Wellington Medical Practice

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 looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment, we rated this key question as requires improvement. This was because structures, processes, and systems to support good governance were in place but not fully embedded into practice. Processes for managing risks, issues and performance were in place but were not always effective. At this assessment, we rated this key question as good. There had been some improvements in how well-led the practice was since our previous assessment. An improvement plan had been developed and implemented with a system for monitoring progress. Staff were supported through a Freedom to Speak Up Guardian if they had any concerns. Structures to support governance and mitigate risks were in place and a suite of policies to support this. The practice worked collaboratively with partners and communities. We found although systems to improve patient access and responsiveness to patient’s needs, the national GP Survey results, a measure of their success, lagged behind the implementation plan they had successfully put in place. However, other measures such as patient complaints, and patients being diverted to other provider services such as A&E had significantly improved. Oversight of advanced, end of life decision documentation, ReSPECT forms, needed oversight in particular when not completed by the practice. Further involvement and partnership working with the Patient Participation Group (PPG) were being discussed by leaders at the practice and the PPG.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders told us they operated a no-blame culture within the practice. Staff we spoke with told us that the culture within the practice had improved and that leaders listened to suggestions and were open to making amendments when systems were not working well. Staff completed CQC feedback questionnaires and the majority, but not all staff found improvements had been made. Staff knew who to go to for support in lead areas. Staff had been involved in the recent review of the practice’s vision statement, mission and values.

The practice’s statement of purpose set out their aims and objectives and as a whole team they developed the practice vision and values. The provider had developed an improvement plan following our previous assessment. Progress against this was reviewed regularly and included local Integrated Care Board (ICB) awareness.

Some staff told us that leaders understood the challenges within the practice and had taken some action to address them.

At the last assessment, we found a lack of oversight of the safe recruitment of staff. At this assessment, we noted improvements. There were now systems in place to ensure that staff were recruited in line with legal requirements. Leaders demonstrated they understood the challenges to quality and sustainability. They had identified the actions necessary to address challenges through action planning which following the last inspection they had shared with the CQC.

Staff knew how to access the policies relating to whistleblowing and the Freedom to Speak Up Guardian. All knew who the freedom to speak-up guardian was, and they told us they felt able to raise concerns with them.

There were policies in place to support staff to speak up if they had any concerns. Details of the Freedom to Speak Up Guardian were available within the practice.

Staff told us that the practice operated a zero-tolerance procedure and that systems were in place to request assistance in an emergency. Patients received a warning letter should their behaviour be unacceptable. The practice continued working with colleagues in the local team who supported staff in managing patients presenting with threatening behaviour. Leaders told us they considered staff wellbeing and there was a range of support available to all staff. Staff told us leaders provided lunches, snacks, and gifts at training events and at festive times such as Christmas. Staff reported they had been in receipt of a recent pay rise.

There were systems in place to ensure that staff completed training in equality, diversity and inclusion. We found no evidence of discrimination in the recruitment of staff.

Staff and leaders told us about the range of meetings they attended. Staff reported the meetings ensured effective communication amongst the staff team as a whole. Staff had completed online training for information governance and confidentiality. Leaders told us they had discussed sustainability and workforce planning. The staff demonstrated their awareness of the organisational structure in place. Leaders demonstrated that there were shared care agreements in place with services in secondary care.

The practice had an organisational structure in place with clear leadership roles and responsibilities including that of the collaborative arrangements with other stakeholders such as the integrated care board and secondary care. The practice maintained a business continuity plan and had discussed sustainability and workforce planning. The practice used the Quality Outcomes Framework (QOF), quality improvement plans and audits as improvement and benchmark tools. Best practice updates were discussed at meetings and during education and training days. The provider was registered as a data controller with the Information Commissioner’s Office and provided online information governance training for all staff. The practice held multi-disciplinary meetings with other allied health professionals for those patients assessed as end of life and with frailties. There were appropriate governance arrangements with third parties, such as shared care agreements for patients in receipt of care and treatment in secondary care.

The Patient Participation Group (PPG) told us meetings took place between themselves and the practice GP managing partner. The practice set the agenda. The PPG wanted ownership and greater input in the future. They hoped to increase the PPG membership. They discussed how as the PPG they could engage with vulnerable patients and promote health services. There was a lack of visibility such as a notice board within the practice on the PPG in order to support recruitment and understanding of the PPG role.

Leaders told us that there are currently 2 members within the Patient Participation Group with whom they engaged with. The practice had arranged for the PPG to have a section on the website in order to share information and minutes of previous meetings.

We saw evidence of the practice leaders working in partnership with key organisations such as the ICB and had effective working relationships with its Primary Care Network (PCN). Care home representatives told us they had access to a professional line in the event of an emergency. However, they told us improvement was still needed in their working relationships with the practice.

Systems to work in partnership with the Patient Participation Group (PPG) had evolved and the GP managing partner worked with the membership. There were plans in place to improve recruitment to the PPG membership to support patient partnership working.

GP partners reported the last CQC report for the practice was used as a benchmark for learning and driving improvement. Following the last CQC assessment new models of working were introduced to improve patients experience of access. The practice participated in improvement plans driven by National GP Patient Survey results, patients comments and complaints and the practice resolve to improve access for their patients. Reception and administration staff and the whole staff team looked at finding solutions to the issues around access. New ways of working were implemented and monitored. Staff were successfully promoted to new roles within the practice to further support improvement plans.

At our last assessment, we found that opportunities to raise, investigate and learn from significant events had been missed and we found that the quality of the record keeping varied. Action taken to mitigate risks and the learning outcomes were not always noted to improve quality. At this assessment we found systems and processes for tracking complaints and significant events were in place and had improved. The provider used the learning from these to drive improvements. The practice had reviewed the responsibilities of administrative and reception staff to ensure a fair and equitable distribution of work. Leaders completed regular audits to improve the care for patients, for example, medicine audits, telephone and access audits, infection control audits and clinical audits. Audit results were cascaded to staff and discussed at their various meetings.