Castle Place 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 inspection for this service since its registration with CQC. This key question has been rated as Good.

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.

The service was aware of health inequalities (due to the deprivation level of the local area) and was working with partner agencies to address future challenges.

Since January 2018, Castle Place Practice had been part of the RDUH. There was a shared vision which aimed to: break down barriers between primary and secondary care for smoother referrals and communication; provide a more seamless journey, reducing wait times and unnecessary repeat tests, use shared records to identify people who need targeted interventions (such as supportive care initiatives) and to support the NHS Long-Term Plan by moving suitable services into community settings, helping local GP practices remain sustainable.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment, support and embodied the culture and values of their workforce, practice and the wider RDUH organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff told us that managers were visible and approachable and that they worked closely with staff and others to make sure they prioritised compassionate and inclusive management leadership.

There were clear lines of responsibility to support capable leadership. The practice had job descriptions for all staff and had ensured staff were aware of their roles and responsibilities.

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

The service had established Freedom to Speak up arrangements with other practices in the primary care network (a group of GP practices working together, alongside other health and social care providers, to deliver more coordinated and comprehensive care to a defined local population) . Staff were aware of how to raise concerns.

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 senior leaders had addressed concerns related to discrimination. Adjustments had been made to ensure all staff were valued. For example, we saw adjustments to support staff working flexibly.

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 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 and practice management team had established governance processes that were appropriate for their service. However, some improvements were required for the management of people with long-term conditions and high-risk medications, to ensure a consistent approach. Staff could access all required policies and procedures. GP partners and 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. 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 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, flu and Covid vaccination programmes.

Staff had made adjustments to improve co-ordination of their service with community healthcare services. As part of the RDUH Trust governance structure, Castle Place Practice governance meetings fed into the Community Care Group Governance and wider trust governance structure, which included any relevant escalations for the Community Care Group Governance meeting. For example, unplanned care pillar escalation (which refers to a structured approach for managing increased demand and pressure on urgent and emergency care services, particularly when patient needs exceed available resources).

The service had a proactive PPG which worked in partnership with the service. The PPG werecommitted to improving the services provided to people registered with the service. They facilitated dialogue between people and the service;collected feedback from people about current health service provision, with suggestions about how the service might be improved;reviewed and provided advice and recommendations on the service's patient survey; supported provision of information and advice and communicated people’s needs, which the service considered in the development of their systems, processes and peoples experience of healthcare provision provided by the service.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.

The service had a quality improvement plan to help drive improvements in services.This focussed on the appointment system, medicine prescribing and supporting the RDUH with pilot projects to integrate primary care services with secondary care services. For example, reviewing the use of artificial intelligence (AI) platforms to ensure they are appropriate for both primary and secondary care; Post‑Discharge Handover Clinic to support the need to reduce repeat admissions to the Acute Medical Unit (AMU) among high-user patients. Achieved by people meeting virtually for 30 minutes with their named GP and an AMU Consultant, to agree a personalised care plan (covering medication adjustments, community response referrals, rehabilitation needs, and advance care planning if appropriate).