Eltham Palace Surgery

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 found the service was not providing well-led care. At our previous inspection in May 2023 we found there was a breakdown in relationship between the 2 GP partners which was negatively impacting staff and patients. Whilst we saw attempts had been made to improve the working relationship between the 2 GP partners, some staff continued to describe the environment as toxic and told us they did not feel comfortable approaching all members of the practice’s leadership team. Staff were unsure who the practice’s freedom to speak up guardian was. The leadership team had not identified or effectively managed the risks found during this assessment, thus impacting the safety and effectiveness of patient care at the practice.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At our previous inspection in May 2023, staff told us they were aware of the breakdown in partnership between the 2 GP partners. Between May 2023 and this assessment in April 2024 we were told there had been a high turnover of staff at the practice. Some staff told us attempts had been made to improve the working environment. However, some staff told us there remained a difficult atmosphere and described the environment as toxic. Staff told us the practice had a clear vision for the future; however, they had not been involved in developing the mission statement, vision or values of the practice. This reflected findings at the previous inspection in May 2023 where we found feedback from staff, patients and partners were not used collaboratively to develop a vision, values or strategy.

Staff had received training in equality and diversity. The practice website included information about the practice philosophy.

At our previous inspection in May 2023, we found there was a breakdown in the relationship between the 2 partners that negatively impacted staff at the practice. At this assessment in April 2024, staff told us they recognised the attempts made by the partners to improve the atmosphere at the practice. However, some staff told us there remained a toxic environment which impacted the care given to patients. This was in part due to some staff telling us they did not find all leaders to be approachable and therefore would not speak to them for advice on patient care. We received many positive comments about the practice manager. Staff told us this member of staff was inclusive and approachable.

At the time of our assessment the practice manager was working their notice period. Following our assessment we were told the provider had employed a business manager in place of the outgoing practice manager and that there was ongoing recruitment for a deputy to the business manager and a reception supervisor.

All staff did not know who the practice’s freedom to speak up guardian was. Some staff told us they could raise concerns; however, they did not feel comfortable approaching all members of the practice’s leadership team.

It was unclear who the freedom to speak up guardian was. We did not see evidence this was this was communicated effectively to all staff members.

The practice environment was suitable for staff and patients with mobility issues.

Staff had received equality and diversity training. At our previous inspection in May 2023 we found there was no staff survey and staff told us they felt ignored by the practice management team. At this assessment in April 2024, we found the provider had asked reception staff to complete a wellbeing survey. This identified that some staff felt overwhelmed and stressed; staff were then invited to discuss the results of this survey in a reception team meeting. Staff were offered free counselling sessions with a local service and created a role of wellbeing champion for a member of staff. However, at the time of our assessment the wellbeing champion had left the practice and had not yet been replaced.

Staff were unclear who the IPC lead was. Some staff were also unsure of the safeguarding leads. Following our assessment the provider sent us an action plan stating roles and responsibilities would be made clear to staff at the practice.

Our assessment identified that improvements were required in relation to the management of risks relating to: • Monitoring of patients with long term conditions. • Management of medicines requiring monitoring. • Safety alerts. • Medicine reviews. • Infection prevention and control. • Fire safety. • Access to appointments. • Communication between leaders and staff. • Staff training. • Staff immunisations. • Contingency planning and recruitment. • Governance processes. Following our assessment, the provider sent us an action plan demonstrating how they planned to address the areas of risk identified. However, the impact of these actions had not yet been seen.

There was a patient participation group (PPG) who met approximately twice per year. Feedback from PPG members was that they found meetings to be helpful, and the practice manager in particular was responsive to suggestions made. PPG members told us they received feedback on areas discussed at previous meetings and were able to speak openly and honestly. Some members suggested they would like more frequent meetings. At our previous inspection in May 2023, we found there was a lack of process for collection of patient feedback. At this assessment in April 2024, we were told that patients were asked for their opinions and feedback on the service, care and treatment received at the practice. The provider shared some examples of recent patient feedback collected by the practice. Positive comments referred to caring clinical and non-clinical staff and feeling reassured following appointments. Many of the negative comments referred to difficulty accessing appointments, not being seen on time and cancelled appointments.

Staff told us they had taken action based on patient feedback. For example, we heard that appointments had been opened 4 weeks in advance in response to patient feedback (previously patients had been asked to call back each week to request a routine appointment). Staff reported they had received negative comments about staff attitude and therefore discussed this regularly in staff meetings. The provider had also reduced the length of the practice’s answer phone message in response to patient feedback.

External partner agencies working with the practice told us that the two GP partners had made initial attempts to find ways to work together; however the two GP partners had not continued to engage with mediation opportunities.

There were processes in place to collect data and feedback from staff and patients. The provider had acted on this feedback. Although some improvements were seen, for example through more positive feedback from staff compared to our previous inspection in May 2023, there still appeared to be negative feedback from patients. In particular, access to appointments remained a concern.

Significant events and complaints were discussed in meetings. However, staff told us they did not always attend these meetings and were unsure how to access meeting minutes. Therefore it was unclear if significant events and complaints were used to drive improvement as this information was not available to all staff.

We saw evidence of significant events and complaints being discussed from viewing meeting minutes. However, it was not clear whether all staff knew how to access this information. The provider had processes to collect feedback from patients and staff. We saw that the provider had made changes as a result; however, we could not yet see the impact of these changes on patient and staff feedback.