Dr B. Bekas

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 previous inspection we rated well-led as inadequate because: there was a lack of leadership and oversight from the provider to ensure services were delivered in a safe and effective way to patients. The practice did not have a clear vision and credible strategy to provide high-quality sustainable care, the practice culture did not always effectively support the delivery of high-quality, sustainable care. The overall governance arrangements and processes for managing risks, issues and performance were ineffective. The practice did not always act on appropriate and accurate information, feedback from the public, staff and external partners to sustain high quality and sustainable care was not always sought or acted upon. There was little evidence of systems and processes for learning, continuous development and innovation. At this inspection we found that these areas had not been adequately improved.

This service scored 25 (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 September 2023, we found that the practice leadership did not always achieve high quality sustainable care. At this assessment we found that this had not improved, and staff reported a lack of support and being unable to implement improvements without fear of retribution. Staff told us leaders were aware of the concerns; however they had not been addressed. The practice leadership was unable to demonstrate they had considered the impact on their staff and how they had implemented supportive measures to ensure the health and wellbeing of some staff.

We were unable to gain assurances from the leadership team that there were plans in place for the development of staff. Staff we spoke with told us that they had been given opportunities to take on additional responsibilities, but they struggled to do the necessary learning whilst carrying out their current roles.

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, including staff from the PCN were carrying out their roles effectively.

Practice meetings were held, but not all staff always attended. Staff were aware of how to report incidents, however from the evidence provided we found learning was not always shared with the team to encourage improvements.

At the time of the inspection, the practice did not have a freedom to speak up guardian in place that staff could approach for support if they wanted to raise an issue. The practice had policies and procedures in place which were accessible to staff. These had all been created or updated in the weeks prior to the inspection and although staff we spoke with knew where to find them, they were unaware of their content. There was a duty of candour policy and equality and diversity training in place, but on reviewing the training matrix some staff were out of date with their training in a number of areas.

Some staff with spoke with told us that their well-being was not always considered when services were planned, or changes were implemented.

On reviewing staff training, we found some staff were not up to date with equality and diversity training. We saw that 6 staff members had not completed training to support autistic people and people with a learning disability. This was not compliant with the legal requirement introduced into the Health and Social Care Act on 1July 2022. We saw an induction process in place for newly appointed staff, but we were not provided with evidence to demonstrate that any new staff had completed it.

Staff told us that practice policies were accessible, but that they were not aware of the guidance contained in them. Roles and responsibilities were not always clear, including the management responsibilities of the practice manager and lead GP. We found there was no clear oversight for the management of risk. For example, there was no fire risk assessment in place, no health and safety risk assessment and no fire drills had taken place. Staff feedback highlighted how patients were sometimes booked inappropriately with staff who did not have the necessary skills to be able to meet the patients' needs. Some new reception staff did not have a clear understanding of the scope of The Additional Roles Reimbursement Scheme (ARRS) which is an initiative that allows primary care networks (PCNs) to recruit new roles to improve access to general practice.

The process to identify, understand, monitor and address current and future risks including risks to patient safety needed improvement. This included the actioning of safety alerts and ensuring learning was shared to mitigate future risk and identify trends. Performance was not always 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 all received the appropriate reviews. We found processes still required strengthening to ensure risk monitoring was effective.

There was a patient participation group (PPG) in place, and one member of the group was very positive about the practice and told us the staff ‘were wonderful’.

We found that although practice meetings were being held, not all staff attended and although we saw evidence of agendas, we did not see any record of discussions or decisions.

We were unable to gain assurances that the practice always worked 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 meetings were held with community teams to ensure patients received 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 told us that learning from complaints and significant events was not always shared. The practice had recruited new staff, however we found no evidence to show that they had completed the induction process devised by the practice.

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 that whilst there were opportunities for development, staff not been given time develop their skills and knowledge during working hours. 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.