The Molebridge Practice

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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 3 quality statements within this key question. We found the provider had not fully embedded governance systems, and there was a lack of leadership and oversight. We found there were no clear systems in place to ensure some staff had the right supervision and skills so that patients received safe care and treatment. We found staff morale was very low, with a number of staff reporting there was a continued lack of communication. Some staff reported being unable to approach leaders for guidance and support. At the time of the inspection, we found there was no practice manager in place. However, staff were being supported by the Transformation & Integration Manager. We found this was not sufficient and there was inadequate oversight to manage risk, issues and performance.

This service scored 18 (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. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

We found concerns which related to the effectiveness of patients' care and treatment. There was a breakdown of communication between leaders and staff. Staff told us they felt communication between leaders and staff was poor and that concerns raised were not listened to. Leaders told us that processes in place were consistently not being followed. For example, we found a number of pathways implemented by the provider that were not being followed by staff.

We were able to gain assurances from leaders that they understood the challenges to quality and sustainability. However, this had not had time to embed and for the changes required to be implemented. Staff told us they did not feel included in the new ways of workings and that communication had been limited. Staff were not always clear on the roles and responsibilities of others within the practice.

We did not look at Freedom to speak up during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

We did not look at Workforce equality, diversity and inclusion during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

Staff told us that new roles and responsibilities were not always clear or that they were given enough time to implement. For example, we were informed that some staff were assigned the role as supervisor but were not aware of what the role entailed and did not have adequate time in their working day to fulfil the role.

Leaders could not always ensure there was enough staff in place, and we were not assured that contingency plans for the needs of the service were adequate. For example, at the time of our inspection 3 out of the 4 GPs and the nurse were absent. Leaders arranged cover with locum GPs and nurses and non-GP roles including Physician Associates, and Primary Care Doctors, who required supervision. However, we noted there were days when the branch surgery was closed due to staffing levels and other days when there was an inadequate number of staff on duty to provider safe care.

We found processes required strengthening to identify, understand, monitor and address current and future risks. This included the actioning of some safety alerts, patients receiving appropriate or timely reviews and adequate supervision of some roles. Patient records reviewed showed that some non-GPs were not always working to NICE guidelines which could put patients at risk of receiving poor care. We found there was not always a clear oversight for the management of risk. For example: supervision was not always adequate, and some staff were working outside their scope of practice.

There was an active patient participation group (PPG) who contacted us with concerns raised to them from patients. We were informed of a public meeting attended by around 50 patients and the Integrated Care Board to discuss on going issues with patient access and care. The PPG informed us that, they and patients felt there was a lack of information from the provider and that services had been reduced with the branch surgery being closed unexpectedly and difficulties booking appointments.

The provider was aware of the concerns raised by patients and was proactively trying to ensure staff were available to cover rotas. However, leaders informed us that staff were not always available at short notice and therefore shortfalls in staffing levels had been unavoidable on some days.

We noted that the practice website did not provider minutes to meetings held by the practice and the PPG or any actions the provider was taking in response to concerns raised.

We did not look at Learning, improvement and innovation during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.