Hill Top Medical Centre

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 assessed all of the quality statements from this key question. Our rating for this key question is Good. However, a few gaps were identified during the course of the inspection in the management of risks and performance. For example: staff recruitment and oversight, those patients highlighted by the clinical searches completed, cervical screening below target and childhood immunisation uptake. The new provider demonstrated that the clinical areas already had improvement action plans in place. Staff told us the practice leaders were inclusive, approachable and visible and described the culture of the service as open, inclusive and supportive.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff demonstrated a clear understanding of their roles and responsibilities and that of others within the practice. They reported one of the main challenges to delivering good quality care included the patients' expectations, phone wait times, patients re dialling and the number of patients who callback as they want medicines free on prescription not to have to pay via the pharmacy.

The practice’s mission statement and purpose was documented as to deliver “Great care, tailored to the needs of the individual.” Staff were aware of the Mission Statement and copies were held next to desks, on notice boards and discussed at monthly staff meetings. Some staff were new to the practice so had not been involved in the development of the statement but were aware of their responsibilities towards achieving its purpose. The practice measured their progress against benchmarks such as: • Quality Outcome Framework (QOF). • Medicine and clinical audits. • The local Quality Improvement Framework (QIF). • Ensuring via clinical audits that staff followed best practice guidance such as the National Institute for Health and Care Excellence (NICE) guidelines. • Compliments, complaints and patient surveys. • Staff surveys. The practice had a succession planning document and business continuity plan which accounted for any issues such as illness of incapacitation of either partner. The long-term focus for the practice was to recruit another partner and provide stability and support to all partners, management team and staff.

Staff told us the practice leaders were inclusive, approachable and visible and described the culture of the service as open, inclusive and supportive. Leaders told us the welfare of their staff was paramount and fully acknowledged the previous 12 months plus had been challenging for staff as well as the partners and they had been mindful of their well-being. Leaders described the contractual and premise ownership complexities that had arisen and of the mitigations they had put in place. They had sought appropriate professional advice. Some issues remained outstanding, and they told us the toll had negatively impacted on their wellbeing at times. It was clear however, that they had support and professional strength to move the practice forward. Leaders demonstrated that they understood the challenges to quality and sustainability. They had identified the actions necessary to address these challenges. The team had clear roles and lead responsibilities, and a new organisation structure had been developed.

There were systems to ensure compliance with the requirements of their duty of candour including access to training and information on local freedom to speak up guardians. The practice had developed a mission statement which included the practice aims and values. The practice had clear roles and lead responsibilities, and a new organisation structure had been developed. The practice had implemented a staff wellbeing plan and had discussed succession planning.

Staff reported that they felt able to raise concerns without fear of retribution. There were systems to ensure compliance with the requirements of the duty of candour. The practice staff had access to a Freedom to Speak Up Guardian. Staff had reported positively on the approachable, kind, professional and patient focused practice GP partners.

The practice maintained a freedom to speak up policy and provided staff with online training. Information was available with contact details of freedom to speak up guardians. Various opportunities for staff and others to raise concerns and issues were provided. These included staff surveys, appraisals and supervision sessions.

Staff said the practice partners arranged social engagements, provided pizza and support at busy times as a thank you, and told us the team supported each other. The staff team described themselves as a diverse group who worked together, others described the team like a second family. Staff reported they discussed their working hours with their line manager and/or practice manager if they needed greater flexibility in their role or needed to change. Two staff reported that they had requested a change, or interim change, that this was agreed and had been implemented.

The practice maintained a staff wellbeing policy and had completed a staff survey with actions taken on the feedback. They also maintained an Equity and Diversity policy which was accessible to all staff. The practice outsourced advice and guidance from an external human resources company and had processes in place for dealing with aggressive behaviour towards staff.

Staff and leaders told us about the range of meetings they attended including a ‘huddle’ meeting held around 11am each weekday to discuss any issues arising. Staff reported that this had improved and ensured effective communication amongst the staff team as a whole. Staff had completed online training for information governance and confidentiality. Leaders told us they had discussed sustainability and workforce planning. They were aware of the impact of reception staff vacancies and were recruited staff to post. The staff demonstrated their awareness of the organisational structure in place with clear leadership roles and responsibilities including staffs lead roles. Leaders demonstrated that there were shared care agreements in place with services in secondary carte and collaborative arrangements with the local Primary Care Network.

The new provider had taken action to address the improvement recommendations made to the former practice provider following their last Care Quality Commission inspection. However, there were gaps in the practice’s recruitment processes and recruitment checks were not always carried out in accordance with regulations. The practice had an organisational structure in place with clear leadership roles and responsibilities including that of the collaborative arrangements with the local Primary Care Network associated staff team. The practice maintained a business continuity plan. The practice had discussed sustainability and workforce planning. The practice used the quality outcomes framework as an improvement and benchmark tool. Best practice updates were discussed at the regular clinical meetings and during education and training days. The provider was registered as a data controller with the Information Commissioner’s Office and provided online information governance training for all staff. The practice held multi-disciplinary meetings with other allied health professionals for those patients assessed as end of life and with frailties. There were appropriate governance arrangements with third parties, such as shared care agreements for patients in receipt of care and treatment in secondary care.

We received no specific feedback from patients regarding their experiences of partnerships and communities.

Staff and leaders told us the practice had an active Patient Participation Group (PPG) and had consulted the group before making changes to services. For example, before introducing a new telephone system. The Care Quality Commission (CQC) contacted the PPG for feedback, but they did not respond. Staff told us the practice collaborated and worked in partnership with a range of health and social care colleagues and took account of their feedback.

Stakeholders such as the local Integrated Care Board (ICB) advised the new partners had made contact with them and when appropriate requested support. They reported positively on the progress made to date under the new leadership.

There were systems and processes in place to gather feedback from partners in patient care such as other stakeholders within primary, secondary and community care as well as staff and leaders. The practice had a patient participation group (PPG) that was relatively newly formed. Suggestions from the PPG were considered and actioned, such as placing information about the Pharmacy First service in the waiting room areas. Meetings with partners and stakeholders were maintained and used to improve the service for patients overall, including compliments complaints and significant events.

The practice leaders and staff worked with stakeholders to build a shared view of challenges and of the needs of the population. The practice demonstrated their engagement and involvement as a member of their local Primary Care Network in sharing learning improvement and innovation.

The practice had systems in place to support shared learning, improvement and innovation. They worked with stakeholders to build a shared view of challenges and of the needs of the population. The practice demonstrated their engagement and involvement as a member of their local Primary Care Network as well as Staffordshire and Stoke on Trent Integrated Care Board. We found some of the practice ideas and innovations at the time of the inspection were planned but aspirational, such as formal outreach work with the local community in respect of sharing learning improvement.