Great Barr 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

At the last inspection we found the practice did not have embedded governance systems, there was a lack of leadership and oversight, the culture did not effectively support high quality sustainable care and there was no evidence of systems and processes for learning, continuous improvement and innovation. At this assessment, we found continued concerns in the leadership and culture of the practice and found the providers had not taken action to address areas of governance, management and accountability and there was no clear systems in place to ensure staff had the skills and knowledge so people had safe care and treatment. We found staff morale was very low with a number of staff reporting there was a continued lack of communication that was having an adverse effect on staff being able to do their job role effectively. Some staff reported being unable to approach leaders for guidance and support. At the time of the assessment, we found the manager was in a distressed state and told us they were unsure who to speak to if they had any concerns and received no support from leaders. We found that there was no leadership in place to ensure there was adequate oversight and there were systems in place to manage risk, issues and performance. There were succession plans in place, supported by a business plan however some areas had been recently embedded and although the practice had made significant improvements, we did not have assurances that these outcomes were fully sustained.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At the last inspection in April 2023 we found that the practice culture did not always effectively support high quality sustainable care. At this inspection we found that culture and communication was still inadequate and staff reported a lack of support and being unable to share concerns without fear of retribution. We found a number of staff very upset on the day we visited, they shared their concerns on how they were being excluded and how communication was poor which was impacting on them being able to do their job appropriately. The practice leaders were unable to demonstrate they had considered the impact changes had affected staff and we found no evidence to demonstrate they had implemented supportive measures to ensure the health and wellbeing of all staff. We found there was a closed culture and learning was not shared with staff to make improvements and mitigate future risks. Since the GP partners had returned in February 2024 to the practice, 1 practice meeting had been held which they had not attended. No evidence was provided of regular meetings with staff and the practice leaders. The minutes of the staff meeting that was held in March 2024, showed that the key points in the value statement of the practice had been discussed. These were being open and honest and respect and fairness was key. The GP partners were unable to demonstrate these values were at the forefront of their leadership of the practice and feedback from a range of staff demonstrated a lack of understanding by the GP partners of the challenges staff were facing and how limited engagement with the leaders was impacting on the practice.

There were systems to ensure compliance with the requirements of the duty of candour, but there was a lack of processes in place for effective communication and shared learning. Staff were unaware of a whistleblowing policy or freedom to speak up guardian. We also found 5 staff had not completed mandatory training which included equality and diversity. The practice had a vision which was displayed on their website which stated "We aim to provide the best possible outcomes for our patients in a safe and welcoming environment. Our Doctors and staff are approachable, respectful and patient-centred. We will continue to invest in our staff, diversifying and developing our skills and knowledge base to ensure that we have a highly skilled, resilient, and adaptable work force to meet the needs of our patients and communities and we will seek to collaborate and work in partnership to strengthen community links and respond to local, regional and national initiatives. Following feedback from staff we found the leaders were not following their vision as staff training was not being updated, staff were not being given time to personally develop and we found limited evidence of contact and working in partnership with community services. The practice values were also displayed on the practice website and stated Accountability, fairness, professionalism, innovation and care. We found the practice was not always responsive to the needs of their patients and identified areas through remote clinical searches where patients had not received the appropriate monitoring and reviews. Many of the staff we spoke with, reported a lack of support and respect by the leaders of the practice and there was inadequate leadership at the practice to ensure high quality care was sustained.

We received numerous whistle blowing concerns which related to the effectiveness of patients' care and treatment due to leadership not being inclusive and staff having no direction or support. Staff described the practice team as supportive, however the leaders were unapproachable and staff felt they had no one to turn too if they had a concern. We were unable to gain assurances that the leaders understood the challenges to quality and sustainability to ensure there was capable and effective leadership. The practice had limited oversight and supervision to ensure staff were carrying out their roles effectively. The leaders had destabilised the clinical team by reducing the number of clinical staff available to provide services. We were told that there were plans for further recruitment of pharmacists to support the existing clinical team, improvement to processes and systems to mitigate risks.

We were unable to gain assurances from the leadership team that there were plans in place for the development of staff. On speaking with staff we found that a number of pathways that had been implemented previously by the caretaking team were not being followed and this had impacted on the effectiveness of care and treatment being monitored. The GP partners had reviewed the nursing provision and current appointment system that had been implemented by the caretaking team and had made decisions to change the flexibility of the system without consultation with the nursing team. We found this had impacted on staff being able to do extra roles they had responsibility for At the time of our inspection, one of the senior members of the clinical team who had been part of the caretaking team and had stayed to support the GP partners and the transistion had been dismissed at short notice which had impacted on the provision of services. The management team found they were not being supported and there was no evidence to demonstrate that the GP partners had reviewed their development and implemented actions to ensure they were able to lead the practice effectively.

Staff told us there had been improvements in the culture during the time the caretakers were in place at the practice, however since the GP partners had returned, staff felt less confident in raising concerns and were not well supported. Regular practice meetings were not held. Staff huddles which were frequently in place during the caretaking period had now been reduced. Some staff told us they were fearful of speaking up due to fear of retribution. We found no evidence of a freedom to speak up guardian in place. Staff were aware of how to report incidents, however from the evidence provided we found learning was not shared with the team to encourage improvements.

