Cardinal 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 assessed all quality statements from this key question. Our rating for this key question is Good. At this assessment we found improvements had been made since the previous inspection published May 2022. There was compassionate, inclusive and effective leadership at all levels and the practice involved the public, staff and external partners to sustain high quality care. Effective arrangements were in place for staff to speak up and improvements had been made to ensure all staff were aware of Freedom to speak up arrangements. Arrangements were in place to support workforce equality, diversity and inclusivity. There were clear and effective governance processes, which supported the delivery of high-quality care. Leaders had a good understanding of local population issues and the challenges and priorities for their service and engaged effectively in partnership and community working. There was evidence of systems and processes for learning and continuous improvement and information was used effectively to monitor and improve the quality of care and service provided.

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.

Leaders we spoke with had a shared vision and strategy to provide accessible, high quality and comprehensive care. They acknowledged there had been some setbacks, for example, the long-standing plan for the practice to move into a purpose built building, had been withdrawn recently. However, the practice had already met with the Integrated Care Board (ICB) and alternative options were being discussed and considered. Practice leaders had managed to successfully recruit 5 salaried GPs and were now fully staffed with GPs. The majority of staff told us that there was a positive and open team culture within the practice and GP Partners, the management team and the team leads were visible and approachable. They were able to contribute to discussions about service improvements, incidents and complaints.

The practice had a clear vision and strategy to provide accessible, high quality and comprehensive care. They had a business plan which listed actions in a range of areas which included for example, vision, staffing, clinical, operational, audits, complaints, staff feedback. Leaders demonstrated that they understood the challenges to quality and sustainability and effective systems were in place to monitor progress with action plans. There were clear processes in place to manage any behaviour inconsistent with the vision and values. There was a bi-monthly staff newsletter, which included a range of updates. These included staff recruitment, staff team changes, activity monitoring data, staff suggestions and practice initiatives.

The majority of staff told us there was compassionate, inclusive and effective leadership and leaders had worked hard to successfully integrate the staff which was difficult due to being over 3 sites. All staff were supported by their team leaders and could approach leaders at any time if they required support. Staff were clear on their individual responsibilities and knew who was responsible for each aspect of the service. There was an emphasis on the safety, support and well-being of staff.

The practice had a team organisation chart which clearly detailed teams and accountability structures within the practice. There was clear oversight and leadership from the GP Partners within the practice, and the management team. This was achieved through a range of meetings where minutes were taken and shared. Clinical and operational leaders had identified lead roles and practice responsibilities, for example, complaints, education and training, information governance and prescribing. Team leaders and staff in each department also had clear roles and responsibilities. All clinical staff had a named GP and practice nurses, and health care assistants had a named advanced nurse practitioner for support.

The majority of staff told us there was an open, honest and supportive culture within the practice, and they were able to raise concerns with the management team and leaders. They told us they had access to a Freedom to Speak Up Guardian, they knew who to contact and would, should they wish to raise any concerns. Staff gave examples of improvements which had been made following staff feedback, which included the use of staff lanyards and a staff suggestion box.

There were clear processes in place for staff to speak up. Information was shared at induction, and updates were given during meetings and minutes were available to staff. The practice provided information in the 3 sites which detailed who the Freedom to Speak Up Guardians were and how to contact them. Freedom to Speak up Guardians had all received additional training to undertake this role.

All staff told us they had received training in equality and diversity. The majority of staff told us they were supported by the practice leaders, their team leaders and their peers. Staff gave examples of support they had been given for example, with flexible working, religious beliefs being listened to, and reasonable adjustments being made, which included specialist equipment being provided. A number of staff commented positively about the monthly staff welfare meetings. Practice leaders supported social events for example, bowling, pizza at the practice, quiz nights and fun runs. Some of the events raised money which was donated to the local foodbank and Macmillan cancer support. Positive comments were made regarding this and the improved team relationships which had been built.

There were systems and processes in place to support workforce equality, diversity and inclusion. This included equal opportunities and equality and diversity policies. All staff had completed equality and diversity training and there was oversight of the completion of this training. Practice leaders recognised staff for a range of awards which included long service awards, at 5, 10, 15, 20 and 25 years, and life events, including for example significant birthdays, paternity and adoption leave and retirement.

