Askern 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

At our previous inspection, the practice was rated good in providing well-led services. At this assessment we have rated the practice as requires improvement for providing a well-led service. We were concerned that leaders did not embody the culture and values of their workforce and organisation. Most staff were concerned to speak up and voice their concerns. Governance and processes were not always followed. There was no learning from complaints. We did not feel they could demonstrate that there was a suitable system for the recording of significant events. There were no plans to address the problems relating to access. However, the practice spoke positively about moving forward and there was a focus on improvements across the organisation to deliver safe and effective care.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The leaders at the practice spoke positively about moving forward, their direction and culture and about making improvements to the surgery. From feedback from staff and whistleblowers we had concerns about staff engagement and culture. From disparities and information from patients, staff and leaders, regarding complaints we had concerns about transparency.

We asked for a copy of the practice future business plan; however we did not receive this until the factual accuracy stage of our assessment. Staff had received equality and diversity training. The practice had carried out work to identify hard to reach communities and had developed an action plan to improve healthcare for this group of patients. Most staff and whistleblower feedback around the culture of the organisation was negative. Almost all staff who responded to our questionnaires said that the practice did not have a clear vision for the future and that they had not been involved in future planning.

The lead GP told us there was succession planning at the practice. The majority of staff and whistleblowers told us that they did not feel they could raise issues with leaders for fear of repercussions and some described bullying. They told us that the atmosphere is tense, staff were stressed, and morale was low.

We saw that there were processes in place for appropriate care and treatment. There were policies for complaints for example, however the practice were not following this policy. Some of the staff record keeping and the significant event recording could be improved. The leadership at the practice told us that they had encountered staffing issues at management level which had affected these processes.

Staff questionnaires told us that staff were aware of what whistleblowing was. Some staff said there would be repercussions from whistleblowing if they were to do so. Most of the feedback indicated that staff knew who the freedom to speak up guardian was, however, some staff said they did not trust the process to speak up. Whistleblowing information received directly by CQC included, there was a closed culture (this means a lack of openness to learning from mistakes, failing to listen to the experience of staff, people, carers and loved ones) at the practice. Staff were bullied and CCTV was used inappropriately against staff. They said senior managers were coaching staff in what to say when completing our questionnaires. We gave the provider high level feedback from our assessment in relation to speaking up. They said they were keen to know which members of staff had spoke up in relation to bullying to see if they could help the staff. They believed that working relationships at the practice were good. However, whilst staff told us they did not feel comfortable raising concerns about working conditions they did tell us they felt comfortable to raise concerns about patient care. Most said they believed that if they raised a concern into safe patient care that it would be looked into and felt this would be acted upon.

We saw that processes were in place; the practice had a whistleblowing policy and a freedom to speak up guardian who worked at a neighbouring practice. The practice told us at factual accuracy report stage that they were one of the first in the local area to have a freedom to speak up guardian. However from feedback from staff we were concerned about the leadership acting with openness, honesty and transparency where some staff felt they could not raise concerns without fear was retribution. Therefore the management team could not fully learn and investigate lessons from concerns from staff.

Staff told us they had completed equality and diversity training. Leaders told us they had an open-door policy. However, the majority of staff and whistle-blowers told us they were in fear of speaking up if they felt that something was not right. They sometimes felt belittled and were not treated fairly and their welfare was not taken into consideration when decisions were made.

The practice had a diverse workforce in place. Equality and diversity training was part of the mandatory training for staff. We saw examples of how the practice had regular meetings with staff.

Feedback from staff and leaders was that all practice policies were accessible on the practice’s computer system Leaders told us that the practice reviewed policies annually. They said there were named leads in place for key areas. Some staff told us via feedback that the senior management had differing understanding of staff roles and responsibilities and there was disruption and no structure to their roles. Some staff said that although policies were in place however, they did not trust that these processes worked in reality.

We saw a sample of the practice polices and saw they were up to date. Clinical searches we carried out on the practice’s clinical system showed good patient care for long term conditions and medication reviews. The provider had a business continuity plan in place. We saw there was a system for recording and acting on patient safety alerts. However, the processes for complaints and significant events could be improved from the information supplied to us. Record keeping in general could be improved.

People were able to access support at the practice rather than be referred elsewhere. For example, a mental health worker was available through the primary care network clinics. The practice had a Practice Participation Group (PPG), this had been in place for many years, with at least 12 members. Members of the group told us that staff asked them for, and they acted on their feedback. Results from the National GP Patient Survey regarding the overall experience of the GP practice was lower than national averages (53.8% compared to 71.3%).

The practice had worked with the Traveller community to make health improvements. Leaders told us that the PPG had received guest speakers from local healthcare professionals.

We sought feedback from a care home where the practice had patients who were resident there. They were unhappy with the service they received from the practice, they struggled to contact the practice and had not received any response to requests for direct contact from them.

The practice worked with the Traveller community to make health improvements. One of the salaried GPs at the practice offered support meetings for bereaved patients on Saturday mornings. The PPG had received talks from healthcare professionals which included dieticians, and hip and knee surgery consultants. Practice leaders told us they provided consultant led clinics at the practice.

We saw the practice had undertaken a number of clinical audits. The clinical searches of the practice patient records system showed that the reviews of patient’s medication reviews and long-term condition management were positive. The practice were able to demonstrate to us that they had increased the uptake of cervical screening. The practice told us over the years they had won awards and carried out education sessions for other GP practices. They had carried out research with national organisations.