Keele Practice

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• 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

This is the first inspection for this service since its registration with CQC with the provider North Staffordshire Combined Healthcare NHS Trust. This key question has been rated as Good.

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities.

Governance systems were proactive and responsive to population need, with the practice adapting recall processes for university students, children and young people to improve engagement with long-term condition reviews, cancer screening and immunisation programmes. This enhanced continuity of care strengthened monitoring arrangements and supported a more patient-centred approach to service delivery.

Managers worked with the local community to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a highly effective and embedded approach to succession planning, integrated into both day-to-day operations and the long-term workforce. There was a strong emphasis on developing and creating a sustainable workforce.

The practice demonstrated workforce modelling, actively developing multidisciplinary roles such as Advanced Clinical Practitioner roles to enhance capacity, retain skills, and improve access for patients.

The service demonstrated strong leadership, resilience and sustainability through a structured governance framework comprising operational, clinical, performance, and governance meetings. This reduced the potential for single points of failure by ensuring key responsibilities were supported through established systems and shared across the leadership team. Consequently, critical knowledge and oversight were maintained, enabling the service to provide safe, consistent, and effective care during periods of absence, transition, or workforce change. They mitigated risk by embedding shared responsibilities and effective systems, ensured knowledge was not dependent on individual staff members during periods of change or absence.

There were multiple, well-established forums for sharing information and learning, including dedicated practice updates for staff, regular team meetings, team learning events, and structured Quality and Safety meetings. The service used a centralised platform to ensure full transparency and accessibility, where all key documents, audits, learning from events, and complaints were shared openly, embedding a culture of continuous learning and collective accountability.

The service-maintained risk registers and were well aware of future challenges and worked with stakeholders and partner agencies and external agencies for these to be addressed.

The service supported students and provided placements for example expanding a partnership with educational providers, such as the university pharmacy students completing the MPharm degree.

Staff told us leaders in the practice was approachable and responded to concerns raised. Staff said that they had open and honest discussions in meetings with any issues arising. They gave examples such as, arrangements for non-clinical staff cover during leave and sickness, lone working measures and of the mitigating actions taken. Staff also told us they found that their leaders modelled the values of the practice.

The leadership team demonstrated strong collaborative leadership and effective partnership working, engaging proactively with neighbouring practices and wider system partners through Primary Care Networks (PCNs). Leaders played an active role in supporting the development and transformation of primary care services across the local area, contributing to service improvement initiatives and shared learning opportunities.

Across the organisation’s primary care directorate, practices were members of three separate PCNs and maintained ongoing collaborative relationships with a further 12 PCNs. This enabled the sharing of expertise, resources and best practice to support service delivery and population health outcomes across the wider healthcare system.

Their collaborative approach ensured that services were aligned, innovative, and responsive to the needs of the population, further strengthening the shared vision and culture of the organisation.

The service had clear policies and procedures accessible to all staff, for example, there was a whistleblowing, equality and diversity and duty of candour policy in place and freedom to speak up guardians accessible both internally and externally to support staff if they wanted to raise an issue. Staff were aware of how to raise concerns.

The service’s Freedom to Speak Up (FTSU)policy promoted a clear “speak up and we will listen” culture. The policy recognised that some groups of workers may feel less able or willing to raise concerns, including locums, students, workers with disabilities, and those from minority ethnic or LGBTQ+ communities. It emphasised that the value of speaking up lies in the information shared rather than the identity of the individual raising the concern.

Staff were provided with a range of options for raising concerns and could choose the method they felt most comfortable using. The service also offered opportunities for anonymous feedback, recognising that anonymity may limit the ability to seek further information, investigate concerns fully, provide feedback on actions taken, or offer appropriate support to the individual raising the issue.

The most senior leaders of the Trust received a report at least annually, providing a thematic overview of speaking up by staff through the services FTSU Guardian.

Policies and procedures to promote diversity and equality were in place. Leaders had implemented transparent and fair systems to ensure equal access to development opportunities, with staff progressing into lead roles. There was a clear and consistent message of zero tolerance towards discrimination, reinforced through robust policies, regular training, and visible leadership commitment. Equality, diversity, inclusion, and human rights were fully integrated across recruitment, training, and organisational culture. Staff reported Keele Practice was a workplace where they felt proud to work.

