Abbey Field 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 the quality statements from the well led key question. Our rating for this key question remains good. At this assessment we found the practice used information to monitor and improve performance. Where improvements had been identified, for example in relation to access, work continued to be progressed. We found effective governance and risk management systems and processes were in place. The majority of staff reported that leaders were visible and approachable and reasonable adjustments were made. There were named leads in place for key areas and staff were clear about their roles and responsibilities. Leaders had a good understanding of local population issues and the challenges and priorities for their service and the practice involved the public, staff and external partners to sustain high quality care. There was evidence of systems and processes for learning and continuous improvement.

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.

Most staff we spoke with and received feedback from told us that there was a positive team culture within the practice and that they felt supported by the GPs and practice leaders. They told us they were able to contribute to discussions about service improvements, incidents and complaints and they felt able to raise concerns without fear of retribution. For example, 1 staff member told us how they felt overwhelmed with the amount of work when they started in their role. They raised this with leaders who directed some of the work elsewhere until they had become more familiar with the work and the practice. There was an emphasis on the safety, support and well-being of staff. Staff told us that they respected and appreciated people's backgrounds and cultural values and that they had received training in equality and diversity.

The practice had a clear vision which focused on providing the best training and clinical practice and being a good and fair employer. Their strategy focused on ensuring the sustainability of the practice. This included focusing on innovation to ease the pressure on clinical and administration teams and ensuring work which can be taken off GPs is, to help them focus on people’s care. Leaders demonstrated that they understood the challenges to quality and sustainability.

Most staff told us there was compassionate, inclusive and effective leadership at all levels and reported that leaders were visible and approachable. Staff told us they all worked across the 3 sites which worked well, and support was available at each site. Staff told us leaders supported the learning and development of staff to build resilience in those teams for the future. For example, they had developed asthma and diabetes teams in the practice, who met quarterly with the audit team to plan and agree their work. They were implementing this approach for women’s health, had trained a lead clinician and were currently training a second clinician for this team. This was in response to the growing demand in these areas.

Information about the key responsibilities of GP Partners, the management team and staff roles were available and understood by practice staff. Staff had clear roles and responsibilities and were flexible in these roles in order to meet people’s needs. The practice had divided staff into teams for example, registrations and audit and each team had a manager who led and supported staff members. There was a list of the functions of each team and their work was discussed regularly and focused on ensuring at least 2 staff members could undertake each function. Practice leaders had arrangements in place to recognise the achievements of staff, for example, long service awards which included a card, present and voucher.

Most staff we spoke with and received feedback from told us there was an open and honest culture within the practice. They felt able to raise concerns with their managers, the management team and leaders, and felt they would be listened to, particularly in relation to people’s care and treatment.

The practice had a whistleblowing policy which included information about arrangements to raise and escalate concerns and contact details of support organisations. There were clear processes in place for staff to speak up. Information about speaking up was available in the staff areas of each practice.

Most staff told us they felt supported by the practice leaders and their peers. Staff gave examples of support they or their peers had been given, for example with reasonable adjustments, flexible working and menopause support. Other staff told us they were encouraged to have regular breaks during the working day and enjoyed taking a break in the wellbeing garden. Practice leaders told us how they had worked with a local charity to develop the wellbeing garden for staff and local people. Leaders told us they held staff training sessions, for example on resilience, healthy eating and stress management. They also supported social events which included Christmas and summer parties, non-uniform days, Pride, and autism awareness events. Staff gave examples of fundraising events, where donations had been given to local charities, which included those who support homeless and LGBTQ+ people.

There were systems and processes in place to support workforce equality, diversity and inclusion, with an emphasis on the safety and well-being of staff. This included an equality, diversity and inclusion policy. The practice had an inequalities lead, whose role was to make the practice more inclusive for everyone. Examples of achievements included, ‘everyone welcome’ banners being used on email signatures, daily posts during carers week and breathing and stress management awareness as part of a team building event. Reasonable adjustments were in place for staff. Nearly all staff had received equality and diversity training. The practice and worked with an external organisation to identify ways to support the workforce to improve population health and access. They facilitated a workshop with staff on tackling the menopause, with solutions and improvements identified and actioned. For example, air conditioning has been installed in the back-office area.

Information about the key responsibilities of clinical and management leads was displayed at the practice sites and staff told us they were aware of those with lead roles. Staff we received feedback from and spoke with, told us they were clear about their roles and responsibilities and who to contact should they need advice or want to discuss any concerns. Staff knew how to access practice policies and received minutes of meetings. Staff took people’s confidentiality and information security seriously.

