Civic Medical Centre

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• 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

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. This is the first inspection for this service since its registration with CQC. This key question has been rated as Good.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. The most recent national GP patient survey results (2024) showed that 85% of respondents felt their needs were met during their last general practice appointment. (The national result for this indicator was 90%).

The clinicians and staff described how they assessed and recorded the patients’ needs, including people’s communication needs. The practice team used the electronic patient records system to code specific needs to ensure staff were made aware of these.

Clinical staff used validated templates, for example, when carrying out care planning or long-term condition reviews, to ensure that all relevant issues were covered including patients’ wider health and wellbeing. One of the GP partners provided support for clinical staff. There were network-level arrangements in place to support clinical staff in associated roles and the practice also provided support for these team members, for example through case review, to ensure needs were being assessed appropriately.

The evidence we reviewed did not raise any concerns about people’s experience regarding delivering evidence-based care and treatment at this practice.

The GP partners explained that evidence-based clinical guidelines were incorporated into normal practice and examples of good practice or unusual cases shared within the team. Clinical staff confirmed they had opportunities to maintain their professional development and had access to clinical support and advice when required. The provider sought advice from external and specialist sources of expertise when appropriate. The leaders told us that managing some long-term conditions was a challenge due to population mobility, cultural factors and the increase of recently registered people. The leaders told us that they had responded by investing in staffing and premises improvements. They did not have a specific strategy to address these challenges in relation to specific long-term conditions but told us they were achieving local targets and making use of available referral pathways and resources.

We carried out standardised searches of the clinical records system to examine whether the provider was monitoring selected long-term conditions in line with guidelines. The practice had systems in place to manage people with diabetes appropriately, for example, referring people with poorly controlled diabetes to the community diabetes specialist nurses. However, we found that over 100 people diagnosed with diabetic retinopathy also had recorded blood sugar levels that were above the ‘normal’ threshold, increasing the risk of adverse health outcomes for these people. We looked at five cases in detail and found in two cases that the practice had not carried out a timely diabetes review following their most recent result. We also found that people with hypothyroidism were not always being monitored appropriately. In the latter case, this appeared to be because the practice did not have an effective process for handling the situation where patients were not responding to invitations to attend for monitoring.

Some people spoke positively about how the practice liaised with specialist services on multiple occasions to resolve issues with the referral process and ensure the patient was seen by the most appropriate service.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The leaders described the way in which the practice liaised with other professionals, for example, local community teams to reduce the risk of people with complex conditions experiencing sudden deterioration and avoid admission to hospital.

Partner organisations did not provide feedback about the practice for this assessment.

Clinicians worked with other health and care professionals to deliver a coordinated package of care for patients with the most complex needs, for example, care planning reviews and end of life care.

People did not provide specific feedback about the support they received to live healthier lives. The most recent national GP patient survey results (2024) showed that 78% of respondents felt they had enough support from local services and organisations in the last 12 months to help manage their long-term conditions or illnesses (The national result for this indicator was 68%).

Leaders told us that supporting people to live healthier lives was a priority for the team. For example, the practice promoted health checks to eligible people and referred people for weight management or other educational and lifestyle advice when appropriate, including structured educational support for people diagnosed with diabetes. However, we remained concerned about the effective management of diabetes within the practice population and the extent to which the practice was successfully supporting people to adopt healthier lifestyles following diagnosis.

The practice offered screening and health checks such as the NHS health checks programme for people aged 40 to 74. The healthcare assistant used structured templates which were integrated into the electronic records system to ensure they covered all components of various checks and reviews. Staff also supported national priorities and initiatives to empower patients and improve population health. For example, clinical leaders had created information videos on measles and Type 2 diabetes which were available to the public on the practice website.

The feedback we reviewed did not show any concerns about people’s experience regarding monitoring and improving outcomes at this practice.

The leaders and staff were able to describe actions taken to encourage people to attend for screening and immunisation, for example, individually contacting people who had not attended cervical screening by telephone to explain the benefits of the test. Staff told us that practice performance was regularly reviewed and discussed at team meetings. However published data up until April-June 2024/25 (NHS England) showed that cervical screening coverage had remained largely static over the previous 12 months.

The practice had systems in place to monitor performance and outcomes, for example, regularly carrying out clinical audit on aspects of prescribing and patient management. However, our standardised searches of the practice electronic records system identified some performance issues, for example, in the management of diabetes. The practice leaders had identified diabetes as a priority and were carrying out audit and improvement work but this was at an early stage and had not yet shown an impact.

The provider was achieving just under 90% childhood immunisation coverage in line with the recommended schedule for children by the age of 1 and 2 years old (2023 figures). However, the most recent published data on cervical screening was markedly below the 80% national target at 57%in June 2023 (NHS Digital). Progress on this indicator had stalled – practice coverage was at 61% in June 2022 and 60% in June 2021. The practice provided information after the assessment from their electronic records system showing improvement to cervical screening coverage (to over 80%) but it is not possible to directly compare these figures against the published data due to different methods of calculation. The practice team was working to increase uptake of cervical screening but this was not yet demonstrated in the published indicators.

People participating in the assessment did not provide specific feedback about consent to care and treatment. The most recent National GP Patient Survey results (2024) for Civic Medical Centre showed that 85% of people were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. The average result on this indicator for all practices in Brent was 89%.

Staff were able to explain how they involved people to obtain consent to specific decisions. For example, the nurse obtained (and recorded) verbal consent from the parent or guardian in relation to childhood immunisations. People with communication needs were given longer appointments to ensure there was enough time to discuss decisions.

There were policies and systems in place to obtain and record informed consent. Staff had completed training on the Mental Capacity Act 2005.