Harraton Surgery

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 carried out an announced assessment of 7 quality statements. We found: Although there had been some improvements since the last inspection, there were still significant concerns about governance arrangements in the practice which had an impact on safe and effective care. This was in spite of concerns being raised repeatedly about governance at the practice since 2015. This demonstrated that lessons were not being learned. Systems and processes were not established and operated effectively to monitor the safety of environment. There were concerns about how the practice worked with the local Integrated Care Board (ICB). Staff we spoke with told us they now knew what a Freedom to Speak Up Guardian was and they were able to tell us who performed the role. There was no patient participation group (PPG) in place to gather feedback from service users. Most staff we spoke with told us they felt the practice was an inclusive place to work and that they felt supported by leaders and did not feel discriminated against.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us that the time since the last inspection in June 2023 had been challenging but that they felt that things were beginning to improve. They told us that new staff who had joined the practice fitted in well. At the last inspection we were told that staff morale was low, but at this assessment staff told us they felt this had improved. However, we saw there were still some concerns with the shared direction and culture at the practice.

There was a 5-year business plan in place which laid out the strategy and vision of the practice, but despite this there remained improvements which needed to be made. For example, the business plan, written in 2023, stated all staff should be up-to-date with training within 6 months, and in June 2024 we saw this was not the case. Some of the other improvements outlined in the warning notices issued following the inspection in June 2023 had not been made, such as improvements to clinical monitoring and ensuring staff had Disclosure and Barring Service checks completed.

At our previous 7 inspections since November 2015, staff reported the practice management team was visible and approachable. However, they did not always report the same of the lead GP. In June 2023, staff told us they were often late to respond or did not respond at all when they were contacted for information/actions. At this assessment in June 2024, staff again told us that managers were supportive and approachable. No staff reported concerns about the lead GP at this assessment. Staff told us that it had been a challenging time for the practice since the last inspection but they felt as though things were improving as more staff had joined.

Staff had annual appraisals, but there was no staff survey or formalised system for staff to give anonymous feedback. At the inspection in June 2023 there was no meeting structure in place. In June 2024 we were told meetings were now taking place, but there was not a complete set of meeting minutes to be able to evidence this.

At the last inspection in June 2023 the provider told us that there was a Freedom to Speak Up Guardian available at a different practice. However, from the staff questionnaires we received, staff said they either did not know who the Freedom to Speak Up Guardian was or what one was. At this assessment in June 2024, staff we spoke with told us they now knew what a Freedom to Speak Up Guardian was and they were able to tell us who performed the role. Staff also told us that they felt the new practice manager was approachable and they felt comfortable raising concerns.

There was a whistleblowing policy in place. We saw that most staff had completed Freedom to Speak Up and Whistleblowing training since the last inspection.

Most staff we spoke with told us they felt the practice was an inclusive place to work and that they felt supported by leaders and did not feel discriminated against.

We saw no evidence of recruitment processes being a barrier to equality, diversity, and inclusion. Training on equality and diversity was available, but we saw from the practice’s training matrix that it had not been completed by all staff. All staff had appraisals and/or one-to-ones.

At the last inspection in June 2023, the evidence we gathered suggested the provider had not developed leadership capacity and capability within the service since this issue had been raised with them on previous inspections. We found that they were not taking ownership to address the challenges and risks faced by the practice. At this assessment in June 2024, we saw that a new practice manager had been appointed, and staff we spoke with said they felt management was approachable and supportive. However, we saw that there were ongoing issues with governance that had not been addressed.

