Windhill Green 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

Patients were involved in assessments of their needs. Staff reviewed assessments taking account of patient’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in patient’s care for the best outcomes and smooth transitions when moving services. Staff made sure patients understood their care and treatment to enable them to give informed consent.

At our last assessment, we rated this key question as outstanding. At this assessment, the rating has changed to good. At this assessment we found that some of those areas previously regarded as outstanding practice were now embedded throughout the majority of GP practices. Whilst the provider had maintained this good practice, the threshold to achieve an outstanding rating had not been reached. The practice is therefore now rated good for providing effective services.

At this assessment, the rating has changed to good.

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.

The service made sure patient’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 above local and national averages. For example, 89% of respondents reported that the healthcare professional they saw or spoke to was good at listening to them at their last general practice appointment compared to the local and national averages of 87%. We discussed individual care with a member of the Patient Participation Group, and they confirmed with us that staff at all levels communicated well with them as a patient, and worked closely with them to assess needs, and explain treatments.

Staff were aware of the health and care needs of the local community they served, and checked patients’ health, care, and wellbeing needs during booking into the service, and during consultations. The practice worked either individually or with others to support some of their most vulnerable and complex patients. For example, they supported 5 care homes and engaged with patients and carers at these homes to assess need and deliver care. In addition, they proactively assessed the needs of palliative care patients, regularly updating care plans and liaising with other stakeholders. At the time of our assessment the practice supported 198 patients who were recorded on their palliative care register.

The practice used clinical triage to assess patient needs and had developed and adopted a policy for this. It outlined their approach to patients requests for appointments including home visits. Members of staff working on reception had received training in care navigation which allowed them to signpost patients to more appropriate services.

The effective assessment of need was supported by services such as translation and interpretation provision, and the availability of hearing loops in all sites.

Staff were able to refer patients with social needs, such as those experiencing social isolation or housing difficulties to a social prescriber, or other local providers when they identified unmet need.

The service planned and delivered patient’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.

Overall clinical records we reviewed during our CQC remote clinical searches showed that care was provided in line with this guidance. Patients with chronic kidney disease and diabetes for example were well managed and medication reviews were undertaken well. We did though note that when we checked 5 records of asthma patients who had been prescribed 2 or more courses of rescue steroids that in 2 cases patients had not been issued steroid cards or received a necessary follow up. When we raised this the practice told us this would be actioned, and a pop-up reminder was developed for the issue of emergency steroid cards.

The practice had systems and processes in place to support the delivery of evidence-based care and treatment. This included the use of clinical templates which were regularly updated and aligned with guidance, and the use of a standardised clinical pathways and referral template. The use of this latter tool ensured referrals carried the correct information and were directed to the appropriate service. This reduced the number of referral rejections experienced.

The practice used clinical audits and ran regular safety searches to assess compliance and drive quality improvement. These were shared along with other important developments and changes to guidance at monthly in-house education meetings. Changes to guidance were also communicated to clinicians at team meetings, and via weekly primary care bulletins. We saw evidence that changes had been made to practice processes following either new guidance or changes to existing guidance. For example, the practice had developed a pop-up to remind clinicians to ensure contraception advice was given to patients of child-bearing age in receipt of teratogenic medicines (these are medicines which can cause birth defects or developmental disorders in a foetus). Information, learning and guidance for staff was also available on their in-house learning hub which was located on their digital management platform.

The service worked well across teams and services to support patients. They shared thorough assessments of needs when patients moved between different services to ensure appropriate care and treatment was provided.

Clinical staff had access to the information they needed to appropriately assess, plan, and deliver care, treatment, and support. This work was supported by the use of standardised clinical templates and their own processes and clinical record developments such as pop-ups to remind staff of important information to consider when treatment planning. We heard how the practice worked closely with others such as the district nursing and palliative care teams and delivered services in conjunction with their primary care network.

The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients 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 supporting those with caring responsibilities.

The provider delivered a range of health assessments which included NHS health checks, new patient checks and learning disability health checks.

We saw during our CQC 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.

