The Birches 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 all quality statements from this key question. Our rating for this key question is requires improvement. At this assessment, we found effective arrangements were in place for partnership working and for improvement and innovation. However, improvements were needed to ensure governance systems for the oversight of recruitment and training were effective. Improvements were also needed to ensure policies, procedures and guidance could be easily accessed by staff and newly written policies needed time to be embedded in practice. We have asked the provider for an action plan in response to the concerns identified at this assessment.

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.

We received mixed feedback from staff; clinical staff were aware of the vision for the service and felt involved in the planning of the practice, whereas non-clinical staff were less aware and involved. The management team told us they had been working on the business development plan for approximately 6 months and advised they had recently shared this with all staff for their information and to obtain their feedback. Leaders told us they planned to hold regular practice team meetings to continue to obtain feedback from staff. We received mixed feedback from staff in relation to the culture of the practice. Clinical staff described the culture as welcoming, adaptable, safe, supportive, amenable, and invested in learning. Some non-clinical staff also described this culture, along with feedback that things were not actioned and there was a lack of communication.

The practice had a documented mission statement, clear vision and business plan for 2024 to 2027, which prioritised high quality, safe and effective patient care. The business plan included areas for patient services to be developed and where improvements had been identified, for example, revitalising engagement with the patient participation group. Leaders demonstrated that they understood the challenges to quality and sustainability. The management team told us they had been working on the business development plan for approximately 6 months and advised they had recently shared this with all staff for their information and to obtain their feedback. The practice had a staff member who was the social events organiser. They organised and promoted social events, to support team building at the practice. We received positive feedback about their role. Examples included bowling and celebrating a range of festivals with food, which included halal, coeliac and vegetarian options.

We received mixed feedback from staff in relation to the leadership of the practice. All clinical staff we received feedback from told us that leaders were visible and approachable. Whereas most of the non-clinical staff we received feedback from did not find leaders visible, and some found them unapproachable. The leadership team did work across 2 practice sites and had recognised that visibility of leaders and the duty doctor, who is the first point of clinical support for staff, could be improved. The leaders had been working towards creating a 6-person workstation in the back reception area and this had recently been established. They planned for the supervisory GPs and duty doctor to be based here to improve visibility and support, particularly to non-clinical staff.

There were clear governance arrangements with staff employed by the Primary Care Network and for collaborative working arrangements with a nearby practice. However, there were not effective systems for oversight, which the partners had recognised. The partners had started to strengthen these and had restructured the practice management team in March/April 2024 by creating 2 practice manager assistants, who covered this practice and a nearby practice. Named staff had specific areas of responsibility and most of the staff we received feedback from were aware of these lead roles.

We received mixed feedback from staff in relation to the freedom to speak up policies at the practice. All clinical staff we received feedback from told us policies were in place for speaking up, however non-clinical staff were not all aware of these policies. Some staff told us they had been informed that new speaking up guidelines were being implemented. This was confirmed by the leadership team. All clinicians we received feedback from felt able to raise concerns and examples were given of where improvements had been made. For example, the process for handling urine samples had been improved, with additional time allocated at the end of the morning nurse clinic, to test and process urine samples to be sent off. However, feedback from non-clinical staff was mixed, and some staff advised they would not be listened to, and others only felt able to raise concerns with certain people who they thought would listen.

The practice had a whistleblowing policy which had been reviewed in December 2018. Some staff referred to this policy. The practice had written a draft staff speaking up policy in July 2024, however not all staff were aware of the policy and how to access it. This new policy needed to be embedded in practice. All staff had been notified of speaking up e-learning training which needed to be completed, but this had not yet been completed by the majority of staff.

We received mixed feedback from staff in relation to how practice leaders supported workforce equality, diversity and inclusion. The majority of staff we received feedback from had completed equality and diversity training, however records of training did not reflect this for all staff. We were given examples of how staff were supported, for example, working hours flexibly to attend Friday prayers. However, some staff told us they had not felt supported with workforce equality, diversity and inclusion. We spoke with practice leaders who told us, for example, they considered requests for flexible working which they balanced with ensuring they continued to meet the needs of people using the service. Leaders told us they used an external Human Resources company to support an open culture.

The practice business development plan for 2024 to 2027, included arrangements for example, to support the staff team, for the new management structure, to increase skill mix, and for training and workforce development. The practice had recently introduced the staff wellbeing employee of the month award, which recognised staff with a £20 voucher each month. The practice had an equality and diversity policy which was last reviewed in January 2024. Practice leaders shared evidence of some adjustments they had made for staff. The practice had implemented a new reasonable adjustment policy in July 2024, however, not all staff were aware of this policy and how to access it. This new policy needed to be embedded in practice. The practice was not able to evidence that all staff had completed equality and diversity training, and some staff were overdue refresher training.

There were named leads in place for key areas of work. Staff knew which staff had lead roles, such as safeguarding and were confident to identify and report safeguarding concerns. Clinical staff who we received feedback from, told us they had received training. Clinical staff were aware of the location of emergency medicines and equipment and knew the arrangements for dealing with medical emergencies and told us these were safe and effective. However, some non-clinical staff told us they were not aware of these arrangements and had not received training. Following the site visit, the provider confirmed they had notified all staff of the location of the emergency medicines and equipment. We received mixed feedback from staff in relation to the availability of policies and guidance and how changes to policies were communicated. Clinical staff told us policies were easily available and they were informed of changes. However, non-clinical staff told us that guidance was not always available, and they were not updated with changes. We spoke with the practice leaders who told us they were in the process of moving to a new platform where policies, including updates, would be more easily accessible to staff.