The governance processes at the practice were not adequate to provide safe and effective care. We saw that systems and processes were not established and operated effectively to monitor the safety of environment. As such we found multiple single-use items which were out of date. A first aid kit and a paediatric oxygen mask in the emergency equipment had both past the dates by which their effectiveness could be guaranteed, while there were no adult pads for the defibrillator. Two Patient Group Directions (PGDs) were also out of date and therefore not suitable for use. This was in spite of there having been an emergency at the practice in October 2023 in which an inhaler administered to a patient from the emergency medicine supply was out of date. The governance and management of staffing was not sufficient to ensure it was safe and effective. We found four members of staff did not have a Disclosure and Barring Service (DBS) check in place, 1 of whom worked in a clinical role. There was no risk assessment to explain the rationale for this. This issue had been raised at the June 2023 inspection also. Following feedback to the practice, we saw that the practice manager has carried out these checks. There was a lack of oversight to ensure mandatory training was kept up to date. One GP had not completed any mandatory training, while another had completed only 8 of 20 mandatory modules. There were also 3 reception staff who had not completed all of their mandatory training. We have seen this has improved since the inspection but there are still some gaps. While we saw there was now an improvement plan in place which sought to address some of these issues, concerns about governance had been raised at the last inspection and a warning notice had been issued.

Patient feedback we saw about working in partnership with other services was mixed. Two of the 3 cases we received from patients spoke about difficulties with care being linked up with pharmacies. However, in the GP national patient survey, 75% of patients said they had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses.

Staff we spoke with explained the processes in place for making referrals to other services and the partnerships they had in place, such as working with the local Primary Care Network. However, they did not give us any examples of how the practice reached out to the local community or sought their feedback, other than through the National GP Patient Survey or the Friends and Family Survey, for which the practice only had access to 1 month’s worth of data.

There were concerns about how the practice worked with the local Integrated Care Board (ICB). Following the last inspection in June 2023 the ICB issued contractual breaches of their own which they felt had not been acted on quickly enough or taken as seriously as they should be. There was also concern about how well the practice worked with others to safeguard people. At the last inspection in June 2023, we saw that the designated safeguarding lead nurse for the ICB had carried out an audit of safeguarding at the practice in November 2022. There was an action plan in place for improvement. At this assessment in June 2024, partners reported that there was still room for improvement in this area.

As at the inspection in June 2023, when we visited the practice in June 2024 we found there was no patient participation group (PPG) in place to gather feedback from service users from different communities.

At the inspection in June 2023, staff said they did not receive learning from significant events, and there were no staff meetings where these or learning from them was discussed. At this assessment in June 2024, staff told us they got feedback from the learning from significant events and gave examples of improvements that had been made as a result of them. However, we did not see a complete up-to-date record of meeting minutes to corroborate this. Some staff said they were unaware of learning from complaints. We saw further evidence that learning at the practice was not adequate.

While some things had improved since the last inspection in June 2023, the practice had not made sufficient improvements in all areas. This was in spite of the practice now having been inspected under this provider 8 times since November 2015. The ratings have been requires improvement 5 times and inadequate twice. At the last inspection, we were concerned about the learning from significant events. The practice also did not seek patient views, and there was a lack of clinical audit to improve outcomes for patients. We also told the practice they needed to improve their systems for monitoring patients. At this assessment in June 2024, we saw there was a programme of quality improvement at the practice, 2 audits had been completed since June 2023. However, the practice still did not have adequate processes in place to collect and learn from service users’ feedback. There was no patient participation group (PPG) in place to gather feedback from service users. A link for the Friends and Family test (FFT) was sent to service users via text message after each appointment to gain feedback, however due technical difficulties the practice could only access service user feedback for June 2024 only. In terms of significant events, we received a SIRMS report which detailed the significant event analysis from Sept 2023 to March 2024. Actions and outcomes were documented. However, there was not a complete up-to-date record of meeting minutes to evidence that important matters were being discussed with the team, such as lessons learned from SEAs. While monitoring of patient care had improved in some areas since June 2023, it had deteriorated in others. We found several areas where the clinical searches suggested that processes in place for clinical monitoring of patients and assessing needs were inadequate. We also found no system had been put in place to ensure equipment, emergency medicines, and Patient Group Directions were kept up to date.