Both clinical and front-facing non-clinical staff had been trained and could refer or signpost patients with specific needs to other organisations. Working with others, the practice had access to social prescribers, health and wellbeing coaches, drug reduction services, and mental health support for young people. In addition, we saw that the service hosted and brought specialist community services into the practice. As examples, these included dermatology, musculoskeletal services, eye screening, and audiology.

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

We saw that the practice showed high Quality and Outcomes Framework (a national voluntary annual reward and incentive programme for all GP practices in England, detailing practice achievement results) performance. In 2024/25 the practice achieved a score of 97.4% against the relevant indicators.

The practice met national targets for child immunisations. We saw that effective processes were in place to call in children for immunisations and that practice staff worked with others such as health visitors to encourage uptake. We saw that 98.5% of those aged over 80 years old had received a shingles vaccination.

Breast and bowel screening rates for patients from the practice were also above national averages. For example, in 2022/23 75.7% of eligible patients aged 53 to 70 had received breast screening compared to a national average of 74.4%. It was though noted that the latest published data for mid-2024 showed that cervical screening rates were slightly below the national target of 80%. At 75.6% of 25 to 49 year olds, and 78% of 50 to 64 year olds. Staff from the practice told us that they were working to increase take-up in this area through proactively contacting patients with repeated invitations and offering both opportunistic and extended hours access to screening. Home screening was also available to learning disability patients and those who were housebound. Current unvalidated data sent to us by the practice during the assessment showed that current progress in 2025/26 was either in line with or slightly above national averages for cervical screening. We saw that the practice closely monitored performance for screening and immunisations and ran regular searches of the clinical system to support this work.

From our CQC remote clinical searches, we saw that patients with long-term conditions such as diabetes were being well managed. After undertaking a population needs assessment the practice had redesigned their approach to supporting patients with long-term conditions such as respiratory patients or those with diabetes and hypertension. Actions included a move to a hub model of care concentrating staff into specialist interest teams based on expertise, and with the ability to better share knowledge and learning. Moving to a digital first approach which will enable patients to receive SMS links and book themselves directly into appointments, and increasing the use of pre-appointment questionnaires to assess need and type of appointment required.

Working within their primary care network (PCN) Bradford North (which consists of this practice and 1 other) the practice delivered effective care to some very vulnerable patients including those at the end of life. For example, their proactive care team (PACT) supported vulnerable patients, including those with complex needs, those at risk of deterioration, and those nearing end of life. PACT was composed of a multiagency team of health coordinators and other professionals. Activities included detailed holistic assessments of patient needs, referrals to other services, and close working and liaison with clinical teams. We saw indications that PACT, in conjunction with other services such as the Marie Curie Responsive Emergency Assessment and Community Team (REACT), were having a positive impact on patients nearing end of life. Using recent data, we saw that patients in the end of life cohort from the North Bradford PCN had significantly lower calls for support than other locality PCNs for these patients. For example, Bradford North patients in this cohort had an average number of 1.7 999 calls compared to averages for other PCNs ranging from 1.8 to 2.4, and 0.9 non-elective admissions per patient compared to other PCN averages of 1.3 to 2.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment. The practice had developed and adopted a consent policy which had last been reviewed in June 2025, and which outlined the practice’s approach to consent processes. In addition, it had developed procedural guidance for photography and making use of visual recordings of patients which followed that of the General Medical Council.

As part of our assessment, we spoke with clinical and non-clinical staff, and they all had a detailed understanding of consent. Most consent was either implied or verbal, although the practice required written consent for more complex or invasive treatments such as minor surgery or the fitting of implants. Considerations regarding consent were also given when providing care to children and young people, and the need to assess the mental capacity of patients to give consent. We saw that staff had received appropriate training in the requirements of mental capacity legislation and best practice principles.

During our CQC remote clinical searches and our onsite visits we examined 5 patient records, and saw that ReSPECT forms (Recommended Summary Plan for Emergency Care and Treatment – a document which holds personalised recommendations for a person's clinical care in an emergency), which included decisions related to Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were both accessible to staff, and had been completed in line with relevant legislation.