Leaders and managers supported staff, and the staff were clear on their individual roles and responsibilities. All staff were clear who to contact should they need advice or want to discuss any concerns. Staff were aware of those with lead roles, such as safeguarding, governance and performance. Staff told us policies and procedures were available and accessible and some staff had been involved in writing these. Staff gave examples of how they ensured people’s confidentiality and demonstrated they took information security seriously.

There were systems and processes in place to ensure there were clear responsibilities, roles and accountability structures to support good governance and management. There were clear policies and procedures in place, and these were easily available for staff to use. The practice had arrangements to ensure business continuity in a range of circumstances. Most of the policies and procedures we read had been reviewed in line with the scheduled review date and had version control and amendments made were documented. The provider had established assurance systems that were appropriate for their service. For example, the workflow oversight spreadsheet showed for each team, the number of tasks awaiting action and the oldest date. This was reported to the management team weekly for awareness and action if needed. There were a range of assurance audits which included for example, the quality of coding, telephone calls and consultations of clinical staff. These were all documented. Managers held a range of governance meetings with staff, during which they discussed clinical concerns, significant events, complaints and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with other staff, as appropriate. The practice used digital services securely and effectively and conformed to relevant digital and information security standards with arrangements in place for the confidentiality of data management.

We received no specific feedback from people regarding their experiences for this quality statement. Members of the Patient Participation Group (PPG) supported the practice at a recent flu vaccination day and used this opportunity to obtain feedback from people. The Access and Digital Care Co-ordinator was there and asked PPG members to introduce him to people if they shared feedback where support with digital access would be useful.

The practice worked with the Integrated Care Board, (ICB) in relation to improving capacity and access. They had met to discuss the short, medium and long term plan for the practice following the recent announcement that the long awaiting new build was no longer going ahead. Staff gave examples of engagement and joint working with other services, both for the benefit of people who used the service, and to support staff in undertaking their roles. Practice staff had identified improvements were needed to the wording in automated responses sent by their online access system, as this may be misinterpreted by people who used the service. They had fed this back to the developers of their online access system, who had agreed to update this during their next system update.

Feedback from a range of partners was positive in relation to how practice staff collaborated for improvement. Some partners commented on their excellent working relationships and positive engagement with practice staff. The practice had quarterly meetings with 3 care home managers, who told us these meetings helped them to work together effectively, identify issues, find solutions and share learning across the homes. They said communication worked well and there was an improved understanding which had developed through these meetings.

We saw evidence of proactive partnership working with a range of statutory, and health and social care organisations. The practice worked with a range of stakeholders to build a shared view of challenges and of the needs of the population. The practice published a quarterly ‘Patient Newsletter’ which included updates from the PPG, stakeholders and the practice, including for example, staff recruitment, appointment data, access arrangements and feedback from people using the service. One of the GP Partners was the Co-Clinical Director of the Primary Care Network (PCN) which had been established for approximately 1 year. The practice engaged well with their local PCN and people benefited from the additional staff members they employed.

There was a learning culture in the practice which leaders actively encouraged, and all staff participated in. Most staff gave positive feedback about their experiences of joining and working at the practice, and the ongoing support and development they received. Staff told us that leaders encouraged development. For example, they had supported a Practice Nurse to complete their Nurse Practitioner training and were continuing to support their training to become an Advanced Nurse Practitioner.

There were systems and processes for learning, continuous improvement and innovation. The practice was a training practice for medical students and GP Registrars (qualified doctors training to become GPs). The practice had 2 GP trainers and 1 GP who had nearly completed this course and accreditation. The practice also supported placements for student nurses and work experience students. The practice held regular education sessions, which involved the wider health care team. Sessions included for example, musculoskeletal assessment. Staff were supported to develop in new or extended roles. The practice held quarterly quality improvement meetings. Where GP partners had identified issues, for example, processes which could have been done better or where learning had been identified, these were documented. An ongoing log was kept which was reviewed to identify any themes. These were then discussed, and priorities agreed for action, which were monitored to completion.