Church Hill Surgery

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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

We assessed 7 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. We found the provider had clear and effective governance processes which supported the safe delivery of care. Staff were clear on their individual responsibilities and knew who was accountable for each aspect of the service. The provider had taken action to ensure that the new governance systems seen at our 2022 inspection had now been embedded into day to day service delivery. Leaders ensured there was a shared vision for delivering patient centred care and staff understood their role in delivering this vision. There was an inclusive and positive culture of continuous learning and improvement.

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 lead GP spoke positively about the provider’s shared vision for delivering patient centred, safe and continually improving care and treatment. Staff understood their role in achieving this vision and reception staff spoke positively about a listening culture where service improvement suggestions were acted upon. The nursing team spoke of an organisational culture where processes were continuously reviewed in order to keep up to date with national guidelines.

The provider’s vision document focussed on delivering patient centred, safe and effective care. Regular staff and clinical meetings promoted a listening culture, ensured staff involvement and also ensured that any potential risks to delivering the vision were understood and addressed.

The lead GP was alert to any examples of poor culture that may affect the quality of people’s care and have a detrimental impact on staff. For example, action had been taken since our last inspection to recruit additional staff and we were told that this had had a positive impact on staff wellbeing. Staff told us that the lead GP and assistant practice manager were visible and approachable; and had the skills, knowledge, experience and credibility to lead effectively.

The provider had designated staff leadership roles and arrangements for oversight (for example regarding safeguarding, long term conditions and practice management).

Staff told us they were encouraged staff to raise concerns and that they were confident their voices would be heard. They gave us examples of where changes had been made as a result of staff feedback (for example uniforms for reception staff and additional document scanning equipment for administrative teams).

The provider operated a ‘Freedom to speak’ up policy which encouraged employees to raise concerns including advising employees to raise concerns with appropriate outside bodies in the event that the concerns were not dealt with satisfactorily internally.

Staff told us that leaders had made reasonable adjustments to support staff to carry out their roles. They felt empowered and were confident that suggestions or ideas would result in positive change to shape services and create a more equitable and inclusive organisation.

Staff had completed equality and diversity training. All staff members were encouraged to suggest agenda items for the provider’s regular staff meetings.

Leaders and managers supported staff; and staff told us they were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews.

We noted that the new governance arrangements identified at our last inspection were now sufficiently embedded into service delivery. 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.

Patient feedback highlighted several instances where practice worked seamlessly with partners (for example with a hospital consultant regarding sharing information and with a local hospital regarding removing referral blockages).

Staff gave examples of where the practice worked in partnership with other services (for example other local practices, district nursing team, local authority safeguarding teams and a local care home).

The district nursing team spoke positively about how its staff shared learning with the provider (for example safeguarding, end of life care). A local care home manager spoke positively about how the provider worked in partnership to support care provision. Both stakeholders spoke positively about open and transparent partnership working arrangements.

The provider convenes regular multi-disciplinary meetings where information is shared between teams and services to ensure continuity of care. Attendees include district nursing, health visiting and end of life nursing teams.

The lead GP spoke positively of a focus on continuous learning, innovation and improvement across the organisation and local system. Nursing staff told us that training opportunities were available to further improve delivery of specific roles. Reception staff told us they were encouraged to speak up with ideas for improvement and innovation; and gave examples of where these suggestions had been implemented.

There are processes to ensure that learning happens when things go wrong, and from examples of good practice. For example, the provider convenes regular clinical meetings where significant incidents and complaints are used to encourage reflection, collective problem-solving and improvement. The provider also has strong external relationships that support improvement and innovation. A fellow practice member of the local Primary Care Network told us they worked closely with the provider to identify innovation that could lead to better outcomes. We noted an online seminar had recently taken place, led by a diabetes consultant.