The service considered NHS Terms and Conditions of Service agenda for change pay rate bands measured against staffs’ roles and responsibilities. Leaders undertook reviews of staff pay, incorporating analysis of the gender pay gap and age-related disparities to ensure fairness, transparency, and equity across the workforce. Learning and development opportunities were actively encouraged.

The service demonstrated a strong commitment to equality, diversity and inclusion, with practical adjustments made to meet the individual needs of staff. This included flexible working arrangements and tailored workplace adaptations to support wellbeing and enable staff to perform their roles effectively.

Training in equality, diversity, inclusion awareness was embedded across the workforce, further supported by the services inclusion at work policy helping to promote understanding, respect and inclusive behaviours. As a result, the service fostered a positive and supportive culture in which diversity was valued and individual differences were respected.

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. 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.

Leaders demonstrated effective, visible and compassionate leadership, fostering a culture of openness, accountability and continuous improvement. A clear vision for delivering high-quality, sustainable care was understood and shared across the service. Robust governance arrangements, clearly defined responsibilities and strong oversight supported a safe, effective and coordinated service delivery.

Governance systems were proactive and continually developed to drive quality improvement. For example, the practice had considered the needs of university students, children and young people within its recall system for long-term conditions, cancer screening programmes and immunisations, recognising that birthday-month recalls were less effective for students who may be away from university during holiday periods. This strengthened monitoring processes, supported continuity of care and promoted a more efficient, patient-centred approach to service delivery. At the time of our assessment, the system was being embedded across the practice.

The service promoted a transparent, learning-focused culture where patient safety was prioritised. Audits, performance monitoring and governance reviews were used effectively to identify improvement opportunities, with timely action taken to achieve sustained improvements in care and outcomes.

Staff described regular appraisals, that supervision and performance review processes supported professional development, accountability and reflective practice, contributing to a positive and collaborative team culture.

Leaders used a wide range of data and intelligence to monitor quality, performance and patient outcomes. Information was routinely reviewed through practice learning events with learning drawn from incidents, complaints, patient feedback, risks and clinical outcomes. The service had access to specialist expertise which also contributed specialist knowledge to support continuous improvement.

Governance and assurance processes were well embedded within day-to-day operations, enabling leaders to identify emerging risks, respond proactively and maintain organisational resilience. The service demonstrated a strong commitment to addressing health inequalities, managing demand effectively and improving outcomes through the use of data-driven decision-making.

Leaders promoted a culture of shared responsibility and continuous improvement. Staff demonstrated a good understanding of patient confidentiality, information governance and information security requirements.

The service worked with other practices within their primary care network to offer extended access, and flu and covid vaccination programmes. The service-maintained relationships across a wide range of partners including PCN practices, community and secondary care, public health, research networks, voluntary care sector organisations, and the ICB. They played an active and influential role in wider system development, contributing to programmes led by the ICB including access improvement and reducing health inequalities. They frequently acted as an early adopter site, testing new models of care and providing detailed feedback to support wider rollout and reduce variation across the system.

Patient partnership was equally strong, with an active and engaged PPG contributing to service improvement and the ambition to increase the participation of students and work age patients.

The practice had a quality improvement plan in place to help drive improvements in services. Staff were encouraged to put forward and test out new ways of working, for example, the advanced clinical practitioner triage approach. Sustainability and environmental responsibility were embedded within the practice’s strategic and operational planning.

The service maintained an annual programme of clinical improvement initiatives to enhance patient outcomes and population health. Clinical audits, including acute sinusitis, sore throat management, cervical screening uptake and childhood immunisation uptake, informed service development and improved clinical practice.

The service is participating in a neighbourhood multidisciplinary pilot for patients at risk of delirium and dementia. Through collaboration between general practice, mental health services, Additional Roles Reimbursement Scheme (ARRS) staff and older adult community teams, identified patients will receive coordinated care aimed at slowing frailty progression, improving outcomes and reducing avoidable hospital admissions. This work also supports the wider neighbourhood health agenda.