The Croft 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

For this focused assessment we requested information from the practice, conducted staff interviews using video conferencing and a staff survey. We found the following:-Staff at all levels demonstrated an understanding of equality, diversity, and human rights. There was evidence that equality and diversity was actively promoted. There were arrangements for the availability, integrity and confidentiality of data, records, and data management systems. There was a positive listening culture that promoted trust and understanding between the practice and people using the service. An active patient participation group had been established. However, recruitment to senior leadership roles was not always safe and inclusive. It was not always conducted in line with our regulations and the practice’s own policies and procedures. Leaders were not always alert to examples of poor culture that may affect the quality of people’s care and have a detrimental impact on staff. The practice had not fostered a culture where staff felt confident about speaking up and being heard without fear of detriment. Governance, management, and accountability arrangements were not always clear and effective and there was a lack of clarity around roles and responsibilities. Leaders still lacked oversight of some policies and procedures, particularly in relation to the management of significant events and complaints. There was limited evidence to show that improvements had been made to the management of significant and complaints since our last inspection. It was not always clear from the records that action arising from significant events had been followed up to ensure improvements were made.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a positive listening culture that promoted trust and understanding between the practice and people using the service. There was evidence of listening and acting on patient feedback, for example increased number of appointments and an improved telephone system which included a call back function. Staff at all levels demonstrated an understanding of equality, diversity and human rights.

The practice had a shared vision and strategy set out in its development plan for 2023/24 which sets out its mission, vision, and values. It included a strategic overview and development plans over the next 3-5 years plus what it aimed to achieve in the current year. There was evidence that leaders understood the risks to achieving their strategy. This was evident in the practice development plan, partner meetings and risk registers. Key risks were identified such as physical space and recruitment difficulties.

Recruitment and succession planning was not always effective, safe and inclusive. There was a lack of transparency about recruitment to some senior roles. Application forms were sometimes incomplete which meant it was not possible to identify gaps in employment history. There was limited evidence that these posts had been advertised in line with the practice’s recruitment policy and its equality and diversity. For all senior leaders, at the time of the assessment, there was no evidence of their qualifications on their human resource records.

Leaders had the capacity and capability to lead effectively, however there were gaps in knowledge about how to manage the significant events and complaints processes effectively in the health care sector. Feedback from staff indicated that there was sometimes a lack of clinical input to decision making. Feedback from staff and other sources was mixed in relation to leaders being visible, approachable, and leading by example. Some staff spoke about lack of approachability and a ‘closed door’ for some managers. 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. Leaders acted on poor culture that may affect the quality of people’s care and have a detrimental impact on staff. Staff were encouraged to raise grievances and there were examples of grievances being handled appropriately and effectively. However, feedback from staff and other sources indicated discomfort with some aspects of the management culture. Some staff felt uncomfortable about speaking up or approaching managers for support.

Feedback suggested some managers did not actively invest time to listen and engage There was a feeling that some managers made decisions without discussing changes with the staff who undertook the work. Lack of clinical input to decision making was also identified as an issue. For some, there was a lack of trust between leadership and staff.

Feedback from staff indicated that they did not always feel comfortable about speaking up. The practice had a Freedom to Speak Up policy, however not all staff felt confident about doing this or approaching managers. In addition, not all staff felt empowered to drive improvement. We were provided with some positive examples of staff ideas being implemented, for example additional cervical screening clinics and changes to triage at reception. However, some staff felt their ideas were dismissed or ignored.

We saw that leaders took action to review and improve the culture of the organisation in the context of equality, diversity and inclusion. For example, there was an equality and diversity policy in place, staff wore rainbow lanyards to signify an inclusive culture to patients and all staff were trained annually in equality and diversity. The practice worked with LGBGT charities for advice and training. There were guaranteed interview schemes and reasonable adjustments were made for staff. Feedback from staff was positive about the open and inclusive culture. They felt they were treated fairly and equally.

There was a clear structure and lines of accountability. However, feedback from staff indicated there was a lack of clarity for some roles, particularly in relation to the management of significant events and complaints.

The practice had a policy and procedure for managing significant events, however it was not consistently applied. Whilst we saw some examples of shared learning, for example, in flash newsletters and partner meetings, it was not clear whether learning was shared systematically and actions followed up. Data or notifications were submitted to external organisations as required, for example notifications of unexpected deaths. There were arrangements for the availability, integrity and confidentiality of data, records, and data management systems, for example the practice had undertaken a cyber security and data security and protection toolkit (DSPT) audit. Data or notifications were submitted to external organisations as required, for example notifications of unexpected deaths. We saw that performance data had been used to improve to monitor and improve the quality of care, for example increased rates of cervical screening.

Since our last inspected the practice had established an active patient participation group. We spoke with representatives from the group who told us that the practice engaged positively with the group and acted on feedback and suggestions for improvement.

There was evidence of listening and acting on patient feedback, for example, an increased number of appointments and an improved telephone system, which included a call back function. We also saw evidence of shared learning from significant events with the primary care network.

Staff told us they worked closely with partners and stakeholders. We saw evidence that the practice collaborated with all relevant external stakeholders and agencies which included the Integrated Care Board, the primary care network and patient participation group. It also worked closely with local charities and community organisations to promote better services for vulnerable people.

Staff and leaders did not always demonstrate a good understanding of how to make improvement happen. There was limited evidence to show that improvements had been made to the management of significant events and complaints since our last inspection. There was limited evidence to show that meetings took place for sharing the learning from significant events with the wider team. It was not always clear from the records that action arising from significant events had been followed up to ensure improvements were made. Staff told us they felt able speak up with ideas for improvement and innovation and there were examples of this. However, some staff felt their ideas were ignored or dismissed.