The Humbleyard 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 7 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was Requires Improvement. Our rating for this key question remains at Requires Improvement to Good. Leaders ensured there was a shared vision for delivering patient centred care and staff understood their role in delivering this vision. There was a positive culture of continuous learning and improvement. We also found the provider had taken action since our last inspection to improve governance arrangements. Staff were now clear on their individual responsibilities and knew who was accountable for each aspect of the service. The provider had taken action to improve governance arrangements regarding safety alerts, significant event reporting, cervical screening protocols and oversight of Controlled Drugs. We also saw evidence that the provider had acted on concerns highlighted in infection prevention and control (IPC) audits. However, some areas of governance required further strengthening (for example monitoring safeguarding training, appropriateness of IPC risk assessment templates and some elements of patient monitoring). Overall, although governance arrangements had improved, it was too early to assess whether these improvements would be embedded and sustained and in some areas, we identified that governance arrangements were not always operating effectively. We have asked the provider for an action plan in response to the breach of Regulation 17 (Good governance) we found at this assessment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders spoke positively about how tangible projects such as a new phone system and website development supported the provider in delivering its objectives. Some staff spoke positively about a listening culture where service improvement suggestions were acted upon.

The provider’s 2024 objectives included a focus on sustaining/developing clinical and non-clinical teams, growing capacity to meet patients’ demand and continuous quality improvement. Regular staff and clinical meetings promoted a listening culture and also ensured that any potential risks to delivering the vision were understood and addressed.

The lead GP was alert to any examples of poor culture that may affect the quality of people’s care and have a detrimental impact on staff. For example, action had been taken since our last inspection to recruit additional staff and we were told that this had had a positive impact on staff wellbeing. Overall, staff told us that the lead GP and assistant practice manager were visible and approachable; and had the skills, knowledge, experience and credibility to lead effectively. However, some staff fed back that leaders were not visible across the practice’s sites and that they did not feel supported. Leaders were aware of staff concerns; having undertaken a staff survey between June and July 2024. We noted proposed actions included work to bring the three locations together to work as one and ensuring that more managers were on site at the end of each day.

Action had been taken since our last inspection such that leaders now had the capacity and governance systems to ensure that the practice’s organisational vision could be delivered and risks well managed. Leaders were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role. For example, we noted the local Integrated Care Board had provided recruitment and medicines management support.

Staff told us they were encouraged staff to raise concerns and most staff fed back that they were confident their voices would be heard.

Staff and leaders actively promoted staff empowerment to drive improvement. For example, leaders had recently conducted a staff survey and had subsequently fed back to staff how they had acted or proposed to act on staff concerns. The provider operated a ‘Freedom to speak’ up policy which encouraged employees to raise concerns including advising employees to raise concerns with appropriate outside bodies in the event that the concerns were not dealt with satisfactorily internally.

Leaders took action to continually review and improve the culture of the organisation in the context of equality, diversity and inclusion. Staff told us that leaders had made reasonable adjustments to support them in carrying out their roles.

Staff had completed equality and diversity training. All staff members were encouraged to suggest agenda items for staff meetings.

Staff understand their role and responsibilities. In most cases there were clear and effective governance, management and accountability arrangements. Managers met with staff regularly to complete appraisals and performance reviews. Leaders spoke positively about how governance arrangements had improved; despite ongoing recruitment challenges and an increased patient list size.

Staff were now clear on individual responsibilities and accountabilities for each aspect of the service. The provider communicated management information via meetings where partners met along with the Business/Practice Manager. Team leads participated in fortnightly meetings to review current issues and drive improvement. A risk register had also been introduced to allow leaders to identify and manage current and/or potential risks to the quality of the service. Action had been taken since our last inspection to address governance concerns regarding significant event reporting, cervical screening protocols and oversight of Controlled Drugs. The provider now also had appropriate systems in place to be able to act on concerns highlighted in infection prevention and control (IPC) audits. However, some areas of governance required further development. For example, safeguarding training and appropriateness of IPC risk assessment templates. Also, the provider had not ensured that all relevant monitoring was taking place i.e. blood pressure or weight. Some patients had not received the correct blood monitoring for a medicine used for heart failure. Other patients requiring a drug to reduce the risk of gastrointestinal bleeding during treatment with certain analgesics or antiplatelet (aspirin) had not had this prescribed. Safety alerts were now discussed at clinical governance meetings but were not circulated to all relevant staff. Medicines risks identified during our assessment (regarding checking emergency medications and clinical searches) had not been identified through the practice governance systems. Overall, although many areas of governance had improved but it was too early to assess whether improvements would be sustained. In some areas, governance arrangements were not always operating effectively.

Patient told us the practice worked seamlessly with health care partners to support care provision, service development and joined-up care (for example regarding hospital referrals).

Staff gave examples of where the practice worked in partnership with other services (for example other community pharmacy, local practices, district nursing team and local authority safeguarding team).

In order to reduce pressure on appointments, the practice had partnered with a local community pharmacy to raise patients’ awareness about common conditions that could be treated by local pharmacies. The local Primary Care Network Pharmacy Lead initially visited the practice to deliver staff workshops: raising awareness about the scheme and how it could relieve pressure on GP appointments. Leaders at the practice showed us data which highlighted the new scheme had already freed up GP appointments for patients who needed them most. The local Primary Care Network Pharmacy Lead spoke positively about how the partnership supported continuity in people’s care and treatment because services were flexible and joined-up.

The provider convened regular multi-disciplinary meetings where information was shared between teams and services to ensure continuity of care. Attendees included district nursing, health visiting and end of life nursing teams.

Leaders spoke positively of a focus on continuous learning, innovation and improvement across the organisation. Training opportunities were available to further improve delivery of specific roles (for example regarding learning disabilities awareness training).

There were processes to ensure that learning happened when things went wrong, and from examples of good practice. For example, the provider convened regular operational meetings where patient survey feedback, significant incidents and complaints were used to encourage reflection, collective problem-solving and drive improvement. Leaders also worked closely with local ICB teams to support learning and improvement in areas such as staff recruitment and medicines management.