Thornton Heath Medical Practice

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

At our last assessment, we rated this key question as Good. At this assessment, the rating has changed to requires improvement.
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. The practice was not consistently following recommended guidance for patients with diabetes.
Generally 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. Where patients didn’t have capacity, and staff took decisions about the patient’s care in their best interest, they involved those people who were important to the patient in the decision.
 

This service scored 62 (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 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. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.
For example, clinicians could offer weight management referral programmes, such as book and learn, which educated patients on what they should eat. The practice had a social prescriber who attended the practice twice a week.
The National GP Patient Survey found 90% of patients felt their needs were met during their last GP appointment compared to the local 91% and national 90%. 88% felt the healthcare professional they saw had all the information they needed about them during their last GP appointment compared to the local 93% and national 92%. There were systems and processes in place to identify patient’s needs and preferences. Patients were coded and an alert put on the system to highlight any specific needs such as the requirement for a longer appointment or the need for a translator.
 

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.
Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw generally demonstrated care was provided in line with current guidance; however, we did find that guidance was not always followed for example 1 search identified 110 patients with a long-term condition that had not been reviewed appropriately. Out of the 110 patients we reviewed a sample of 5 records and found all 5 patients were not being monitored in line with what was expected, there was no appropriate follow up. When we raised this with the practice, they explained that some of their patients were non-compliant with medication, they also devised an action plan and said they would review all patients identified and would involve a specialist team to assistant and set up a joint clinic to monitor these patients.
Another search identified 12 patients prescribed Nonsteroidal anti-inflammatory drugs (NSAIDs). We reviewed 5 patient records in detail and found all 5 patients did not have gastroprotection which is needed to reduce gastrointestinal (GI) adverse events. When we raised this with the practice, they said they would review these patients, discuss in a clinical meeting and look at how they can prevent this happening again.
We did not see any evidence that the practice had undertaken any 2 cycle audits, we did see some single cycle audits.
We reviewed 5 (DNACPR) records and found decisions were appropriate and were made in line with relevant legislation; however, we identified a coding issue, so when we searched for records not all were showing up. We also identified that some notes were not detailed or reviewed in a timely manner. When we raised this with the practice they informed us, they would review all records and monitor coding.
 

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.
 

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. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.
Data from the 2025 the National GP patient survey showed that 66% of people completing the survey felt they received enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. This was slightly below the local 70% and national 69% results. In addition, 69% of patients said the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment compared to the local 76% and national 74% results.
 

The service did not meet all national targets for screening and immunisations. At the time of our assessment, the latest published information from the UK Health Security Agency (UKHSA) showed that the practice did not meet the World Health Organisation target of 95% as 4 out of 5 childhood indicators were below 80% for the number of children immunised against various infectious childhood diseases.
The practice told us they worked with the PCN care coordinators to encourage patient uptake. The practice had also recently started to give nurses a list of patients due for screening or immunisations so nurse would now contact patients directly and educate them and book them in for appointments, the nurse feedback that she had noticed an improvement with patients attending. The practice also had a recall system and sent texts to patients with information about cervical screening.
The National GP Patient Survey results showed that 88% of respondents felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment compared to the local 93% and national 92%. 84% felt involved as much as they wanted to be in decisions about their care and treatment compared to the local 92% and national 91%. These results were lower than the local and national averages.
We did not see any evidence that the practice had undertaken any 2 cycle audits, however we saw single audits, however these did not demonstrate impact or quality improvement for patients.
 

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. All staff had completed mental capacity training.
Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. The GP told us that if there was doubt as to someone’s capacity, this was also recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.