Highgate Group Practice

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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 looked for evidence that staff monitored people’s care and treatment and supported them to live healthier lives.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

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.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

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 and support. This support did not only relate to physical health but also to mental health.

The practice employed several psychotherapists which allowed them to provide an in-house therapy service for its patients. Referrals for therapy were made through GPs only. The practice told us that by having this service in-house, that it facilitated close working relationships between the clinical and therapy teams to provide joined-up care for the patient.

The practice told us that the therapy sessions consisted of more than one therapist working with individuals and families. This was to enable more than one perspective and instigate creative approaches to problem solving. Clinical records of patients receiving therapy were kept separate from medical notes, which allowed for confidentiality and a safe space for open discussions. This service had been in place for over 30 years and was available not only to registered patients at the practice, but also to the other practices within the local primary care network.

In addition, the practice ran an in-house counselling service for patients experiencing difficulties with their mental health. The counselling was delivered by an experienced counsellor based within the practice. Patients were referred directly by their named GP, again facilitating a close working relationship between the clinical team and the counsellor to provide the patient with a holistic care plan. Providing this service meant patients were able to access counselling in a timelier fashion, thereby reducing the wait for appointments with local NHS Talking Therapy services or secondary care mental health services.

The practice offered a regular in-house phlebotomy service for those patients the practice had identified as vulnerable. This included patients with physical and learning disabilities, and elderly patients. The practice told us this facility was in place to minimise travel barriers (to local hospitals) for patients if blood testing was required as part of their care.

The practice also ran a community gardening project. This was managed by the practice’s social prescriber and was based at the practice location. The project aimed to take advantage of the potential therapeutic benefits of using outdoor green spaces to improve mental well-being, combat isolation, and strengthen community ties. Patients taking part in this project were encouraged to take an active role regarding the management of the garden, partake in gentle physical exercise, and build new relationships with fellow participants.

Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. The practice website included links to self-care information on several health issues. Identifying risks to people’s health, including those in the last 12 months of their lives and those with caring responsibilities was actively monitored by the practice.

The practice routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive, consistent and met the expectations of people themselves. We saw that performance data was routinely monitored and reviewed at clinical staff meetings.

The practice held a weekly multidisciplinary meeting (MDM), allowing the clinical team to meet, to ensure delivery of effective, safe and co-ordinated care. An agenda was distributed in advance of these meetings which included a list of patient cases which required review and input from members of the clinical team. Leaders told us that the MDM’s ensured that patients with the most complex care needs were monitored regularly and their care plans updated as required.

The UK Health Security Agency (UKHSA) data for the period of 1 April 2024 to 31 March 2025 showed the practice had met the World Health Organisation (WHO) minimum recommendations for the uptake of 3 of 5 indicators relating to childhood immunisations. The other 2 indicators were less than 3% below the minimum uptake level. On the day of our assessment, the practice provided us with unverified data for the uptake of childhood vaccinations (for this clinical reporting year) up to the day of the assessment, which showed a consistent uptake of childhood vaccinations above 80%. The practice had a proactive recall system for patients who had not attended the practice for routine scheduled appointments.

NHS England data from June 2024 showed the practice had not met the target for uptake of cervical cancer screening for eligible patients aged 25 to 49 years (66%) or for eligible patients aged 50 to 64 years (71%). The target for both age groups was 80%. We noted (again) the practice had clear proactive recall systems for patients who did not attend screening appointments. On the day of our assessment, the practice provided us with unverified data for the uptake of cervical screening (for this clinical reporting year) up to the day of the assessment, which showed a consistent uptake of cervical screening of 80%. Screening appointments were offered at the practice and, under the local enhanced access scheme, at other locations across the borough during the evening and at weekends, to provide flexibility for working age patients.

The practice had GP partners with specialist training and experience in gynaecology and women’s health. They were able to offer consultations (and where required procedures such as coil fitting) relating to women’s health in house. This reduced the wait patients may have experienced if they were referred to secondary care.

There was a comprehensive list of clinics run by the practice which were available to existing patients. Other clinics, for example minor surgery, could be accessed by patients from other practices within the PCN.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.