School House Surgery

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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 all quality statements for this key question and rated the practice requires improvement for providing well-led services. This was because the practice did not always have effective governance processes for identifying and managing all risks, issues and performance. We recognised there had been improvements to the practice under the management of the new provider, and staff feedback was positive about working at the practice. However, as some of these changes were recent or yet to be made, the provider was unable to evidence improvements were embedded or sustained.

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.

Staff told us everyone was hardworking and motivated to provide high quality, patient focused care. Staff described a positive culture with improved morale since being under the management of the new provider. They felt the practice was moving towards a positive future, and although there had been many changes, they appreciated the support and encouragement of their management team. However, many staff commented about premises issues that affected their wellbeing such as an uncomfortable temperature in the building, an inability to open windows, lack of break rooms or rest areas and worn office equipment. All staff were looking forward to moving to their new purpose-built premises, but told us they felt unclear about when this would be ready. Leaders explained they were all waiting for a confirmed timeline from the commissioners for healthcare, NHS Sussex, for when the move to the new premises would occur. Leaders told us they recognised they were on an improvement journey. They were open and honest about what they had achieved and their evolving plans to address challenges, including those they had faced with the premises since they became the new provider. They explained they had invested in improvements to working conditions, within the limitations of the premises. This included mobile air cooling to increase comfort for staff and patients at times of higher temperature. They had a strategy and vision that included improving access to appointments, proactive care of patients and those with unmet needs, recruitment, workforce development, and improving patient outcomes. They described their barriers to enhancing services, for example, they were limited on growth and workplace improvements due to the practice building and size. Leaders explained that their values were: innovation, excellence, care and respect. They were passionate about finding radical solutions to delivering primary care that met the needs of patients.

The practice shared a clear vision and credible strategy to provide high quality sustainable care. They had a culture which supported this vision. We looked at the practice business plan and this included the goal to move into a new premises. However, this did not describe interim measures to address the issues with the current building and improve working conditions for staff. Following our assessment, the practice told us they continued to look for solutions to improve the working conditions for staff, within the constraints of the existing buildings. They were also working with the commissioners for healthcare to resolve the issues.

Staff told us there was compassionate, inclusive and effective leadership at all levels. They told us they were mostly happy with the communication at the practice. However, they were concerned that the future leadership of the practice was unclear. Regular team meetings and discussions were held, including multidisciplinary team meetings, and staff group meetings. Staff told us leaders listened to their feedback and they shared some examples where changes had been made. Leaders told us about their long term planning and future ambitions, such as their plans to review the staffing structure to increase capacity and managerial oversight of key areas. They were passionate about continuing to build resilience at the practice and develop their staff from within their organisation.

At the time of our assessment the practice managers and lead GPs were nearing the end of their contracts, and it was unclear how these posts were going to be filled. We shared our concerns about this, and the lack of clarity about the future organisational structure with the provider. The provider sent us details of their new leadership structure and told us how they planned to share it with staff. The new structure clearly set out key roles and responsibilities for staff and managers and those in lead roles. However, the structure had yet to be embedded before its effectiveness could be assessed. Following our assessment, the practice told us they have now embedded their new structure, which is regularly reviewed to ensure it meets the needs of the practice.

Staff told us there was an open and honest culture at the practice, and everyone was able to raise concerns without fear of retribution. Although not all staff were aware of the Freedom to Speak Up (FTSU) Guardian, staff told us they felt encouraged to raise concerns and knew how to do this. They felt the leaders at the practice were approachable and always listened to their concerns. Leaders told us they welcomed the candour, openness and honesty of their staff.

There were processes for staff to speak up internally, including through regular meetings and ad hoc discussions. There was a freedom to speak up (whistleblowing) policy for all staff employed by the provider, which included contact details for the FTSU guardians as well as staff in the people and culture team. However, this policy was not well known by staff.

Staff feedback was mixed about their wellbeing, working arrangements and terms of employment . Positively, staff told us that shift patterns were fair, there were equal opportunities for development, there were safety measures in place, and wellbeing initiatives such as free eye tests. We received mixed comments about workforce diversity, including people from differing race, cultural backgrounds and gender.

