Hockley Farm 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

At the time of our inspection, there were some gaps within governance, management and accountability arrangements. There was a lack of clear roles and responsibilities within the management structure due to staff absences. There was a lack of shared direction for the service from practice leaders which impacted wider governance processes. Staff turnover was high with some staff reporting difficult working conditions due to conflicting direction within the practice management. The areas we looked at within the assessment were; shared direction and culture; capable, compassionate and inclusive leaders, freedom to speak up, workforce equality, diversity and inclusion, governance, management and sustainability and learning, improvement and innovation. Due to the gaps we found within the governance of the practice, we issued the practice with a breach of regulation 17 (good governance). We requested that the practice submitted an action plan notice to us to provide us with assurance of how they planned to address our concerns.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders did not have a shared direction within the practice, which was impacting on staff within the practice. There was a lack of shared vision and strategic goals.

Due to the lack of shared direction, a number of processes were not working at the time of our inspection. For example, recruitment of staff including managers. This was impacting on staff morale and turnover meant there were a number of vacancies within the practice. This put additional workload on remaining staff who had reported this was unmanageable and was putting patient care at risk.

Staff we spoke with were positive about leaders individually, however the lack of shared direction was causing conflict within the practice.

There were limited evidence of processes in place from leaders to improve the practice. Leaders were aware of issues within the practice but could not agree on ways to solve these.

Staff we spoke with reported they felt they could raise their concerns to leaders within the practice however had little confidence these would be addressed or improved. There was some evidence of people raising concerns internally which had not been acknowledged by practice leaders.

Staff leaders had circulated information to staff about raising concerns and provided external support to go to if necessary.

Staff reported there were difficult working conditions due to the culture of the practice where the leaders were unable to share direction. Staff were proactive in trying to cover areas of work where staff absence was a problem, however often had little training or support for this. Staff told us they were working hard to support the practice through staffing shortages and had been given additional work within their remit to complete.

There were some gaps within recruitment files for new staff including DBS checks (disclosure and barring service check to review peoples criminal records to ensure they are safe to work with vulnerable people) , immunisation records and training requirements. The practice did complete some of these checks following our inspection however there was a lack of oversight of these upon joining the practice. **Please write DBS in full and explain what this is**

Staff were not always clear around governance and accountability arrangements at the practice at the time of our inspection, due to the lack of shared directions within the partnership. Staff told us they were often told conflicting information by leaders and were caught in the middle of leaders' disputes. The impact on staff wellbeing and culture of the practice was negative and had resulted in many staff absences. Whilst the practice were trying to recruit more staff, there was a lack of agreement on recruiting managers.

A lack of management and accountability meant there were often gaps in processes such as oversight of staff training, recruitment, and demonstrating learning and improvement within the practice.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff and leaders had a good understanding of how to make improvements happen within the practice. However, due to a lack of meetings occurring within the practice and leaders being unable to agree on implementing changes there had been no improvement or changes made to the practice.

We reviewed processes for investigating significant events and found there were some good documented investigations however these had not always been discussed and shared with practice staff. We also found evidence of some significant events which had not been fully documented. There had been an increase in complaints received within the practice which we saw had been investigated and responded to however there was a lack of review to prevent recurrences.