Trent View Medical Practice

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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

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 Requires Improvement. Our rating for this key question is Good. The service had made improvements and is no longer in breach of regulations. We found the provider had improved governance processes, which supported the safe delivery of care although some areas required further improvement and/or embedding such as incident reporting and oversight of high risk medicines. Staff were clear on their individual responsibilities and knew who was accountable for each aspect of the service. Some staff did not always feel supported and involved. The patient participation group (PPG) worked with the practice but did not always feel listened to and involved.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders we spoke with had a shared vision and strategy to provide patients with high quality care. The leadership team had had dedicated time to plan for the next 12 months and had developed a vision statement and had plans for it to be shared with staff and patients. They acknowledged there had been challenges with patient satisfaction re access, but they had successfully recruited additional GPs and nurses and made significant changes to how calls were handled. Staff gave mixed views on the support they received. There was strong recognition for the local team support received, but some staff felt they were not well supported by senior management as they spent little time at the Trent View sites. They told us they were able to contribute to discussions about service improvements, incidents and complaints. They acknowledged there were regular staff meetings, but these were usually held at the providers other service based in Brigg and they could not always attend. Staff reported that they felt able to raise concerns with leaders without fear of retribution and they knew how to access the whistleblowing policy.

A wide range of regular meetings were held. Detailed minutes with action plans were shared with staff. The provider had a detailed improvement plan which they had shared with their commissioners. They were aware of patient feedback regarding access and had made significant changes to improve and were continually reviewing this. There was a regular schedule of meetings including clinical, nursing, multidisciplinary and team meetings. Most staff had completed equality and diversity training. The practice had a whistleblowing policy and there were systems to ensure compliance with the requirements of the duty of candour.

The majority of staff told us they felt supported and that managers were only a phone call away. They said they were notified, and arrangements were in place to provide support if their team leader was away. Some staff told us that the senior management rarely visited the Trent View sites, and they did not feel senior managers were visible and approachable. They did not feel involved and felt a lot of their work was being centralised to the providers Brigg site. Most meetings were also held at the Brigg site, and they did not always feel involved. Staff told us they did feel well supported by their local line managers. Staff told us they had regular appraisals and training for their roles. Leaders told us they visited the Trent View sites at least weekly but said this was variable and that they had an open-door policy. They told us the local team leaders managed day to day operations and reported to them.

Systems were in place for regular staff meetings and records of meetings were maintained and shared. Staff were organised into specific teams and each team had a team leader who was responsible for day-to-day management of staff and operations and reported to the senior management team. Whilst staff had a good understanding of their role and who to report to some staff felt the senior management should be more visible and involved in day-to-day operations. Appropriate recruitment checks were completed for staff and recruitment files were well organised.

Staff had access to policies and procedures. Most staff told us they felt supported and that managers were only a phone call away although they did not always feel listened to. They said arrangements were in place to provide support if their team leader was away. They were aware of whistleblowing procedures although not all were aware of the freedom to speak up guardian.

Staff had access to whistleblowing and the freedom to speak up guardian policies and procedures. Regular meetings were held and minutes were shared with staff.

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.

Leaders and managers supported staff, and staff were clear on their individual roles and responsibilities. Significant improvements had been made to processes and these were regularly monitored.

The provider had developed and implemented a detailed improvement action plan since the last assessment and made several significant improvements to governance processes that were appropriate for their service. They had developed systems to monitor quality and support patient care althpough soem of the systems required further improvement and/or embedding. Staff could access required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Managers recorded any actions arising from these meetings and ensured they shared these with staff. Staff took patient confidentiality and information security seriously and received training in these areas.

The patient participation group (PPG) had quarterly meetings. The group had 10 members. There were good relationships with the management. The PPG were able to raise concerns. They told us didn't always feel listened to and would have liked more involvement in improvement planning. They said they have some administrative support provided by the practice, including a minute taker for meetings. However, they said meeting minutes were not produced in a timely manner. They felt this impacted on their effectiveness in tracking and pursuing actions. Since January 2022, every PPG meeting had been attended by the Business Manager, with the occasional invited guest for example, social prescribers. More recently a partner GP had attended and also the primary care network (PCN) manager. The practice had put in place an optional travel expense reimbursement scheme for PPG members attending meetings. This helped ensure there was no financial barrier to any patient wishing to join the PPG.

Leaders told us there were quarterly PPG meetings, attended by the patient services lead, GP and/or management staff. A manger also met with the PPG chair every month. They said there was a good working relationship with the PPG.

Commissioners told us the provider had kept them informed of improvements made.

There were regular meetings with PPG representatives and minutes showed open and frank discussions. Meetings were attended by a GP and/or management staff.

Leaders supported continuous learning, innovation and improvement across the organisation. They encouraged creative ways of delivering equality of access and had made significant changes to enable them to achieve this. Staff and leaders had a good understanding of how to make improvement happen and they had developed action plans and regularly monitored these.

The provider had made significant changes through detailed action planning to improve all aspects of the service including access. They had improved staff training and encouraged staff to develop. There were improved processes to ensure that learning happened when things went wrong. They embraced new technology and had implemented new systems to improve such as management of patient records, dispensary processes and access. They had supported patients to access new technology and had an NHS App ambassador supporting patients and staff in the NHS app functionality. They were innovative in developing new systems to support access and the dedicated urgent care team had been nominated at the local Safecare Federation awards 2024 for team of the year. They had developed a data quality programme to enable them to monitor the effectiveness of new systems.