The practice used digital services securely and effectively and conformed to relevant digital and information security standards. Arrangements were in place for the oversight of fire safety. The practice leaders had applied to remove a GP from their CQC registration. During our assessment the provider identified 5 complaints where it was unclear if they had been acted on. They took action to review and were acting on these. The provider had a process for completing pre-employment recruitment checks, however they were not always able to evidence these had been completed. For example, a second reference for 1 staff member, checking professional registration before commencement of employment for 1 clinician and ongoing registration checks for all clinicians. The provider checked and confirmed all clinicians were registered. The provider was in the process of reviewing and improving their recruitment processes. Systems for the oversight of training, were not effective. The practice was not able to evidence that all staff had completed mandatory training. This included basic life support for some non-clinical staff, safeguarding adults and safeguarding children for non-clinical and nursing staff, learning disability and autism awareness, freedom to speak up, and equality and diversity training for clinical and non-clinical staff, at the appropriate level to their role. The provider had recently identified a practice manager assistant to lead on training and were improving the oversight of training. The practice was not able to evidence chaperone training for 2 non-clinical staff who undertook this role. These staff had received a standard Disclosure and Barring Service (DBS) check. The provider took immediate action and started the enhanced DBS application process, identified training for completion, amended the chaperone policy arrangements so people would not be left alone with a chaperone, and shared these arrangements with staff.

The practice was rated 3.5 out of 5 stars from feedback on the Healthwatch Suffolk website. The most recent 10 reviews were mixed, with 3 rated 5 stars, 2 rated 3 stars and 5 rated 2 stars. Positive feedback related to ease of contact, access to appointments, willingness of staff to help, and a speedy response for a cancer referral. Less positive feedback related to difficulties with access to appointments, poor communication, and lack of confidentiality in the reception area. The practice had 2 reviews on the NHS website, 1 rated 5 stars and 1 rated 4 stars. Both related to access and included improvements which had been made to access and noted staff were helpful, caring, kind and efficient and people felt listened to. The practice collated and reviewed a range of feedback. For example, a patient survey asking about experiences of reception staff and methods of appointment booking was undertaken in March 2024. The practice had acted on the feedback and had installed a TV screen, provided chairs with arms in the waiting area and a GP was now available in the reception area for easy access and advice.

Staff gave examples of engagement and joint working with other services for the benefit of patients. The practice worked with a nearby practice to provide extended access 1 evening a week. They were also working with local pharmacies to implement ‘pharmacy first’ an initiative for people with minor ailments to attend a pharmacy. The practice shared their plans for a range of community projects, which included open days for health promotion in the local areas and also in Ipswich for those with less access to health care services, and condition based open events, for example for diabetes and women’s and men’s health.

We received positive feedback from partners about how the practice worked with their Primary Care Network (PCN), which included attendance at PCN meetings. (Primary care networks are groups of practices who work together to improve primary care services). The practice engaged with commissioners and responded when information was requested. The practice had a patient participation group (PPG) which had previously been engaged with practice events, for example health promotion meetings supported by health professionals and helping at flu clinics. The last meeting of the PPG was approximately 1 year ago, and members were keen to continue to engage with the practice. The practice business plan for 2024 to 2027 had identified the need to revitalise engagement with the PPG.

The practice worked with other health and social care services to meet people’s needs. There were clear governance arrangements with staff employed by the Primary Care Network, and for collaborative working arrangements with a nearby GP practice. (Primary care networks are groups of practices who work together to improve primary care services). Arrangements were in place for extended access appointments for people on a Wednesday evening.

We received a range of examples from clinical staff and non-clinical staff of how the practice encouraged and supported learning, improvement, and innovation. The practice has 3, Tier 3 Educational Supervisors with another clinician training for this role. A Tier 3 Educational Supervisor delivers educational and/or clinical supervision to Foundation Doctors, GP trainees, advanced practitioners, allied health professionals, nurses, first contact practitioners and other health professionals. Educational Supervisors were supernumerary and were not expected to hold their own clinics. This meant they were accessible to clinicians, could provide learning as issues arose and could support during patient consultations, if necessary, which was beneficial for patients. The practice had created a clinical/educational hub in the reception area to facilitate easy access to senior clinicians for non-clinical staff.

We saw evidence of a range of audits which included, the safe use of medicines, acting on safety alerts, recalling people who had not attended for a long-term condition review, following up people referred for suspected cancer who had not been seen, and cervical screening uptake and actions to improve attendance. The GP partner confirmed there was a process to review and close tasks when clinicians left the practice. We saw evidence of regular monitoring of a range of feedback sources. This included feedback from the previous online appointment system to the new online appointment system, the friends and family test, google reviews and patient surveys led by the practice. Feedback was documented and reviewed to identify any themes and trends where improvement could be made, and we saw examples of improvements which had been made.