- GP practice
Millrise Medical Practice
Report from 4 April 2024 assessment
Contents
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
Well-led
Following our last inspection, we told the provider they must ensure care and treatment was provided in a safe way to patients and recruitment procedures were established and operated effectively. We also advised the provider to take action to improve cervical screening uptake and make improvements to their practice website, for people wishing to register with no fixed address. At this assessment we found that the provider had taken action to address most of the areas identified for improvement, except for recruitment procedures. Since the last inspection there had been several staff changes including that of 2 practice managers. The practice had designated roles for areas of accountability and succession plan supported by a business plan. They had developed a risk register, which was regularly discussed and updated. Information of concern had been shared to the CQC in respect of a backlog of documents. Clinical searches found this risk had since been mitigated and the practice acknowledged this within their practice risk register. The practice leadership were aware that they had further work to do to embed and monitor processes to assure themselves of maintaining improvements. We found there were gaps in some areas of governance for example: • Not all staff were aware of the practice mission statement vision/values or the practice organisational structure. • A lack of a systematic approach to maintain clear oversight on all staff training and appraisals. • Shortfalls remained in staff recruitment processes as recruitment checks were not always carried out in accordance with regulations. • Staff were observed in the late afternoon, leaving the building, and returning without logging in or out of the building resulting in a potential fire log risk. • Staff reported a lack of clear communication from credible sources. • The non-clinical staff team were spilt with divisions affecting the whole practice teams working atmosphere.
This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.
Not all staff demonstrated an awareness of the practice mission statement or strategy and were unclear in their role in achieving the practice strategic aims. Leaders requested and gained support from NHS England’s Supporting General Practice Team to assist and provide an independent view of the practice, including changes in its staff culture. This work had commenced well in advance of our inspection and was ongoing. Staff reported they could access information resources with regards to wellbeing. Some staff reported they felt undervalued, not listened to and disengaged in respect of changes made to their roles or responsibilities. We identified a negative atmosphere in the back reception office area. Individual staff were open as to the reason for the atmosphere. Some non-clinical staff ignored or choose not to speak with or to specific staff members. Staff reported that the leadership team were aware of their concerns, the impact of the atmosphere and that it had become disrespectful in nature and continued out of work. Staff not involved in the team spilt felt staff attitudes and responses needed to be tackled. A team meeting had been held and the partners listened to staff views. Some staff told us they found the meeting challenging and disrespectful towards the GP partners. We spoke with leaders to ascertain if there had been any discussions regarding changes in staff roles. Staff told us these changes had been made in response to staff reporting workload stress and post sick leave. Staff affected were aware of why changes had been made. However, on discussion this had not been documented. Leaders had obtained external HR support prior to November 2023 regarding staff disciplinary and performance management. Leaders suggested to improve staff culture by introducing a staff charter for all staff, including GPs, but this was rejected by staff.
A mission statement had been developed which included the practice aims and values. There were systems to ensure compliance with the requirements of the duty of candour. When people were affected by things that went wrong, they were given an apology and informed of any resulting action. However, during the period of a lack of handover between the former practice manager and interim practice manager, complaints had not been completed as outcomes on the complaint tracker. Staff had access to a Freedom to Speak Up Guardian (FSG) and information on how to contact the local external FSG. They had access to online equality and diversity training and a lone worker policy was in place to support their safety and security. Minutes from various meetings demonstrated that the practice had a strategy and bench marking was in place. Staff exit interviews were held to consider any learning or improvements. The partnership described themselves as passionate about providing high quality and compassionate care. They had invited NHS England Supporting General Practice Team (SGPT) to attend the practice. To provide independent support and identify ways to improve the care of patients and staff well-being. During our visit we identified a potential fire log risk when we observed staff leaving the building and returning without logging in or out. It was not clear if staff were on official breaks, as some staff ate lunch at their workstations. The practice was aware of divisions within the team and had employed an external human resource service for guidance support and advice as well as the SGPT. The practice planned to recruit to the vacant practice manager position. Staff training, appraisals and competency reviews with development goals were in place. However, some were outstanding but scheduled by the interim practice manager and some had not been documented by the former practice manager. As a result, these were in the process of being repeated.
Capable, compassionate and inclusive leaders
We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.
Freedom to speak up
We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.
