Little Lever Health Centre & Little Lever Library

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• Overview
• Shared direction and culture
• Freedom to speak up
• Governance, management and sustainability
• Learning, improvement and innovation

We assessed all quality statements in this key question. Leaders and staff did not have a shared vision and culture. Learning was not a priority and was not shared, and staff said the provider did not listen. Managers were visible for the hours they worked, and they supported staff, but the provider was not supportive. Staff did not feel they were treated equally or fairly. The culture was not one of continuous improvement and staff were not given time and resources to try new ideas. This is the first inspection for this service since its registration with CQC at the current location. This key question has been rated as inadequate. We identified a breach of regulation in relation to good governance.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a vision: “To enhance the health, well-being and lives of those we care for by working within the local, national guidance and regulations”. We did not find the provider worked within all guidelines or regulations. There was a business continuity plan, but this did not effectively detail how the practice would manage if the GP was not available. It stated the Strategic Health Authority should be informed, but Strategic Health Authorities ceased to exist in 2013. It also mentioned the remaining partners providing cover, but there were no partners; the provider was a single-handed GP. The provider worked full-time, but all other staff, including all clinicians, were employed part time. There were 2 practice managers, employed for the same 20 hours a week. There was no-one else with any management responsibility employed, so for over 50% of the time no manager was available should a problem arise.

The practice supplied is with their Freedom to Speak Up policy, titled, “Freedom to Speak Up in Primary Care”. This was a document from NHS England, published in November 2017, that the practice had adopted. It gave the names of 2 external Freedom to Speak Up Guardians but did not detail how to contact them. Elsewhere in the policy a different person was named as the Freedom to Speak Up Guardian. The policy stated the provider was committed to an open an honest culture, and what people said would be investigated. We did not find this during this assessment.

Governance processes were not effective. Practice meetings were held infrequently. The locum GPs did not attend these so although significant events were mentioned, there was limited discussion and no challenge about clinical concerns. We saw some policies were not being followed. The recruitment policy stated all new starters would have weekly 1 to 1 meetings with their manager, and a probation review, usually after 3 months, with the lead GP and practice manager. There was no evidence of these for the 2 most recently employed staff members.

Learning from significant events was not managed. Clinical significant events concerning the provider did not have oversight or scrutiny by other clinicians, so improvements were not put in place or monitored. The practice carried out some clinical audits, but their value was limited. For example, an audit from July 2024 highlighted some issues, and the clinical searches carried out as part of this assessment showed the provider had a lack of understanding about the issue. There was a PPG that met once a year. We were told it was not possible to set up more regular meetings due to a lack of staff resources at the practice.