life for people. For example, the salaried GP had a Special Interest (GPwSI) in Dermatology, and the lead GP had a special interest in Musculoskeletal (MSK) diseases. All staff were encouraged to put forward and test out new ways of working, through multiple communication channels and structured processes. Regular team meetings and one‑to‑one discussions provided staff dedicated time to raise suggestions, discuss challenges, and contribute to service improvements. A staff WhatsApp group was used for day‑to‑day communication and allowed quick sharing of ideas or concerns.