Matching Green 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 7 quality statement from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was inadequate. Our rating for this key question is good. There were improvements in governance processes identified at the last inspection, for example the practice now had a clear vision collaborated and staff understand the values of the practice and there was a positive culture where people felt supported to speak up. There was a diverse and inclusive workforce and the practice and worked in partnership with both the local Primary Care Network (PCN) and commissioners to improve services for people. We identified improvements to support the safe delivery of care, for example in processes to ensure Patient Group Directives (PGD’s) were delivered in line with national guidance and in systems to record Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions. Leaders had taken immediate action to improve these findings during the assessment and had reviewed and improved these processes.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At the last inspection, the practice did not have a clear vision and there was no credible strategy to provide high quality sustainable care. At this assessment staff we spoke with confirmed staff knew and understood the vision, values and strategy and their role in achieving this. We saw the values were clearly displayed in the practice reception area for staff and members of the public to view. The provider described ongoing work to create an environment of a 'flat' organisation structure where every staff member felt they could contribute. Staff we spoke with described how they contributed to this work. Since the last inspection, the practice had developed a quality improvement programme for the practice and we saw evidence of second cycle audits, with a focus on medicine optimisation to improve patient safety and effectiveness.

Following the last inspection the practice had identified actions to improve progress against delivery of the strategy. We saw evidence that areas identified within the action plan were discussed at practice meetings, for example staff training and medicines management. All staff had received equality and diversity training. The practice had processes in place to identify hard to reach communities to improve healthcare for these groups of patients.

Leaders described an inclusive leadership team at all levels. Leaders provided ongoing training and development opportunities for clinical and non-clinical staff to enhance their skills to perform effectively. Leaders encouraged peer support to practice and Primary Care Network staff. Staff shared examples of a compassionate inclusive leadership team. Staff told us they had received regular appraisals and were given opportunities to discuss development and training needs during their appraisals. Leaders told us they had an open-door policy. Staff we spoke with reported a positive working environment.

The practice employee handbook supported the practice aims to design and implement policies and procedures that met the diverse needs of the service and workforce, in accordance with the Equality Act 2010.

At the last inspection not all staff were aware the practice had a Freedom to Speak Up Guardian. At this assessment staff told us they felt able to raise concerns and be listened to and knew who to raise concerns with. Leaders confirmed concerns were discussed at team meetings and minutes shared with the team, where appropriate.

We saw that the practice had access to a freedom to speak up guardian, and there was a whistleblowing policy. Staff had access to counselling services to support people who raised concerns.

The practice told us they valued diversity in the workforce. They told us they worked towards an inclusive and fair culture by improving equality and equity for people who work for them. They told us all staff were valued, listened to, and empowered to contribute to the practice’s success; all staff wellbeing was prioritised, providing support and resources to promote physical and mental health; and teamwork and collaboration were always encouraged, recognised and achievements and contributions celebrated. Staff feedback included examples of reasonable adjustments for individual team members during the COVID-19 pandemic.

Equality and diversity training was part of the mandatory training for staff. We saw how the practice had regular meetings with staff, and ensured meeting meetings were available for staff who could not attend those meetings, for example for staff who worked flexible hours.

At the last inspection overall governance arrangement were found to be ineffective. We found that leaders were unaware that some of their systems and processes were ineffective, for example as identified from the clinical searches; there was no overarching system to review outstanding workflow; the practice did not assess the quality of the system to process external letters and action them and the safeguarding policy shared was not reflective of the current status. At this inspection we found the Safeguarding policy shared with the lead inspector included details of the deputy safeguarding lead who had recently left the practice. We shared our findings with the provider who made amendments to the policy. We spoke with a range of staff to review the number of outstanding tasks and found the implemented task system to be effective. We spoke with the lead administrator, whose role included urgent referral management and non-urgent referral processing. They described systems and processes and undertook monthly referral audits. Systems were in place for other members of staff to continue with monitoring referrals in their absence. We reviewed the number of outstanding tasks - there were 66 outstanding task and no urgent tasks. The oldest task was from December 2023, however this contained information only and no action was required. There were 5 outstanding tasks for reception, all urgent tasks had been completed. The provider took immediate action on the findings from the clinical searches, this included discussion with another provider responsible for reviewing and downloading blood test results. We were assured there was sufficient governance structures in place to support this process which had been initiated by the local commissioning team. Staff knew how to access practice policies and all policies were accessible on the practice’s computer system. There were named leads in place for key areas.

