Russell Street Group 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

During the assessment we reviewed how the practice provided well-led services. We found leaders could not demonstrate they had the capacity and skills to deliver high quality sustainable care, the overall governance arrangements were ineffective, the practice did not have clear and effective processes for managing risks, issues and performance and there was little evidence of systems and processes for learning, continuous improvement and innovation. As a result, we have identified a breach of Regulation 17: Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders and staff told us about the numerous staffing changes and challenges this brought to the day-to-day management of the practice. Staff were unclear if the practice had a clear vision for the future and staff did not always feel involved in developing any strategic planning at the practice.

The practice had an improvement plan for 2023/24 which set out its values and objectives following an internal workstream which reviewed different components of the practice with different recommendations and actions. However, the improvement plan was not used as a live document as originally intended, not all staff were aware of the plan or recommendations and there was no evidence that leaders understood how to achieve their strategy. For example, the practice could not provide evidence of a risk register or demonstrate that progress against delivery of their strategy was monitored and reviewed. We also saw the member of staff who led on this workstream had left shortly after presenting the work to the leaders.

Most staff told us they felt leaders were visible, approachable and said they felt listened to. Staff acknowledged the challenges they had with recent changes in leadership and spoke positively about the new manager joining and felt communication and support would improve. Staff who recently joined the practice felt welcomed by leaders and colleagues. However, staff feedback also demonstrated that leaders were not always inclusive and collaborative in their approach to strategic direction and decision making.

Leaders could not demonstrate they understood the challenges at the practice and therefore had not always identified actions to address these. For example, we highlighted a number of concerns throughout the assessment that had not been identified or mitigated by the practice. This included areas relating to medicines management, significant events and CQC registration. There was a lack of team meetings in place which meant staff did not often have the opportunity to raise concerns or items to discuss, be involved in strategic planning or receive regular updates. When meetings were held, the meeting minutes lacked detail. For example, it did not provide details of attendees, there was no standing agenda and areas which had been discussed provided very limited information. This meant staff referring to minutes would not always have a clear understanding of the updates, learning or actions. There was no process in place to seek staff feedback to help to direct future improvements. However, leaders told us they wanted to implement this in the future.

Staff including leaders within the practice were unclear on the arrangements to raise concerns. This included the role and importance of ‘Freedom to Speak Up’. Staff told us were unaware of how and who to raise external concerns to.

The processes to foster a positive culture where staff felt that they could speak up and that their voice would be heard were ineffective. Whilst there were processes including policies and supporting processes, staff were unaware they existed, the policies were out of date and not accurate. For example, the contact details for the external Freedom To Speak Up Guardian were incorrect.

Staff told us they had access to training in equality and diversity. Most staff told us they felt they were treated equally and fairly by practice leaders and colleagues.

Staff had undertaken equality and diversity training. Leaders told us they would make reasonable adjustments for staff where required to enable them to carry out their roles effectively.

Staff and leaders shared the challenges the practice had experienced over the last 12 months. Staff told us, the changes had impacted the overall governance framework and management of the practice. Staff told us and could explain different policies and systems used as part of the governance framework, however there was confusion between different members of staff and leaders as to different aspects of governance with many staff and leaders providing differing accounts as to different aspects of governance and management. This indicated the governance framework was not effective or embedded. Staff also informed us that up until the assessment in June 2024 there has been no recent review of the governance arrangements. We asked to see the business continuity plan, but staff were unsure if the plan existed, where it was and what to do in the event of a major incident. An updated business continuity plan which provided guidance on contingency plans in case of various emergencies and untoward events that could affect the service was provided shortly after the site visit. Leaders could not demonstrate they understood their regulatory responsibilities to notify the CQC of registration changes or to submit statutory notifications, such as notifiable incidents. For example, we found CQC registration updates had been significantly delayed following changes to the registered manager in July 2022 and we were advised of a notifiable incident from February 2024 that should have been reported to CQC. We also found the 2 sites we visited as part of the assessment did not display their CQC rating as required by regulation.

We found systems, processes, and policies existed within the practice, however, our findings throughout the assessment demonstrated these were ineffective, out of date, not accurate or sufficiently embedded. This included ineffective processes to manage administrative tasks, significant events, CQC registration, CQC notifications, internal health and safety risks policy management and staff development. There was a lack of oversight of systems and processes to monitor the quality of care in relation to the management of patients who were prescribed high-risk medicines, patients with long-term conditions and patients affected by safety alerts. The practice had not identified these risks to patients prior to our assessment so that action could be taken to keep patients safe. The practice did not react sufficiently to risks identified through internal processes but relied on external parties to identify key risks before they started to be addressed.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Throughout the assessment, all staff told us there had been a significant amount of change in staffing and leadership within the practice. This included changes in clinical and non-clinical leadership within the practice and staff told us this had negatively impacted how the practice promoted continuous learning, innovation and improvement. Staff told us the main priority for the last 12 months had been to manage the day to day provision of services.

There were limited processes which aligned to learning, innovation and improvement and staff and leaders did not always demonstrate a good understanding of how to make improvement happen. There was limited evidence to show that processes were in place to ensure learning happened when things went wrong or that actions were followed up. For example, we were alerted to 2 significant events which had not been reported or investigated and there was a lack of meetings in place to share learning from significant events with the wider team. We reviewed a number of clinical audits, however, the provider was not consistent in providing a summary of findings, learning outcomes and clinical meeting minutes we reviewed did not provide any updates or discussions of results. This meant information was not always used effectively to monitor and improve the quality of care. Leaders did not actively seek staff feedback to assist the practice in making improvements. Whilst one previous employee was responsible for creating an improvement plan, many staff were unaware of its contents and leaders could not demonstrate progress against this plan.