There were clear responsibilities, roles and systems of accountability to support good governance and management. We reviewed a range of policies, which included for example, environmental sustainability, fire safety, service continuity and safeguarding. There were effective processes to review, update and share changes with staff. Managers held regular practice, and departmental meetings, during which they discussed performance, emerging risks, obtained feedback and shared information with staff. Managers recorded any actions arising from these meetings and ensured they shared these with staff. The practice used digital services securely and effectively and conformed to relevant digital and information security standards with arrangements in place for the confidentiality of data management. There were some assurance systems which were regularly reviewed and improved. This included those for managing risks for people and staff such health and safety checks, and significant events. There were clear action plans in place to ensure risks identified were mitigated, actions completed and monitored to ensure they were sustained. For example, the backlog of summarising had been identified and additional staff capacity was in place to reduce the backlog. There were a range of assurance audits which included for example, infection prevention and control and oversight of the work of non-clinical staff who processed letters. However, the medicines risks we identified during our assessment had not been identified through the practice governance systems.

There was an active patient participation group (PPG) who met with practice staff every 2 months and represented the views of people using the service. Representatives from the PPG described members and practice leaders had worked together and made positive changes. This included for example, upskilling nursing staff, so they were able to prescribe. Access to transport to the practice had also been improved through the use of a dial a ride scheme, where people could pay a small cost to be picked up from home, taken to their appointment, and dropped home again.

One of the GPs was the Clinical Director of the Primary Care Network (PCN), and the practice manager was the PCN Business Manager. The PCN team included a range of multidisciplinary staff who were available to support the needs of people at the PCN practices. Staff included for example, clinical pharmacists, a health and wellbeing coach, adult and childhood mental health support and a first contact physiotherapy service. Practice leaders told us they now directly employ social prescribers and a specialist social prescriber to improve continuity for people using the service. Each PCN practice had a care home lead who had responsibility for the oversight of the medical care and treatment of people who lived in a care home. Staff gave examples of engagement and joint working with other services, both for the benefit of people registered at the service and people in the wider community. This included, for example, a monthly dementia coffee morning. Leaders told us they continually developed their call triage process and were 1 of the top referrers to community pharmacies. The practice worked with the Integrated Care Board, (ICB) to ensure appropriate antimicrobial prescribing under the Rewarding Appropriate Prescribing scheme and also in relation to improving capacity and access.

We saw evidence of proactive partnership working with a range of statutory, voluntary and health and social care organisations. We received positive feedback from a range of partners in relation to how practice staff collaborated for improvement. For example, 1 organisation, who supported access to accredited training for people with a range of abilities and mentoring to improve mental health, confidence and wellbeing, gave feedback about the positive impact developing the wellbeing garden had on attendees. The practice identified and supported people who they felt would benefit from being involved with this organisation.

The practice worked with stakeholders to build a shared view of challenges and of the needs of the population. Practice leaders and staff worked with a range of external partners, for example, other health and social care professionals, mental health services, housing, LGBTQ+ and homeless support organisations, to support people with a range of needs. We saw examples of when the provider had engaged with commissioners and people using the service when changes were being considered and proposed. This included for example, in relation to improvements to access.

There was a learning culture in the practice which staff and leaders actively participated in. Most staff gave positive feedback about their experiences of joining and working at the practice, and the ongoing support and development they received. Staff told us that leaders encouraged development. For example, they were currently supporting a nurse to complete a contraception update and a receptionist had been supported to complete nurse training. In January 2023, the practice had introduced group clinics for people with newly diagnosed diabetes which were led by a GP and health coach. During the face to face clinics, diabetes was explained, along with the importance of annual checks and lifestyle choices and help that was available. Since starting, 13 clinics had been completed with 50 people seen. The practice had been engaging with secondary care regarding establishing a chronic kidney disease outreach clinic to provide care nearer to people and support them with engaging with self-management.

There were systems and processes for learning, continuous improvement and innovation. Staff were supported to develop in new or extended roles. The practice had 2 GP trainers and was a training practice for medical students and GP Registrars (qualified doctors training to become GPs). The practice also supported placements for combat medical technicians, student nurses, apprentices, and work experience students. We saw evidence of regular monitoring of a range of feedback sources in order to learn and improve the service. This included feedback from the friends and family test and surveys. Feedback was documented and reviewed to identify any themes and trends where improvement could be made, and we saw examples of improvements which had been made. The practice were looking at systems to further support their resilience through innovation, for example automation of read coding and they were on the list to be part of a trial for the automation of blood tests.