Sidley Medical Practice Also known as Dr Lawton & Partners

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 6 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was good. We found the provider did not have clear and effective governance processes, which supported the safe delivery of care. They had failed to promote a positive culture of continuous learning and improvement. Information about risks, performance and outcomes was not used or shared effectively to improve care. We found a breach of regulations for the Well Led key question and have told the provider to take action.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders told us about recent changes in the partnership and management of the practice. There were concerns about capacity and capability within the new leadership arrangements. Concerns from staff and leaders related to insufficient practice management hours and time spent on site. There were concerns that clinical leaders had insufficient time to manage both a clinical and managerial workload which led to delays and backlogs of tasks.

The provider had not developed a shared vision or strategic direction. At the time of inspection, they were unable to provide evidence a business plan or any key objectives.

Feedback from staff was mixed about how visible and approachable leaders were and whether they led by example. Some felt that their ideas were dismissed or ignored and that requests for support and advice were not always responded to in a positive way.

There was limited evidence to show leaders were knowledgeable about issues and priorities for the quality of services. The provider had not established processes for ensuring areas identified for improvement were acted on.

Staff indicated that they did not always feel comfortable about speaking up. Feedback was mixed as to whether leaders acted with openness, honesty, and transparency. Communication was sometimes poor. Staff did not feel empowered to drive improvement and were not encouraged to do so. Morale was very low.

The provider had recently developed a Freedom to Speak Up Policy. However, the policy did not identify a freedom to speak up guardian. This meant staff did not have clear processes for support if they felt unable to raise concerns via their line manager or other routes. Feedback from staff corroborated this.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff were not always clear about lead roles and responsibilities within the practice. Some staff could not identify who the lead for safeguarding in the practice or who their line manager was.

The provider did not have a detailed organisational structure chart which meant line of accountability were unclear. There was no evidence of processes, including regular, structured meetings to identify and manage performance, outcomes and risks.

We had no specific feedback from patients about partnerships and communities.

Staff and leaders told us that the practice had not yet fully embraced collaborative working with the Primary Care Network (PCN) and that the previous partners had taken the practice out of the PCN. At the time of inspection, practice leaders were unable to provide examples of shared learning with partners and communities that had led to better outcomes for people. Following the assessment leaders told us they had re-joined the PCN and that partnership working had improved.

Feedback from partners was mixed. Some partner organisations said they worked well with the practice in the provision of care. However, some partner organisations reported poor joined up care and a lack of co-operation an unwillingness to listen and work collaboratively to improve the standard of care provided to patients. We saw evidence to show that feedback from partners was not always responded to in an appropriate way.

The practice had some processes in place that facilitated partnership working for example, regular multi-disciplinary team meetings to discuss elderly patients with complex health and social care needs. However, there were no similar arrangements for discussing and reviewing children at risk. The practice did not have processes in place to ensure its safeguarding registers were regularly reviewed and kept up to date not did it work with local authority partners to reconcile information to ensure it was accurate. Practice policies and procedures for learning from incidents were not being followed which meant that lessons were not being shared with partners to facilitate improvement across the local primary care network.

Feedback from staff indicated that learning from incidents and complaints was not routinely shared. They were unable to provide examples of innovation and improvement across the organisation and local system. Leaders told us, that in common with other GP practices they had introduced a range of software and applications to help improve the patient experience. However, they were unable to demonstrate improved outcomes as a result. Staff told us they felt they had insufficient training to use some of the applications which made them difficult to navigate and for the benefits to patients to be realised.

Whilst the practice had policies and procedures for managing significant events and complaints, these were not always being followed. Appropriate action and lessons learned were not always identified which meant there was limited scope for improvement.