Mayfield 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

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 good. At this assessment, the rating remains the same.

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 was effective by assessing and reviewing their health, care, wellbeing and communication 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.

Reception staff were aware of the needs of the local community. 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. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing.

Our remote clinical searches found the service had effective systems to identify people with previously undiagnosed conditions such as diabetes.

People with long-term conditions, including chronic kidney disease stage 4 or 5 (advanced stages) or hypothyroidism (an underactive thyroid), received the appropriate monitoring.

Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The service 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.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance. For example, we viewed 5 clinical records to look at people prescribed disease modifying antirheumatic drugs (DMARDs). (DMARDs are medicines to reduce inflammation and prevent joint damage) People who are prescribed DMARDs require regular monitoring, and we found all of them were reviewed appropriately.

The service 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.

The service held regular monthly department meetings, including administration, clinical, partner and whole team meetings to ensure all teams were up-to-date with relevant information and changes.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. Managers told us there was an open-door policy which enabled staff to raise concerns and queries in a timely manner which helped support a positive working relationship.

The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

People had access to other services provided by the local Primary Care Network (PCN - a local group of GP services working together with community health, mental health, social care, pharmacy, and voluntary services), such as social prescribers who signposted people to healthy lifestyle programmes and various organisations for financial or housing assistance.

Representatives from local care homes that the service worked with, provided overwhelming positive feedback about the consistent, supportive and timely communication they received weekly ward rounds and telephone conversations.

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, patients at risk of developing a long-term condition and those with caring responsibilities.

The reception and waiting areas displayed posters and leaflets with information designed to support people to make healthier choices.

The services website contained information and links to other sources of information to support people in making healthier choices.

Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

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.

Childhood immunisations data for 2024-2025 showed the service had exceeded the national target of 90%.

The service performed better than the England average in relation to bowel cancer screening. Data from 2024-2025 showed the service scored 75% against the England average of 70%.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance. People with long-term conditions were offered an annual review to check their health and medicine needs were being met.

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

Staff we spoke with demonstrated the importance of ensuring people understood what they were consenting to and the importance of obtaining and recording consent following the delivery of care or treatment.

We reviewed 6 Do not attempt cardiopulmonary resuscitation (DNACPR) forms which were completed to a high standard, with best interest decisions documented where required following appropriate capacity assessments. Peoples wishes and preferences were clearly recorded. Where DNACPR decisions had been completed in secondary care, GPs reviewed these to ensure they remained appropriate, valid and reflective of the person’s current circumstances.

Clinical and non-clinical staff had completed Mental Capacity Act 2005 training. Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded.

Decisions were appropriate and were made in line with relevant legislation.