Dalton Surgery

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, we rated this key question as requires improvement due to identified concerns which included not effectively assessing patient needs, and undertaking only limited quality improvement activity. At this assessment, the rating has changed to good, although there are some areas where the practice needs to make improvement.

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.

The practice made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patient feedback from the 2025 National GP Patient Survey indicated that satisfaction with how the practice worked with them to assess their needs was generally in line with local and national averages. For example, 88% of respondents reported that the healthcare professional they saw or spoke to was good at listening to them at their last general practice appointment, this compared to local and national averages of 87%. Feedback from a representative of the Patient Participation Group confirmed that as a patient, practice staff had worked closely with them to assess their specific needs, and explain treatments.

Members of staff working on reception had received training in care navigation which allowed them to signpost patients to more appropriate services, and patients were also able to utilise a digital triage and online consultation platform to securely submit medical symptoms or administrative requests to have their clinical needs assessed.

The practice had effective systems to identify patients with previously undiagnosed conditions. Our remote clinical searches showed the practice had good performance with no missed diagnoses of diabetes being identified.

Patients with communication needs were considered, and they were supported accordingly, for example through the provision of a hearing loop, and the use of interpretation and translation services. To assist in the management and assessment of the ongoing needs of patients we saw that the practice maintained registers of vulnerable and complex patients such as end-of-life care patients, and patients with a learning disability.

As part of our assessment, a CQC GP specialist advisor (SpA) undertook a series of remote clinical searches to patient records. This was to assess the practice’s processes and procedures in relating to the management of patients with long-term conditions. This included patients with hypothyroidism, asthma, chronic kidney disease and high-risk diabetes.

Overall, we found that patients with long-term conditions were being monitored and supported. For example, all patients diagnosed with chronic kidney disease levels 4 and 5 (patients with a severe loss of kidney function) had received timely monitoring and no patients were overdue monitoring. Performance in this area had improved since our last assessment in 2025 when 7 patients had not received necessary blood monitoring within the previous 12 months. However, we also identified some areas of care and monitoring which required improvement. For hypothyroidism we identified 6 patients out of 303 in total who were overdue thyroid function test monitoring (this was an improvement from 45 patients identified in 2025). Though, in 4 out of 5 records we examined we saw that these patients were overdue medication reviews. We also reviewed records for patients who had received 2 or more courses of oral steroids for asthma exacerbations in the last 12 months. From a selection of 5 records, we saw that in only half the prescribing instances (4 out of 8) was a consultation documented. All these patients had though received an annual documented asthma review. Finally, for patients with high-risk diabetes we noted that whilst all 5 patient records we examined showed that patients had received appropriate follow-up of their raised HbA1c, 3 did not have a coded annual medication review noted. Following feedback, the practice told us that moving forward oral steroids would not be issued to patients without an assessment by a clinician, and that once assessed that the prescribing decision would be documented. In addition, for patients with hypothyroidism, that they would ensure that medication reviews were appropriately coded when undertaken.

We saw that the practice had systems in place to ensure staff were up to date with evidence-based guidance and legislation, and that this was both disseminated to staff, and discussed at clinical meetings, as well as forming the basis for future clinical audits.

The practice worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. We saw that processes were in place to monitor referrals to other services such as urgent suspected cancer referrals. Staff from the practice worked with wider health care teams to support vulnerable patients or those with complex needs.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. In addition, the practice 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, patients who were at risk of developing a long-term condition, and those with caring responsibilities.

The practice delivered a range of health assessments which included NHS health checks, learning disability health reviews, carers health checks, and health checks for persons on the severe mental illness register.

Staff had been trained, and could refer or signpost patients with specific needs to other organisations for services such as weight management and stopping smoking. Working within their primary care network (PCN), the patients were able to access support from social prescribers including a mental health social prescriber, and health and wellbeing coaches. Their PCN also facilitated a Monday Club at a nearby venue with numerous drop-in activities to improve wellbeing and reduce social isolation.

We saw during our remote clinical searches that processes were in place to diagnose and support patients at risk of developing conditions such as diabetes and chronic kidney disease.

The practice regularly monitored people’s care and treatment to continuously improve it. They sought to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Since the last assessment we saw that the practice had improved some areas of performance. For example, clinical decision making by non-medical prescribers were now subject to audit and assessment. However, it was noted that there were some areas of performance where improvement was still required.

Overall, we found that patients with long-term conditions were being monitored and supported, with only minor areas of minor concern noted. and that patients in receipt of specific medicines which required regular monitoring had received the necessary testing and monitoring in a timely way. Practice staff regularly ran searches to identify patients who required monitoring and reviews, and had recall processes in place to invite patients for monitoring.

The practice performance was below 1 of 2 national targets for cervical screening, and had met the other. The latest published screening performance (30 June 2024) showed 73.9% of 25–49-year-olds and 80.3% of 50–64-year-olds had been screened against a target of 80% for both age groups. We discussed cervical screening with staff from the practice; we were told that staff worked hard to engage with patients and promote screening. Patients were contacted by the practice on a routine basis as well as opportunistically, and patients were able to access cervical screening appointments on a Saturday clinic. Latest data shared with us by the practice showed that 2025/26 Quality and Outcomes Framework performance for cervical screening indicated that 73.4% of 25–49-year-olds and 82.8% of 50–64-year-olds had been screened.

Child immunisation performance was satisfactory with all 5 target measures exceeding the 90% minimum target. The practice informed us that they had measures to escalate concerns regarding the failure to vaccinate children or if children missed planned appointments. They had also appointed a staff member who as part of their role followed up with parents and carers when children missed immunisation appointments.

The practice had processes in place to promote patient participation in national cancer screening programmes. Data from 2024/25 showed that bowel cancer screening rates were 77.4% compared to a national figure of 71.8%. Breast cancer screening rates were 66.7% which was below the national rate of 70.4%.

At the previous assessment in 2025 we reviewed the performance dashboard of the practice’s local Integrated Care Board (ICB) and saw that the practice was an outlier for some areas of performance. At this assessment we saw that performance had shown an improvement overall. For example, the percentage of dementia care plan reviews undertaken had risen from 65.8% to 72.6%, and the percentage of patients on the severe mental illness register with all health checks complete was now 43.1% having previously been 18.9%.

Patient responses to the 2025 National GP Patient Survey indicated that they felt they were supported by local services with 75% reporting that they felt they had enough support from local services and organisations to help manage their long-term conditions or illnesses, which was above the local average of 70% and the national average of 69%.

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

As part of our assessment, we spoke with a range of clinical and non-clinical staff. From these discussions we found that they had a detailed understanding of consent. Most consent within the practice was either implied or verbal, although the practice required written consent for more complex or invasive treatments such as minor surgery. Staff also considered consent issues when providing care to children and young people, and the need to assess the mental capacity of patients to give their consent to care and treatment including referrals.

We saw that staff had received appropriate training in the requirements of mental capacity legislation and best practice principles, including the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff had also received information governance training, and were aware of consent processes for the sharing of patient records.