Halcyon 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 assessed all 6 quality statements under the effective key question. We looked for evidence that staff involved people in decisions about their care and treatment and provided them with advice and support. This is the first inspection for this practice since its registration with CQC. This key question has been rated as good.

We found staff involved people in decisions about their care and treatment and provided them with advice and support. Services worked in harmony, with people at the centre of their care. The practice provided health prevention and promotion education tailored to their community. Staff worked with local organisations including 3 Universities, a health facility for homeless people, an LGBT+ group, a hotel housing asylum seekers and a care home for the Chinese community in order to understand the specific needs of different groups within their population and reduce health inequalities.

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.

People felt involved in the assessment of their healthcare needs and felt confident that staff also understood their individual and cultural needs. In the national GP patient survey 2024, 92% of people felt their healthcare professional had all the information they needed about them; this was the similar to the national average. All staff were aware of the needs of the local community and used digital flags within the care records system to highlight any specific individual needs.

The practice had carried out a mental health audit in February 2024. The audit identified people did not always have an agreed care plan in place. In response, leaders changed the way people were recalled for review and dedicated a member of staff to monitor this recall.

Staff checked people’s health, care and wellbeing needs during health reviews. In the national GP patient survey 82% of people felt their healthcare professional considered their mental health needs during their consultation which was higher than the national average of 73%. Clinical staff used templates to support their reviews of people’s wider health and wellbeing. Staff referred people with social needs to a social prescriber. The practice had 88 carers (0.5% of the practice population) on their register who received a carers pack and were prioritised for annual vaccinations. All staff had completed mandatory training on recognising and responding to Sepsis. Sepsis is a serious condition in which the body responds improperly to an infection which can be life-threatening. The practice displayed posters of the UK Sepsis Trust assessment guide in every clinical room.

The practice planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. The practice had a large transgender population and staff undertook shared care agreements with external providers of transgender care including bridging prescriptions, based on guidance from the National Institute for Clinical Excellence (NICE) and the British Medical Association (BMA).

Our review of clinical records showed that all monitoring of people with Asthma, Diabetes, Chronic Kidney Disease and Hypothyroidism was carried out in-line with current guidance. Staff worked to maintain people’s safety by carrying out monthly searches of the clinical systems to identify people who required monitoring or review. There was an extensive program of audit and quality improvement, this ensured that care was being delivered in line with best practice. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. All staff we spoke to described how they use a variety of evidence databases to maintain up-to-date clinical knowledge and shared information at clinical meetings. As a teaching practice they provided individual clinical supervision and weekly tutorials for GP trainees which any clinical staff could attend. The practice provided a regular program of health education sessions for their PPG.

Staff always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care. The practice worked with other services to ensure continuity of care for example bridging prescriptions for transgender people. There were clear and effective referral pathways such as “Right to Choose” pathway for adult ADHD and autism assessments which had significantly reduced the waiting time for people.

We saw that communication between staff was open and frequent, for example in the daily huddle meeting which had standing agenda items such as discussion of complex or vulnerable patients, clinical issues and safeguarding. Staff were given protected time for these brief but useful meetings which were well attended, minuted and included all teams, in addition to a weekly clinical meeting. Communication was facilitated through a ‘WhatsApp’ group where staff shared urgent and general information and useful clinical updates. All staff stressed that no identifiable patient information was ever shared on this group.

There were regular multidisciplinary team (MDT) meetings with Health Visitors, District Nurses, and staff at the local hospice. The practice had close links with local universities for example they had a stall at university open days. Staff worked closely with a service provider for homeless people (Health Exchange) and signposted homeless people there. Staff told us there were clear channels to share information to and from out of hours services. Staff at Urban Health Primary Care Network (PCN) described the practice as a “valuable member who fully participate in locality and PCN meetings.” Ulster and Aston Universities described their partnership with the practice as valuable and positive and told us that staff are always professional, approachable, and willing to go the extra mile to assist them.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. The practice supported people to live healthier lives and where possible, reduce their future needs for care. Staff focused on identifying risks to people’s health, including those who are (or might be) vulnerable such as transgender people and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, for example staff frequently referred people to local weight management programs. Funding had recently been withdrawn for their smoking cessation service and now people were signposted to local organisations for support in quitting.

The practice had a lively program of health education through its PPG, inviting a range of speakers such as a Dementia specialist from the local hospital. The practice had a social prescriber who organised events such as a recent carer support session. The practice played an important role in educating international students, refugees and asylum seekers about how the NHS works and how to navigate it.

We saw a range of self-help information on the practice website. There was information in the waiting room about self-care and support services however it was all in English. There was no information about interpreters or chaperones in other languages or about cancer screening programs. However, staff told us that a waiting room display about cervical screening was planned as the practice had identified that international students particularly, did not understand what this was as it is called a “pap smear” in other countries and this caused an issue with compliance. Staff took part in charitable awareness-raising events such as the Glow Walk for mental health and Breast Cancer Awareness Day.

The practice routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met clinical expectations and those of patients. This provider took over the practice under a new CQC registration in May 2023. CQC data on cervical screening is a snapshot from June 2023 which does not accurately reflect the practice’s performance under this provider. The practice provided evidence of their action plan to improve uptake of cervical screening, especially in the 25-29 age group. This included education of international people as to what cervical screening is, why it is important, who should have it and why screens done abroad are not accepted by the UK National Screening Program, providing evening and weekend clinics, robust call and recall systems and alerts to inform any clinician that screening is due so they can encourage the patient to attend. There were comprehensive systems in place to ensure that a result was received for every cytology sample taken and that abnormal results were followed up.

CQC data for childhood immunisations covers the period from 01/04/2022 to 31/03/2023 and is therefore not relevant to this provider. Unverified data provided by the practice showed an increase in uptake of childhood immunisations and leaders told us they have improved the processes by which children are identified and called for appointments using the “Good Housekeeping Guide” provided by the ICB and Child Health Information Service (CHIS). Administration staff had been trained in how to request an immunisation history for children born abroad and there was a robust “child not brought” policy.

The practice monitored outcomes for patients through an extensive programme of audits. For example, reviewing the prescribing of correct doses (based on guidelines) of ferrous sulphate (a form of iron), ‘Epi-pens’ (for the emergency treatment of severe allergic reactions), SGLT2 inhibitors (a medication to reduce blood sugar for Type II Diabetes), lipid management ( for example cholesterol) and hypnotic medicines and sleeping tablets (medicines prescribed for anxiety and sleep disorders which can be addictive).

The practice told people about their rights around consent and respected these when delivering person-centred care and treatment. People we spoke with and the evidence we reviewed did not raise any concerns around consent. People understood their rights about consent to the care and treatment they were offered. Clinicians understood the requirements of legislation and guidance when considering consent. Clinicians supported people to make decisions ensuring their views and wishes were considered during care planning. Assessments of mental capacity were carried out when needed and were decision-specific. Staff told us they were able to adapt or translate information about care and treatment so that people could understand, to support them making informed decisions. All staff we spoke to had completed relevant training and were able to discuss how to gain informed consent for treatment.

We reviewed a random sample of staff training records which showed staff had up-to-date training on informed consent, the 2005 Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). We saw that consent was documented and processes were in place for chaperones to be present if requested. We reviewed a random sample of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and found that they were made in line with relevant legislation, were appropriate and reviewed regularly. Staff made decisions within the requirements of the Mental Capacity Act 2005 including the duty to consult others such as carers, families and/or advocates, where relevant.