There were systems and processes to support the workforce, this included human resource support. Wellbeing, inclusion, and mandatory training such as equality and diversity were part of the staff induction. There were plans to improve workplace wellbeing with a new premises development. There were also benefits of working in a large organisation where staff could work remotely or at other sites. Under the provider, all staff had access to wellbeing resources and an employee benefits platform called Heartbeat.

Practice leaders demonstrated they were developing effective processes for managing risks, issues and performance. They told us they were focused on maintaining a financially sustainable practice, with a stable workforce that adapted to the challenging landscape of primary care. There were plans for emergency preparedness, including for major incidents, and there was a business continuity plan. Staff told us there had been many changes and improvements to governance, quality assurance and management. However, staff were not always clear on current roles and there was a lack of awareness about the responsibilities of staff at the practice. They told us they were positive about the future and were confident that the leadership team were taking action in response to their concerns.

We recognised there had been improvements to the practice under the management of the new provider. We saw evidence of processes and protocols that had been brought in or improved, to identify, mitigate or manage risk. Some of these changes were recent or yet to be made, therefore we were unable to evidence they were embedded or sustained. Regular meetings took place, including for individual teams, clinical, non-clinical and leadership. There were monitored systems for managing significant events, complaints and safety alerts. Regular clinical searches and audits were carried out to ensure patients’ health was monitored in relation to the use of medicines. The practice demonstrated there was a programme of quality improvement activity, including through clinical and internal audit. However, some of these processes were not established or operating effectively. Leaders did not always have oversight of some processes and therefore failed to identify risks when assurance processes did not operate as intended. During our assessment we found gaps in processes including safeguarding systems and processes, emergency medicines and equipment, medicines management, infection prevention and control, staffing including training and immunisation records, prescription security, and governance arrangements. Throughout the assessment we found all staff and leaders were engaged with the inspection process, responsive to our findings, and eager to make improvements. Following our inspection, the practice sent us a response to our initial findings and how they planned to address the areas of concern.

There was an active patient participation group (PPG) who represented a group of practices in the local primary care network. The PPG told us they had 5 practices in their group and held regular events. They had presented information on the network and its services/developments, on the GP practices and their developments, breakout groups for each practice’s patients to ask questions and provide feedback to their practice manager, information from staff (mental health team, pharmacists, social prescribing, and physiotherapists), community pharmacy service updates, and support on using the NHS App. They told us their key priority was to want to encourage patient engagement, as a low number of patients represented School House Surgery. The practice reported that the feedback from the PPG was positive about recent changes such as new technology to integrate with their phone system.

We found staff and leaders were open and transparent, and they told us they collaborated with all relevant external stakeholders and agencies. The management team told us they had a patient group for the practice and at provider level. They told us they wanted to improve their patient participation group and were considering developing a local group alongside their network group.

We received feedback from partners including the commissioners of the service, NHS Sussex integrated care board (ICB) and Healthwatch. Healthwatch told us they had received little feedback from patients. They explained that the main queries were regarding the future of the practice and location of new premises, however they were engaged with the planning. There were concerns about the impact on certain patient groups if the new premises would be further to travel. The ICB shared that they were in regular communication with the practice management team about their improvements and priorities. The ICB were aware of upcoming management changes. They were also discussing remedial building work whilst the plans for the new premises were being developed.

We found the practice was developing positive and collaborative relationships with external partners to build a shared understanding of the needs of the population, and to deliver services to meet those needs. As the practice was now under the management of a large provider, there was collaborative working with their other local GP practices to deliver improved services. This meant they used opportunities to work at scale, sharing resources as well as staff where needed.

Staff told us leaders supported them in their development and encouraged them to take up learning opportunities. Staff were given allocated time to complete mandatory training, were offered additional training and were encouraged to suggest improvement ideas. Staff gave us examples of changes to the delivery of services following staff feedback, such as improvement to the recall system for patients that ensured an effective and priority driven method. Leaders told us they sought staff views through meetings and individual conversations. They were passionate about implementing innovative ways to manage and address the challenges in primary care.

There was evidence of systems and processes for learning, continuous improvement and innovation. Significant events and complaints were used for learning and improvement at a practice and provider level. The practice also used patient views to improve services, including through the friends and family test, the local practice network patient participation group, complaints and compliments.