The practice had some policies and procedures in place which were accessible to staff, however we found there was no freedom to speak up guardian outside of the practice that staff could approach for support if they wanted to raise an issue. The practice had a whistle blowing policy in place, however the policy had not been reviewed since it expired in March 2023. There was a duty of candour policy and equality and diversity training in place, but on reviewing the training matrix for all staff we found some staff were out of date with their training in a number of areas.

Staff told us that there well being was not considered when services were planned or changes were implemented. For example: risk assessments hadn't been completed for staff that required a review of their workplace. We also found that due to the number of appointments given to nurses, this impacted on them being able to take a break during the day. The reduction of administration time for the nurses had also been implemented without any prior consultation with the nursing team on how this would affect them being able to do their roles effectively. Feedback from the management team highlighted the lack of support they had received from the GP partners and decisions were being made without prior discussion with the managers to ensure the continuity of services. For example: a longstanding GP locum was cancelled with 24 hours notice by the GP partners which had impacted on clinical availability and had added pressure to the administration staff in trying to manage appointments. On the day of inspection we found a number of staff in a distressed state. Feedback from a range of staff showed there was a lack of support from the GP partners and staff felt unable to approach the leadership team if they had concerns.

The management team told us there were policies and procedures in place for the safe recruitment of staff, however these were not provided on the day of inspection. We found that staff had been recruited, but there was no evidence to demonstrate that the appropriate checks had been completed, which included professional registration. Staff had been employed in advanced clinical roles, however, there was no training records to demonstrate that newly recruited staff were up to date with training relevant to their role. On reviewing staff training, we found 5 staff were not up to date with equality and diversity training, the GP partners had not completed updates on bullying and harassment. We were told there was an induction process in place for newly appointed staff, but we were not provided with evidence to confirm this.

Staff told us that practice policies were accessible. Roles and responsibilities were not clear and staff felt there were not supported by the leadership team. Staff were unaware who the governance lead was. We found there was no clear oversight for the management of risk. For example: The fire risk assessment had not been updated and we were provided with no evidence on the day of inspection when this would be carried out. Staff feedback highlighted how patients were booked inappropriately with staff who did not have the necessary skills to be able to meet the patients' needs. This had been reported to the leadership team, however no action had been taken.

We found processes still required strengthening to ensure risk monitoring was effective. We were unable to gain assurances that risk assessments had been completed for health and safety and at the time of inspection, the management team were unable to provide us with any evidence of what risk assessments were in place. There was an ineffective process to identify, understand, monitor and address current and future risks including risks to patient safety. This included the actioning of safety alerts and ensuring learning was shared to mitigate future risk and identify trends. On the day of inspection we found a number of outstanding tasks and referrals, some which dated back to March 2024. The leadership team told us there was a process in place to monitor tasks and a member of the administration team had this role. However, on speaking with the administration team they were unaware that this was part of their responsibilities. There was no clear communication and systems in place to ensure all tasks and referrals were acted on in a timely manner. Due to the lack of clinical leadership, performance was not monitored effectively to ensure patients were receiving the appropriate care. On reviewing a random sample of patients on high risk medicines or with long term conditions we found they had not received the appropriate reviews.

The management team told us that they were in the process of organising a patient participation group (PPG). There was a link with information on how to join the PPG on the practice website, but we were provided no evidence to demonstrate what had been done within the practice to encourage patients to attend a meeting.

We found practice meetings were not being held regularly. Since the partners return in February 2024, one practice meeting had been held with the whole team, however the GP partners had not attended. Staff reported a lack of support and poor communication from the leadership team.

We were unable to gain assurances that the GP partners were working with the primary care network and stakeholders to ensure that resources were planned and there was regular collaboration and partnership working to meet the needs of the patients.

We found no evidence to demonstrate that the practice had processes in place for partnership and community engagement. For example, we received evidence to demonstrate that safeguarding meetings were held, however we were unable to gain assurances that these meetings and the outcomes were being shared with health visitors or local community services. We were told that multi disciplinary meetings were being held, but no evidence was provided to demonstrate that regular meeting were held with community teams to ensure patients receive the appropriate support, care and treatment.

Feedback from staff highlighted they were unable to develop their roles due to time constraints and not being given protected time to do their learning updates. Staff informed us they were expected to do updates in their own time. Staff told us that learning from complaints and significant events was not shared and evidence provided showed 1 staff meeting had been held since the GP partners had returned, however they were not present at this meeting. On reviewing the minutes of the meeting we found no evidence to demonstrate that incidents or complaints had been discussed. The practice had recruited new staff, however we found no evidence to show what training had been completed and no monitoring processes were in place to ensure staff kept up to date with training relevant to their role.

The practice leaders were unable to demonstrate they had effective systems in place to demonstrate learning and development. We identified gaps in staff training in a number of areas that the practice deemed as mandatory. We found there was limited opportunities for staff development, with staff not been given time to their training during working hours. We were unable to gain assurances that the systems that had been implemented by the caretakers during the period of time the GP partners were away from the practice had been followed and were being used to ensure the continuity and sustainability of services. The lack of leadership was demonstrated through inadequate arrangements to ensure improvements were implemented and maintained, safety of patients was regularly reviewed through monitoring and learning was shared with the practice team to mitigate risks.