Royal Arsenal Medical Centre

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 7 quality statement from this key question. We have combined the score for this area with scores based on the rating from the last inspection in 2018 which was rated good. Following this assessment, this key question is now rated as requires improvement. Although staff we spoke with reported they felt senior management were approachable and described positive working relations, we found the provider did not always have clear and effective governance processes to support the safe delivery of care. Not all staff knew who was accountable for each aspect of the service and designated leads were not always named in practice policies.

This service scored 57 (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 were able to describe how they responded to patient needs in a holistic manner. All staff showed knowledge of the practice’s vision and values. Senior leaders demonstrated awareness of the local demographics and adapted access needs accordingly. As staff meeting minutes were not always detailed or clear, and had no standard agenda items, it was not fully clear if all staff were always kept informed of recent events within the practice.

Staff we spoke with reported they felt senior management were approachable and supportive. Staff also stated they felt supported by their colleagues and described positive working relations. Senior leaders did not always ensure staff were aware of the roles and responsibilities of others within the practice. For example, senior leaders did not always ensure policies were up-to-date and include the names of designated leads. There were numerous gaps identified in the recruitment files of staff. Whilst many of the outstanding items were sent to us following our onsite assessment, we were not fully assured there was sufficient oversight of recruitment processes. Staff references and employment histories were not always obtained prior to commencement of employment within the practice.

The practice had a whistleblowing policy in place and all staff we spoke with knew how to access this. All staff members spoken with reported they felt able to raise concerns to senior leaders without fear of retribution. Staff did not know who the Freedom To Speak Up Guardian was. Practice policies did not contain the name of a Freedom to Speak Up Guardian and leaders were unable to confirm the name of the person with this role. Guidance from NHS England (Freedom to speak up in Primary Care, 2016) states that primary care providers should name an individual as the Freedom to Speak Up Guardian who is independent of the line management chain. Without this information, staff may not know how to raise concerns, or where to seek advice and support, particularly if their concern is about someone senior in the practice or their direct employer. If concerns about patient care are not addressed, there is a potential risk of harm to patients.

Staff spoken with reported they felt respected within the practice and stated that colleagues would support one another. Staff explained that each colleague offered different skills and experience (both from current and previous employments), and individual input was valued amongst the team. We received 6 staff feedback forms. All staff feedback forms received stated that they felt their views were listened to and acted upon within the practice.

All staff spoken with were able to detail how they kept patient information secure. Workspaces within the practice were kept tidy and no confidential patient information was observed to be left unattended. The business continuity plan included out of date information and did not contain up to date information for all staff working in the practice. Details included contact details for staff no longer employed at the service. Risk assessments were not always up-to-date. Additionally, the practice did not have an IPC risk assessment. Staff were not always clear on the roles and responsibilities of others within the practice. The provider’s quality assurance processes had failed to identify the shortfalls with medicines optimisation and the management of patients with long-term conditions.

Staff spoken with during the assessment had knowledge of local services and were able to describe where they would signpost patients to for further support. The practice worked in collaboration to meet the needs of their patients. For example, there was a multi-disciplinary team meeting held every 4 to 6 weeks in which a geriatrician, psychiatrist and community nurses would attend. The practice adopted a multi-disciplinary approach in attempts to engage with non-responding patients. For example, enlisting the support of the clinical pharmacist or administrative staff.

Staff spoken with reported they were able to raise training needs to senior leaders and were supported in participating in additional learning relevant to their roles. The practice demonstrated active engagement with a number of ongoing projects and research. For example, using the TARGET antibiotic checklist (a resource to support appropriate prescribing of antibiotics) and monitoring the most cost-effective solutions to prescribing. The practice supported medical students as a teaching practice, and was looking to develop further to also incorporate nurse teaching. The practice was in the process of reinstating a practice nurse who specialised in diabetes management.