Bridport Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective - This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on the best available evidence.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains rated Good.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. The servicedemonstratedeffective systems and processes to support people whorequiredrecall monitoring. This included routinely inviting people for annual health reviews andlong-termcondition reviews, such as for chronic kidney disease and hypothyroidism, in line with national guidance. Staff were able to refer people withadditionalsocial needs, including those experiencing social isolation or housing difficulties, to a social prescriber. Information was shared appropriately with staff and other agencies to support the delivery of coordinated care. Leadersmonitoredreferral activity, including delays, and carried out audits to ensure urgent cancer referrals were actioned appropriately.

The latest verifiable data from NHS England showed cervical cancer screening uptake at the service averaged 69.8% among people aged 25 to 49, and 77.1% among people aged 50 to 64 who met the eligibility criteria. Although both figures were below the nationalminimumtarget of 80%, the service described a proactive approach to improving uptake and patient education. This included offering Saturday appointments with a nurse at the surgeries or bookings through Primary Care Network (PCN) out of hours arrangements.

However, during our remote clinical searches, we noted29 people with a potential missed diagnosis of diabetes, which equated to approximately 1.6% of the total population of people with a confirmed diabetes diagnosis (around 1,800 people).A review of five of these people’s clinical records showed that three had not been coded as having diabetes, despite evidence of either consecutive raised blood results or historical abnormal results that had not been followed up to confirm a diagnosis. Following this review, leaders demonstrated people identified as requiring further assessment had been reviewed in line with national guidelines.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

During our clinical searches, we noted a total of 3025 people with a diagnosis of asthma. We noted 9 people who has been overprescribed rescue inhalers. We reviewed a sample of 5 records which highlighted 3 records where staff had not always used clinical templates effectively such as documenting what had been recorded during medicine reviews or asthma reviews to ensure management plans remained accurate and effective for future care planning. This was despite, the service ensuring asthma medicines had not been made available for repeat prescribing in the records we reviewed. In this example, this meant there were safety netting mechanisms to ensure a clinician reviewed whether the medicine was appropriate prior to prescribing. We noted 110 people who had been prescribed 2 or more courses of rescue steroids in the last 12 months. In a sample of 5 records reviewed, all 5 people had not had an adequate asthma review with care plan in place, in the last 12 months. The sample we reviewed also highlighted 3 people had not had an adequate assessment prior to prescribing of rescue steroids and had not been followed up within 48 hours of presentation of acute exacerbations in line with evidence-based guidelines. Following the review of these clinical records, the service had ensured people who were identified had been reviewed to demonstrate safe and effective care and treatment.

However, the service had systems and processes for updating clinical guidelines and protocols. Leaders demonstrated how clinical guidelines had been shared with teams via email bulletins and staff meetings. We noted in clinical supervision audits, examples of case reviews which documented how care provided had been effective.

The service had an induction programme for clinical and non-clinical staff which included information for training, appraisal and guidance for providing evidence-based care. Clinical staff had access to local care pathways and prescribing guidelines with the British National Formulary (BNF).

The service worked well across teams to support people, particularly when people moved between different services.

The service worked with stakeholder organisations such as secondary healthcare providers to establish and maintain safe systems of care for people. For example, staff used a clinical decision support the process to log and monitor referrals which included correspondence from external professionals involved in the people's care.

Furthermore, the service worked with the primary care network’s (PCN) ageing well team to support housebound and vulnerable people with frailty through treatment planning and regular ward rounds for those residing in local commissioned care homes as part of a multi-disciplinary team.

The service had a system in place for processing newly registered people’s information and summarising medical records. The service had an action plan in place supported by administrative staff to reduce the backlog of 181 summarising records to ensure accurate information available for clinicians. There were processes to monitor and manage care when people were moved between services such as after referral to secondary care, or admission to hospital. A review of the service’s clinical system indicated people’s test results were being managed in a timely manner to inform future care and treatment planning.

During our review of the service’s clinical records systems, we found examples of effective plans for the movement of people across multiple services. Referrals and discharge summaries were managed appropriately and considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service offered a range of health promotion provisions and supported people to make healthy lifestyle choices. For example, we observed the service had blood pressure monitors in the waiting area of Bridport Medical Centre to improve the accessibility and empower people to manage their own assessments. Staff understood the needs of the population and used this knowledge to offer advice on prevention, early identification of risk, and managing long‑term conditions. For example, the service supported national priorities and initiatives to improve population health such as smoking cessation, weight management, and screening services. The service employed a social prescriber that connected and supported people with activities, groups and services that improved their health and wellbeing.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured people’s outcomes were positive and consistent, and met both clinical expectations and the expectations of people themselves.

Outcomes for people were generally in line with local and national averages, such as meeting national minimum targets for childhood immunisations. The service regularly monitored Quality and Outcomes Framework (QOF) indicators and demonstrated they had carried out audits to improve clinical quality. For example, the service carried out an audit development plan in relation to the service’s leg ulcer provision. The service previously delivered wound care through a practice nurse working twice weekly with limited standardisation of assessment and documentation. Through the recruitment of a tissue viability nurse, the service assessed the caseload required to meet people’s needs and developed bespoke clinics. This demonstrated increased appointment capacity across the clinical team, a total of 48 appointments a month, used to accommodate demand in the service’s expanded immunisation services. The tissue viability nurse supports efficient and consistent continuity of wound care with regular auditing to meet aligned evidence-based leg ulcer pathway standards, such as Doppler diagnostic assessments (used to measure blood flow in the legs and check for Peripheral Artery Disease), healing progress and escalation rates.

As part of the service’s audit programme, the pharmacy team had demonstrated the monitoring of people prescribed warfarin (blood thinning medicine used to prevent and treat dangerous blood clots, such as deep vein thrombosis, pulmonary embolism, and stroke). Effective blood monitoring ensures people prescribed warfarin at the correct dosages and receive International Normalised Ratio (INR) testing at regular intervals. The audit, in November 2025 identified 18 people who were prescribed warfarin with 5 people who were overdue monitoring with documented follow-up. This was an improvement from the previous 12-month period of 15 people with overdue blood monitoring, as a result of regular clinical searches, improved recall and escalation processes.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood the legal requirements around consent. Mental capacity was assessed where appropriate, and consent was recorded accurately in the person’s clinical record. There was evidence of shared decision-making and staff had received training in the Mental Capacity Act. We also found that Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) and Treatment Escalation Plans (TEP) records had been completed in line with national guidance.