Castletown 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

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. There were failings in the management of the practice. This was inadequate and ineffective. There was no suitable leadership, and the culture was not open. There was a lack of effective systems and processes in place at the practice to demonstrate clear oversight of governance arrangements. Staff fed back that they were not aware they could speak up and felt unsupported and there was a lack of training.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

We were concerned that there was not suitable leadership provided at the practice and that the culture was not open. Concerns raised by staff before our assessment were, staff were stressed, staff were bullied and there was a lack of staff support. They said this had led to a high turnover of staff and inexperience. Staff felt their health and welfare were at risk. Feedback from staff at the time of our assessment was mixed. Some staff told us that the conduct and demeanour of the provider caused them stress in the workplace and the working environment was hostile and they were not treated respectfully. Others told us they were supported by the provider. Following our assessment we received emails from some staff stating they were supported. We received whistleblowing information saying the provider had contacted staff and asked them to email the commission to say how good the provider was at their job, after our interim feedback on the assessment. Staff were said to be worried at this and did not want to do this. Whilst discussing record keeping the provider told us they had no ‘admin skill’ and agreed that ‘it’ (the running of the practice) had failed. The provider initially blamed staff because governance arrangements were ineffective. They then acknowledged that they had the responsibility for the whole practice and struggled with the administrative duties. The provider acknowledged some staff did not have the experience for the roles which they were recruited into.

During the assessment process the provider did not maintain professional behaviours and values towards the CQC members of staff. They raised their voice during interviews, would not listen to members of the inspection team and interrupted. We saw that there were mostly processes in place for appropriate care and treatment. There were other governance policies in place, however the practice were not following some of these such as the staff training and recruitment policies.

From staff questionnaires some staff told us that they were unaware they could speak up or who the freedom to speak up guardian was. They were only made aware they could do this when the CQC questionnaires were sent to them. Some staff fed back that they felt they received no support in their role. Some staff fed back they knew how to speak up and were supported. We received several whistle blowing concerns prior to our visit stating staff had left the employment of the practice due to bullying. The provider told us it was ‘bad luck’ that people keep reporting him for being ‘bad’ with staff.

The practice had a whistleblowing policy in place which included a section on freedom to speak up which some staff were not aware of. The provider told us the staff could speak with them, the practice manager or the local integrated care board (ICB) if they had concerns, there was an open-door policy at the practice.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We had concerns about the sustainability of the practice. There was no substantive practice nurse and the staff were inexperienced and were not provided with training to carry out their roles, staff turnover was high.

There was a lack of effective systems and processes in place at the practice to demonstrate clear oversight of governance arrangements to ensure risks to patients, staff and visitors to the practice were considered, managed and mitigated appropriately. For example, there were insufficient numbers of suitably qualified, competent and skilled staff employed. Staff were not receiving appropriate support or training to enable them to carry out their duties. Recruitment procedures are not being operated effectively. The practice were not following their own policies. There were failings in the management of the practice. This was inadequate and ineffective.

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.

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