Dartmouth Health & Wellbeing 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

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment in April 2016, we rated this key question as Good. At this assessment, the rating remains unchanged.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. When a person did not have capacity to make a decision, a best interest process was followed, which involved representatives for the person.

This service scored 75 (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 were effective. They appropriately checked and discussed people’s health and care needs with them.

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.

Staff and leaders were aware of the needs of the local community. The service had implemented a digital triage system (the use of online forms and secure messaging to direct patients to the most appropriate care) and recognised that people may support during the transition, further support was provided by the PPG to enable people to navigate the new system. The service offered people the option of contacting the service by telephone or in person if they were unable to access online services to have their needs assessed.

Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

Staff checked people’s health, care, and wellbeing needs during health reviews. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber (Social prescribing is an all-age, whole population approach that works particularly well for people who: have one or more long term conditions; who need support with low level mental health issues; who are lonely or isolated; who have complex social needs which affect their wellbeing). Feedback from people using the social prescribing services was positive.

The service also had access to Dartmouth Caring, who supported those in need, with the aim of helping people to live their lives as they choose, reducing feeling of isolation, and improving emotional and physical health and wellbeing. Services included a wide range of support. For example, social activities, transport, health events, and home visits.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP Specialist Advisor. These search criteria are freely available for practices to access at any time.

We evidenced during the clinical searches that there were effective reviews and monitoring of people with asthma and diabetes. However, some improvements were required for those with previously undiagnosed conditions and long-term conditions.

We reviewed the records of people with hypothyroidism (also called underactive thyroid; when the thyroid gland does not make enough thyroid hormones to meet the body's needs) who had not had a thyroid function blood test monitoring with the last 18 months. We evidenced 1 out of 5 records reviewed had not had the required blood tests.

We reviewed the records of people with a missed diagnosis of diabetes. We evidenced 1 out of 5 records reviewed the person had not been informed of this.

Following our clinical searches, we obtained evidence at our site visit, which showed these people’s clinical records had already been reviewed, with information of people having attended appointments for reviews and the required testing/monitoring having been actioned.

The service always 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. They worked to develop evidence-based good practice and standards.

Clinical staff had access to relevant national and formulary (comprehensive information used by healthcare professionals to promotesafe, effective, and cost-efficient prescribing of medicines and treatments) guidance, as well as local policies/guidelines and used this information to help ensure that people's needs were met.

Staff told us they received regular updates about evidence-based care and treatment from leaders at the service. Where there were changes in process guided by learning at the service, staff told us that they were informed and involved in implementing changes.

As part of our assessment, a number of set clinical record searches were undertaken by a CQC GP Specialist Advisor.

We identified during the clinical searches there were effective reviews and monitoring of patients following receipt of Medicines and Healthcare products Regulatory Agency (MHRA) alerts. For example, those relating to diabetes. However, some improvements were required to ensure a consistent approach to these. We reviewed the records of people prescribed a nonsteroidal anti-inflammatory drug (medicines used to reduce pain, fever, and inflammation) in people aged over 65 years or anti-platelet (medicines that prevent blood clots) in people aged over 75 years. Both medicines increased the risk of digestive tract bleeding. We evidenced that 3 out of 5 records reviewed had not been prescribed a proton pump inhibitor (medicines that protects the digestive tract from bleeding).

Following our clinical searches, we obtained evidence at our site visit, which showed that these people’s clinical records had already been reviewed, with information of people having reviewed and these medicines prescribed if deemed clinically appropriate.

Staff were aware of the need to complete accurate and full records, so that information did not need to be repeated by people to different services.
People received coordinated and person-centred care. This included when they moved between services, when they were referred, or after they were discharged from hospital. Care and treatment for people in vulnerable circumstances was coordinated with other services. There were established pathways for staff to follow to ensure people’s needs were met.

Multidisciplinary meetings took place that included all practices within the Primary Care Network (a group of GP practices that work together with other local health and social care organisations to provide integrated services for their communities).

The service had dedicated a care home team to provide continuity of care for people living in care homes. This had resulted in a reduction in hospital admissions and people being able to be cared for in a familiar environment.

There were clear and effective arrangements for booking appointments and transfers to other services.

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.

Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, people at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

Through referrals to Dartmouth Caring, people could access support from alcoholics anonymous, breast cancer support and other support groups and networks.

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

The service had not always met 1 of the 2 national targets for cervical screening of 80%. The provider was aware of the population of its service and had undertaken a project to promote cervical screening. The service provided evidence of unverified data, with rates for 2025/26, showing a 5% increase (from 77% to 83% for the eligible population aged 25 to 49 years old).

The practice had achieved the World Health Organisation (WHO) recommended rate of 95% for 4 of 5 childhood immunisations. They had not achieved this for aged 5-year-old Mumps, Measles and Rubella (MMR) childhood immunisations, having attained 87.7%. The provider was aware of the population of its service and had undertaken initiatives to increase this. For example, children who were not brought to appointments were followed up with contact made with their parent or carer and promotion of the importance of childhood immunisations. Families were encouraged to take up the offer of vaccination for their child. Nurses took time to address their concerns, providing evidence-based guidance and signposting to credible sources of information. This helped families to make an informed choice for their child.

The provider submitted evidence of 11 clinical audits which they had carried out to improve outcomes for people. These covered medicines, asthma inhaler usage and ADHD (attention deficit hyperactivity disorder) medicines monitoring and shared care compliance. Leaders and staff told us that audits were discussed at clinical meetings; this was confirmed in the minutes of the meetings we reviewed, which showed the findings were shared and learning outcomes/changes to practice or policies/procedures were cascaded to staff.

People did not raise any concerns regarding the practice seeking their consent to care and treatment.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making. Clinicians supported patients to make decisions.

Documentation in relation to minor procedures was appropriately completed to demonstrate informed consent had been obtained.

Relevant staff had been provided with training in the Mental Capacity Act. The service monitored the process for seeking consent appropriately and patient record searches demonstrated that consent was recorded appropriately. We reviewed Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions for 5 people and found they had been completed in line with relevant legislation.