We identified there were still some gaps in governance systems, for example we identified 8 invalid Patient Group Directives (PGDs). These were signed by a salaried GP who had resigned from post in April 2024. We spoke with the Lead GP who confirmed they led this process and had not reviewed the PGDs. Leaders took immediate action to ensure all PGDs were reviewed and appropriately signed by the authorising clinician and had actions in place to mitigate the risk in the future. We reviewed 4 Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision and identified that 2 GP initiated DNACPR decisions had not been documented in line with the practice policy and in line with national guidance. Immediately after the inspection the Lead GP confirmed an audit of all patients with a DNACPR decision had been undertaken. Clinical searches we carried out on the practice’s clinical system showed improvements in the management and monitoring of patients with long term conditions, high risk medicines and medicine reviews. However, we identified further strengthening of these systems was required, in particular in the management of patients with acute exacerbation of asthma. We discussed these issues with the provider who provided evidence to show they had acted and no patient harm had been identified. The provider had a business continuity plan in place. There were some effective arrangements for identifying, managing and mitigation risk, however we identified there were areas for improvement in the overall management of risk and implementation of risk systems to monitor risk.

People were able to access support at the practice rather than be referred elsewhere. For example, people had access to musculoskeletal first contact physiotherapy services available through the primary care network. Results from the National GP Patient Survey (2023) regarding the overall experience of the GP practice was 69.3% slightly below the expected 71.3%. At the last inspection, the practice did not have an active Patient Participation Group (PPG). At this assessment leaders told us they had tried in the past to set up a PPG, but patients had not shown interest ; and they were in discussion with the other local practices (who also are facing similar issues) to have a Primary Care Network (PCN) wide PPG. The practice had taken steps to advertise local self-care option for patients on a television screen in the reception area and planned to use this platform to advertise and encourage patients to join the PPG.

The practice employed additional role reimbursement staff (ARRS) through the Primary Care Network (PCN) to support collaboration and partnerships. Staff described how they supported people to provide holistic and effective services for the patient population. For example, we spoke with the social prescriber who accessed mental health training for their development and knowledge to support those who required assistance with their mental health conditions. Staff had attended training provided by the local commissioners to support their knowledge and understanding of modern slavery, this included how to identify people at risk or being forced to do things against their will.

The practice worked with primary care partners to deliver against local health checks targets. Feedback from partners demonstrated 110% of delivery target had been achieved within the last 12 months. The practice worked with commissioners, for example the practice had engaged regularly with the Integrated Care Board (ICB) to monitor actions identified at the last inspection.

The provider worked with the Primary Care Network (PCN) to undertake quality improvement work , for example developing new roles such a Children and Young Persons Mental Health practitioner, new rooms had been transformed from storage to clinical spaces, in addition patients could be referred to pharmacies using the ‘’Pharmacy first’’ service.

Leaders told us they encouraged patients to use innovative way to work towards healthier lifestyles using technology, for example health apps to manage diabetes and respiratory conditions. Staff were encouraged to identify and implement quality improvement for example referral and appointment waiting time audits. We saw that staff had been supported to undertake professional development, for example care navigation training to support their roles. Significant events and complaints were reviewed and discussed at practice meetings to learn lessons and make improvements and adjustments to care.

Significant events and complaints were low in numbers and were discussed at practice meeting promoting a culture of continuous improvement. We saw the practice had reported and taken immediate action following a cold chain breach. Staff had been informed, including PCN staff and the practice had undertaken a cold chain audit. We found clinicians attended monthly time to learn sessions organised by commissioners and clinical staff attended monthly training and update sessions. At the last inspection audits were not embedded at the practice as business as usual. At this assessment we saw the practice had undertaken a number of second cycle clinical audits as part of a quality improvement programme. Clinical searches showed that patients prescribed anticoagulant medicines monitoring had improved and patients of childbearing age prescribed a medicine to treatment a number of conditions were on appropriate pregnancy prevention programmes following these audits.