Pearl Medical 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 all the quality statements for this key question. We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open and fair culture. At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has changed to good.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders and staff told us that there was a strong shared direction and culture. This was consistently described by team members in terms of working to provide the highest quality care, ensuring people had access when they needed it and taking account of people’s needs, circumstances and choices.

The practice leaders had identified short and longer-term priorities in line with their vision for service direction. For example, since the COVID-19 pandemic, they had identified accessibility of the service as a priority for improvement and developed a strategy to address this with progress being regularly monitored and communicated across the team. The practice leaders identified local and national initiatives in line with their vision for the service, for example, the practice had declared itself a ‘Safe Surgery’ under the Doctors of the World scheme, ensuring that lack of documentation was not a barrier to patient registration.

Leaders demonstrated that they understood the challenges to quality and sustainability and had identified the actions necessary to address these challenges. Staff were wholly positive about the quality of leadership within the practice. Staff who had worked in a number of primary care environments described the lead GP at this practice as among the best leaders they had worked with. The leaders were described by the team as: leading by example; being proactive; well organised; supportive and approachable.

There were processes in place to support effective leadership, for example, an ‘open door’ policy and regular meetings. Staff had access to appraisal and supervision appropriate to their role.

The practice collated staff feedback and reported on the actions taken in response to this feedback. For example, allocating additional staff to assist colleagues during peak times and implementing suggestions from clinical staff to make consultations/treatments more efficient and comfortable for patients.

The practice encouraged candour, openness, and honesty. Staff feedback was collected during annual appraisals, regular 1 to 1 discussions and practice meetings. The Whistleblowing Policy included internal and independent contacts to whom staff could raise any concerns.

Staff and leaders told us that the practice benefited from having a diverse team that reflected the local community.

The practice had a policy on workforce equality, diversity and inclusion and included consideration of equality in relevant policies, for example staff recruitment. The practice was physically accessible. The practice provided staff with fair opportunities to develop their experience and skills. Staff had undertaken equality and diversity training.

Staff were clear about their roles and responsibilities. They told us there were clear policies and processes and any updates and changes were shared and discussed with the team.

The provider had established governance procedures that were appropriate for their service. These were updated routinely and in response to any changes. For example, the business continuity plan had been updated following a national IT outage. Staff could access all required policies and procedures via a shared drive. Managers held regular practice meetings with staff, during which clinical concerns and emerging risks were discussed. The practice were making good progress migrating to a new cloud based practice management system which had been implemented by the primary care network.

Representatives of the patient participation group reported that the provider engaged positively with the group. For example, sharing patient feedback, survey results and updates about staffing and the service.

Staff and leaders were positive about local partnerships and the impact of effective collaboration on health outcomes. For example, the clinicians were able to describe how they liaised effectively with community health teams to ensure that people with complex conditions were able to be treated promptly at home and with access to specialist input to avoid rapid deterioration or hospital admission. Leaders participated in strategic local partnership working and were making effective use of network resources for the benefit of people using the service.

Partners spoke positively about the practice’s involvement in partnership working and collaboration to provide an effective and responsive service.

There were clear processes in place to support partnership and joint working, for example staff had been educated on the roles and responsibilities of attached staff in associated roles (that is, funded by the primary care network). The practice was proactive in seeking feedback from partners to improve their working relationship. For example, results from a survey undertaken by the practice with 7 local pharmacies showed that the practice was responsive and efficient when dealing with queries, prescription requests and medication errors.

There was a strong focus on continuous learning and improvement throughout the practice. The practice leaders were able to demonstrate their commitment to learning from incidents, feedback and other sources of information. They had recently identified a serious problem originating outside the surgery but involving pathology reports. The leaders had responded immediately and openly with partners and people using the service to resolve the problem. Staff had the skills, knowledge, and experience to deliver effective care, support, and treatment. Staff told us that they had access to good supervision and learning support and this was a strength of the practice. For example, the clinical pharmacist told us they had a daily supervision slot integrated into their schedule at the practice (additional to administrative time). They said this was very helpful and not commonly offered by other practices in their experience.

The practice was an active proponent of system-wide improvement. For example, the lead-GP had instigated a primary care network sponsored project looking at ways of improving care at the primary and secondary care interface with engagement from relevant partners. They had produced a report including detailed analysis and recommendations for improvement (for example, recommending a change in the summaries provided to primary care from A&E). The results had been shared with the North West London NHS commissioners for consideration.