Rowner Surgery

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• 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

There were not established and effective governance systems operating to provide timely and effective oversight of risks. People reported concerns relating to some staff conduct, their responsiveness and professionalism. These had been addressed and were being actively investigated. We found evidence of remedial actions being taken. Improvements were required specifically in the oversight of medicines, safe recruitment of staff and the progression of issues raised with the management team.

This service scored 64 (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 some members of the management team were not visible, accessible or supportive to staff. They told us they did not always feel listened to. Their contribution or achievements were not acknowledged or celebrated. Leaders acknowledged improvements were required and changes to their direction and culture needed time to establish and embed. Staff showed commitment, compassion and interest in people. They had willingly undertaken additional roles and duties due to staff vacancies. However, some staff were not clear of what was expected of them within their role and how this directly contributed to the wider organisation’s objectives.

There were not established and effective systems in place to promote adherence to the values of the organisation. For example, some staff had not completed mandatory training. There were no formal supervisions processes in place for clinical and non-clinical staff. Individual and collective performance was not consistently monitored by the leadership team. Where discrepancies had been identified such as in how staff coded clinical conditions, the practice failed to report progress against risks identified in earlier senior management meetings.

Staff had not had stability, openness and transparency within their leadership team until recently. They reported positively on recent changes with the introduction of an interim management team who were benefiting from the support, advice and guidance of an external consultant. Staff told us they were now being actively encouraged and supported to provide feedback. They told us they believed some of the partners had the skills, knowledge, experience and credibility to support the staff to lead effectively.

There were not established and effective systems in place to demonstrate inclusivity in the practice. Staff did not have protected time to undertake supervisory duties. Equality impact assessments had not been conducted to consider the impact of changes on people and how to mitigate any potential detriment.

Staff knew how to report concerns. They told us there had been changes to their management and leadership team that had been unsettling. Staff told us they were trusted to work with autonomy but would appreciate further training, support and assurance from the management team.

There were established and effective systems in place to support staff to speak up should they have concerns. The practice had nominated speak up champions for staff to approach if they felt unable to directly raise concerns with the management team. Staff also had access to external speak up champions if they felt more comfortable to do so. Concerns raised by staff informally and formally were all recorded, investigated and responded to and any learning identified and shared to drive improvements.

Staff told us they valued their colleagues and the opportunities to support one another, share learning and diversify their knowledge and skills base. Some staff did not feel confident raising concerns or questions but told us they welcomed the support of the Integrated Care Board (are NHS organisations responsible for planning health services for their local population) and the inspection team to inform improvements to their working environment.

There were not established, effective and inclusive systems and processes in place to demonstrate the leaders had reviewed, considered and improved the culture of the practice. Staff views and opinions had not always been requested, welcomed or captured to inform the development of the service. There was no systemic review of policies and procedures to ensure they were reflective of best practice. Reasonable adjustments had been made in response to health and safety considerations.

Staff were not actively involved in contributing to governance systems and overseeing and establishing safe practices.

The provider did not have established and effective governance, management and accountability arrangements. We found there was not effective oversight of people experiences, medicines, this included the prescribing of some high-risk medicines and the monitoring patients with some long-term health conditions. The provider had not established searches of their clinical system to alert staff to potential risks to patients such as prescribing considerations or Medicines and Healthcare products Regulatory Agency alerts. There were not effective systems in place to assess, managed and support both clinical and administrative staff improvement in their current and future performance. For example, clinicians did not receive regular clinical governance and oversight of their work and non-clinical staff had not formal development arrangements. Risks to the quality of the service were not consistently identified, assessed, monitored, mitigated and/or removed. Meeting minutes lack details of discussions held, actions taken and how learning had been disseminated and embedded to improve 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.

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