Castlegate & Derwent Surgery

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 requires improvement at providing well-led services because systems and processes in place were not working as intended, overseen effectively, or structured in a way that enabled the provider to fulfil their responsibilities to the practice population. At this assessment we have rated the practice as inadequate. We found that quality and governance systems had not improved.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The leadership articulated they were trying to 'keep their head above water' the staff told us they did not know what the future strategy was.

The practice did not submit a written vision or strategy for the future. At the time of our inspection the leadership team told us they were experiencing operational difficulties and were focusing on ensuring the practice functioned on a day to day basis. They had recently had a public board meeting to share some of their issues and outlined their intention to stabilise the practice in order to focus on clinical care, staff retention and safe practice. There was evidence to suggest that the practice was undertaking initiatives to improve such as total triage.

We spoke with partners, staff in leadership roles and staff via questionnaires. Leaders told us they had a number of strategies for communicating with staff including emails and face to face meetings. However, staff were very clear that they did not feel communicated with effectively with some stating they worked within a toxic or closed culture. evidence we found indicated there were no whole team staff meetings where issues could be discussed and addressed. Meetings were compartmentalised into individual departments and people.

We did not see evidence that staff were being managed effectively. The practice at time of assessment did not have a practice manager in post, staff in acting management roles had not had adequate training. We were not reassured that there were processes in place which demonstrated leadership within the practice was effective.

Staff told us they felt leaders in the organisation did not listen and that their was a poor culture of leadership. Leaders told us they had adopted strategies such as open board meetings but they admitted that they had not discussed affairs at the practice openly they felt some information was sensitive. They told us they sent frequent emails to the staff but recognised they did not have staff meetings where the whole team was present. There was no staff survey Therefore they were able to demonstrate they shared information to their staff but had insufficient systems to gather staff feedback. The leadership had recently held an 'open' board meeting but informed us they had not been able to discuss all of the issues at the practice as some were business sensitive and confidential. however, staff informed us they were unhappy with the culture at the practice, we noted that over 20 staff had left since our last inspection. We were unable to ascertain as to why staff had left as there was no records kept of exit interviews and we were told this was not common practice. In addition, staff felt unable to escalate their concerns in confidence to the leadership had recently held an 'open' board meeting but informed us they had not been able to discuss all of the issues at the practice as some were ongoing and confidential.

There was a Freedom To Speak Up (FTSU) guardian in place. However, not all staff new who the FTSU was. Furthermore, the leaders had not taken the opportunity to nominate a FTSU from within their Primary Care Network (PCN). In fact their FTSU was their lead GP partner. This meant staff did not always feel safe to raise their concerns.

Staff told us via our questionnaires that they felt excluded from meetings. Leaders did not use the benefit of staff members experiences when reflecting on significant events. Staff told us they felt disconnected from the leadership team. Staff had left and were not being offered exit interviews.

We did not see evidence that the leadership team worked to include staff in decisions made in relation to the place in which they work. Staff at the time of assessment were not wearing a uniform. We saw no evidence that would indicate leaders do not act in a manner which excludes people based on diversity.

The leadership in the practice acknowledged there were issues with assuring quality and cited their current operational challenges.

We noted several issues during the course of our assessment that indicated that quality assurance within the practice was not functioning correctly. for example, there was out of date medicines being stored in a fridge, the emergency trolley was stocked with unnecessary items that would hinder finding the right equipment swiftly when required, doctors bags had not been monitored properly with some partners unaware of their storage arrangements and there was a large backlog of complaints.

We spoke with care home staff and asked them if the new service was satisfactory. they told us that they struggled to access GP's on behalf of their residents. they had not been consulted on the process and had not been asked for their ongoing feedback.

The practice told us they had changed the way they supported care home residents. A regular meeting took place at the practice where individual residents were discussed with other professionals such as paramedics and district nurses. a decision was then taken about what support people required and who would provide it. A care-coordinator role had been developed to oversee this process.

We consulted with stakeholders. They continued to express concerns over the practice and how it was run and operated.

We noted the practice had not carried out any quality audits to establish whether the new process was successful.

Leaders told us of the difficulties and challenges they currently faced. they were focused on trying to ensure patients needs were met on a day to day basis and were attempting to implement systems such as total triage and EPS to do this.

We saw no evidence that indicates at the time of inspection the practice were involved in any innovative or quality improvement work. The leadership team do no include the staff, or external partners in learning from significant events. The practice told us they were aiming to implement a total triage model. The practice supplied a brief implementation plan in relation to the introduction of total triage.