Workforce equality, diversity and inclusion
One staff member had not had a pay rise under the former practice manager, but following a discussion with partners this had been rectified as they were unaware of this lack of equity. It was alleged that a role of a full-time electronic coder had been advertised at a higher pay rate than the current part time coder. Leaders advised their organisational need was for a full-time electronic coder to provide a consistent approach. However, leaders appreciated job share opportunities could be a possibility. There was a lack of harmony in the non-clinical staff team. This had led to a divide and a poor working atmosphere between the administration and reception team. This had included, but was not limited to, a member of staff being singled out by some members of the team. Leaders told us they employed an external human resource (HR) service and had appointed a lead GP in HR to ensure fair and equitable treatment of staff. Staff said they worked a variety and range of hours demonstrating some flexible working arrangements. Leaders told us they considered equality, diversity, and inclusion when recruiting new staff to the team.
Staff had completed equality and diversity training, however not all staff had been in receipt of an induction to their work or an annual appraisal. A staff survey had not been undertaken to assess staff wellbeing. Staff records included occupational health considerations such as staff vaccination and inoculation histories and risk assessments for those staff that required additional reasonable adjustments.
Governance, management and sustainability
Clinical staff reported awareness of the practices organisational structure however, some non-clinical and new staff were not aware which was fed back to leaders to action. Leaders were aware of the recent impact of staff shortages within the administration and reception team, with staff completing additional hours following some staff leaving. The ability to provide additional hours and support staff through induction was described as challenging at times. Leaders were aware of the issues and had recruited to vacant positions. Some staff recruited had found the role was not suited to them and had left, other new staff had stayed and enjoyed the role. All staff reported that communication could be improved, with clearer sanctioned communication pathways.
The practice had taken action to address the majority but not all improvements recommendations made since last CQC inspection. Improvements included infection prevention, security of blank prescriptions, and training in safeguarding to the required level. However, continued gaps were found in safe recruitment processes. An organisational structure was in place including collaborative arrangements with the local PCN. However, not all staff were aware of their roles, this was fed back to leadership team for action. Business continuity plan was in place in addition to a formal risk register for identifying, managing, and mitigating risks which was discussed by the governance lead at practice meetings. The provider was registered as a data controller with the Information Commissioner’s Office. Staff completed online training for information governance and confidentiality. Leaders addressed sustainability and workforce planning, noting non-clinical staff attrition and actively recruiting for vacant positions. Staff had job descriptions, but not all new staff had received effective induction training. Staff were subject to competency reviews. Staff reported they would welcome more regular whole practice meetings. The practice held multi-disciplinary meetings with other allied health professionals and attended most Primary Care Network meetings. Governance arrangements with third parties, such as shared care agreements for patients in receipt of care and treatment in secondary care. We reviewed the processes for workflow letters and pathology back logs. We found the information shared was accurate. Backlog had been added to the practice risk register.. It had been reported timely, action had not been taken with the potential for patient risk. However, at the time of the inspection our clinical searches found the backlog activity had been actioned and this was being monitored, including whether there were back logs to allay delays in treatment.
Partnerships and communities
The practice had an active PPG and had consulted the group before making changes to services. For example, before introducing a new telephone system, the PPG told us they felt valued and included in the development of the practice. We were in receipt of information of concern which alleged the practice did not engage with the local primary care network (PCN). The practice was a member of the local PCN whose minutes demonstrated the practice had some engagement and involvement. However, it was noted that trust between services needed further organisational development facilitated by the local Integrated Care Board (ICB). The local PCN was a combination of 4 practices whose joint vision included the creation of healthier communities and a commitment to the provision of more patient appointments within their core hours. Their values included: Working in collaboration and partnership, seeing continuous improvement, valuing people, professionalism, communicating at all levels and build positive relationships. There was evidence of minutes of meetings and engagement with the local ICB and the PCN.
NHS Staffordshire and Stoke on Trent ICB were aware of the information of concern shared to the CQC. The practice of its own volition had engaged NHS England's Supporting General Practice Team for independent support and guidance.
The practice was aware of the National GP Patient Survey and used this to action plan and inform its delivery of patient services. The practice held regular meetings for clinical staff; these included regular agenda items such as, significant events, complaints, and best practice updates. The minutes from the meeting were accessible for all staff in their absence. There was evidence seen within the complaints, suggestions and significant event records and feedback from the PPG and local care home that patient views were acted on to improve services. The practice worked with stakeholders to build a shared view of challenges and of the needs of the population. The practice was a member of the local PCN whose minutes demonstrated the practices engagement and involvement. However, it was noted that trust between services needed further organisational development input to be facilitated by the local ICB. The practice worked with the staff at the local care home to provide GP services to meet patients’ needs this included regular ward rounds. The practice had engaged with the local ICB and Supporting General Practice Team to enable sharing of good practice and learning. There was evidence of clinical audits and sharing good practice and learning as well as through complaints and significant events. Partnership working and collaboration was evident in the minutes of meetings reviewed, including the PPG and local care home.
Learning, improvement and innovation
We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.