Agenda item

The Chief Operating Officer (COO) Together First CIC, Barking & Dagenham GP Federation and a General Practitioner of The White House Surgery presented a Care Quality Commission (CQC) Report on Together First to the Committee. This described the CQC judgement of the quality of care of services provided at Barking Hospital. It was based on a combination of what was found when the inspection took place between 7 to 19 December 2023 with follow up interviews during January 2024, information from the ongoing monitoring of data about services and information gathered from the provider, patients, the public and other organisations. The overall rating which was classed as good was based on an assessment of services for safety (including safeguarding systems), effectiveness, caring, leadership and responsive to people’s needs, the latter being specifically rated as outstanding. This represented an upgrading on the previous inspection conducted in 2018 when the service was rated as good across all inspection service areas. 

The inspection identified five areas as listed which required improvement to which the COO informed the Committee that four had now been achieved. The one area still be to be resolved and which would take time, concerned a review of policies and procedures to check that they fully reflect the services practices. The COO was confident this work would be completed by May 2024. 

The Committee placed on record its congratulations to the staff and management for achieving an overall rating of good and commended the positive comments about the services provided at the Hospital .Responding to the findings of the Inspection, which was presented at the meeting and set out as Appendix 1 to the covering report, a number of questions and comments were raised, focussing particularly on the pathways and progress of improvements as follows:

·  Members were interested in how Together First would share their positive experiences and good practice to support others within the sector. The COO stated that they regular share details with others with relevant data sets across the health care sector especially with the GP surgeries in the Borough. This was particularly evident during the period of the pandemic.

·  Given the impressive staff retention staff rates at Together First CIC what advice would they give to other health organisations who might want to follow their approach. The COO emphasised the importance of creating the right culture and working environment, involving the staff directly, valuing the individual’s contributions for continuous improvement and better performance. Providing staff with support and the freedom to innovate allows them to be the bast they can. Alongside this doing insights training has helped to identify the gaps in service and go out to recruit the right skill sets in the workplace which runs alongside getting a healthy work/life balance.

In a follow up question, the COO described how they sought to achieve the right organisational culture by setting exceptionally high standards for the core team which staff are expected to meet. In return people are allowed to work within the boundaries, largely remotely. Also, the organisation places high store on recruiting local people who have a vested interest in doing the best for the local community. 

·  The value of partnership working was highlighted through the achievements of the GP Federation and having a dialogue. It was recognised that whilst there had been an Integrated Care Board (ICB) reform in the Health Service, Federations generally had not been well-considered. Therefore, further improvement was required to minimise the confusion regarding the role of Federations and Primary Care Networks (PCNs) generally, notwithstanding that locally it works for us. The structural inequality and the need to address matters was recognised by the COO who stated that it had been exacerbated during the period of austerity. 

·  The distinction between inner and outer London pay was discussed. Whilst this did have an impact on recruitment and retention in Together First, the COO emphasised that for clinicians it was not all about money and that working in a safe environment where they feel respected alongside effective management structures was equally important.

It was reported that the ICB had acknowledged the pay differentials in its new workforce strategy and was committed to abolishing it by levelling up. Obviously, this will depend on finding more money and as a consequence it had been escalated to London Regional level who in turn were applying pressure to the Department of Health to resolve the matter. Whilst this would be welcomed for the record it was noted that in reality Essex paid higher rates and therefore represented greater competition than inner London for GP retention rates for North East London.

The Chair concluded the discussions with a comment about sharing the best practice with other GP practices in the Borough whose CQC reports have not been as positive as that presented this evening. The COO responded that Together First CIC maintained positive relationships with CQC NHS Commissioners, and this was exampled by the fact that following a local practice going into special measures last year they were brought in as a sub contactor to help the practice successfully get up to standard.

The Committee noted the report.