High Green 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. There were clear and effective governance, management and accountability arrangements. However, Freedom to Speak Up needed strengthening to ensure staff knew how to raise concerns openly. Staff understood their role and responsibilities. Managers and leaders could account for the actions, behaviours and performance of staff. Information was used effectively to monitor and improve the quality of care. Leaders implemented quality frameworks to improve equity in experience and outcomes for people using services and tackle known inequalities.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff we spoke with demonstrated local knowledge of the practice population and responded to people’s needs with dignity and respect. We saw evidence they had all completed equality, diversity and inclusion training.

The aims and objectives of the practice were included in the Statement of Purpose, which was included within a comprehensive business development plan. There was a documented risk register which was continually reviewed to manage identified risks and challenges to service delivery.

Staff told us that they felt they had inclusive leaders and had weekly management meetings, monthly staff meetings both clinical and non-clinical, where changes to operating procedures were initially communicated. Staff told us that they feel supported by the GPs and management team.

Minutes of meetings were stored on the practice intranet to ensure that staff not present for the meeting are aware of the meeting content. A monthly staff bulletin was also stored on the practice intranet, with examples we viewed advising staff to take breaks during Ramadan for their health and wellbeing.

Staff we spoke with told us they did not know who their named speaking up guardian was within the practice. They did not feel comfortable to share concerns about other staff with leaders due to the close relationships. However, they stated the business manager had an open door policy and they would speak to them about any safety concerns.

There were policies in place for whistleblowing and Freedom to Speak Up which named the practice manager as guardian. However, neither had considerations for how leaders could investigate concerns raised about themselves independently, for example, by having an externally appointed guardian, in line with recommended guidance. Therefore we were not assured the provider was taking all practicable steps to tackle barriers to speaking up, taking into account the small size of the staff team.

Staff told us that they felt valued, supported, and that their views and suggestions were considered by the management team. We saw evidence that times of spiritual reflection, self-improvement, and heightened devotion and worship were observed, e.g. Ramadan where staff were supported.

The practice had an equality and diversity policy and promoted equity to all people, including staff, with diverse needs and protected characteristics, such as sexuality (LGBTQIA+) age, religious, disability, race. They committed to undertake a race equality audit on an annual basis, and if disadvantages in employment or under-representation, were identified the practice would undertake positive action measures allowed by law to rectify this.

All staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. Receptionists we spoke with were aware of their roles and responsibilities and knew who to approach if they needed support in areas such as safeguarding or infection control and control. Leaders could describe their governance arrangements for the practice and told us that leads for each area had been identified. They described the systems in place for monitoring quality outcomes for patients.

There were processes in place to keep staff up to date with changes within the practice. We reviewed the minutes from a staff meeting and found that staff were kept updated of changes within the practice. For example, new staff recruitment, changes to the new telephone system, patient registrations and wellbeing services available to staff working at the practice. There was a suite of policies in place to support the governance within the service. There were processes in place to review and update the policies. A business continuity policy was in place to support the practice to continue to deliver services in the event of an unplanned disaster such as loss of domestic services, a pandemic, service outages, or other potential threats.

The practice worked in partnership with their patients by reviewing results from patient feedback surveys and using them to improve services. Staff we spoke with told us they were engaged in the evaluation of the appointments triage system and their views were considered in managing demand and capacity.

Staff we spoke with told us the practice worked with peers within their primary care network on quality improvement. For example, they collaborated on educating women in the importance of early cervical cancer screening to improve uptake rates in their local population. The project was funded through Women’s Health Hub which will investigate the reasons behind low uptake, and develop solutions to address the barriers experienced by eligible people.

The practice engaged with the Integrated Care Board (ICB) primary care and their medicines management teams. The practice hosted trainee doctors to obtain experience of general practice. To enable the practice to be achieve training status, a comprehensive audit of systems and processes was conducted by system partners to ensure safety.

The practice had systems and processes to support business function and details of external stakeholders they engaged with accessible to all staff. They were part of a primary care network and worked closely with other GP practices within the network to improve services which were a priority for their local population.

Leaders told us that several several improvement projects which had been initiated to improve equality of experience, outcomes and quality of life and regularly carried out clinical audits to drive improvements within the practice. For example, an audit of the monitoring of gestational diabetes in pregnant women resulted in a dedicated recall system being put into place for this group of patients.

The practice intranet was supported by an external provider with input from the local ICB to ensure that clinical information was up-to-date with evidence based best practice guidelines. There was an audit programme in place; however the majority of audits had been conducted once and yet to be repeated to assess if the changes had been effective. The practice were one of 5 local GP surgeries participating in a Women's Health Hub Programme, a project set up to improve cervical screening uptake rates by educating citizens of the importance of early screening. This was ongoing and it was anticipated positive outcomes would be achieved through joint working between the practices and their communities.