Central 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, however there were some areas that the practice needed to improve.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. There were shortfalls in following recommended guidance with patients prescribed certain medication. For example, clinical searches were undertaken and out of 10 searches related to medications there were 2 areas of improvement.

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. Staff followed mental capacity act guidance involving those important to individuals in best interest decisions where the individual themself did not have capacity.

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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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. However there were some patients whose care and treatment needs were not always fully met. For example, from our review of clinical records for patients we found 1 patient did not have the required blood monitoring, 1 patient had a HbA1c which was just within the threshold for diabetes, 2 years previously and had not had a follow up blood test to confirm the diagnosis the practice did attempt phoning the patient several times, however no letter was sent.

Five patients did not have appropriate proton-pump inhibitors(PPIs) to reduce gastrointestinal (GI) adverse events.

The practice informed us they supported carers by offering social prescribing and actively offering the flu vaccination.

The practice undertook proactive reviews for dementia, learning disability and mental health adjusting appointment length to accommodate the needs of these groups of patients.

The practice was dementia friendly, veteran friendly accredited and a number of the non-clinical team had completed the mental health first aider training.

The practice worked closely with the Identification and Referral to Improve Safety (IRIS) domestic abuse advocate they informed us they were 1 of the highest referring practice in Merton and at the time of inspection was 1 of only 3 practices in Merton who were fully IRIS accredited.

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. The provider had effective systems to identify people with previously undiagnosed conditions. 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 overall care was provided in line with current guidance.

However whilst overall evidence-based practice was routinely being followed we reviewed a sample of 5 patients identified as having a potential missed diagnosis of diabetes and found 4 patients had been correctly coded as having non-diabetic hyperglycaemia (pre diabetes) and 1 patient who had a raised HbA1c (a measurement of too much sugar in your blood) which was just within the threshold for diabetes and had not responded to the request for a follow up blood test to be done for 2 years to confirm the diagnosis, the practice did attempt phoning the patient several times, however no letter was sent. The practice informed us they had a very high diabetes prevalence of 12% of its registered list size around 1200 patientsshowing its ability to detect and diagnose diabetes.

We also reviewed 5 patient records prescribed medication for high blood pressure and heart failure and found 1 patient did not have the required blood monitoring Once we raised these concerns with the practice they informed us; they had contacted these patients immediately.

We reviewed 5 patient records prescribed (Nonsteroidal anti-inflammatory drugs (NSAIDs) and found all 5 patients did not have proton-pump inhibitors (PPIs) to reduce NSAID-induced gastrointestinal (GI) adverse events. Although we only looked at 5 records the search revealed 26% of patients prescribed this medication did not have PPI. Once this was raised with the practice they addressed this immediately and contacted all necessary patients.

The practice had set up group consultations in (Tamil and English) to enhance diabetes care has multi-disciplinary meetings with the community diabetes specialist nurse.

The practice also participated in paediatric together clinics on behalf of the PCN with a local paediatrician.

We were also informed the practice participated in a Southwest London chronic kidney disease (CKD) pilot to increase prescribing of guardian medicines, and best practice updates were shared.

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.

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. Staff told us they worked collaboratively with their primary care network (PCN), they had done diabetes talks at the local temple. In addition to this the practice had participated in engagement work at the local mosque discussing blood pressure and cardiovascular disease. The pharmacist had also done talks about strokes.

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, for example patients could be referred to a national weight loss programme, smoking advise was given and the practice conducted diabetic screening every year.

The practice implemented an enhanced programme for early-onset type 2 diabetes, with targeted personalised interventions.

The practice had collaborated with the community services specialist dieticians to deliver in person sessions at the local temple focusing on diabetes and cardiovascular disease. One of the doctors was in the processing of finalising a book to provide education related to diabetes in both English and Tamil including culturally appropriate recipes, this had been written in collaboration with the diabetes specialist dieticians.

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.

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.

The practice did not meet all national targets for screening and immunisations however were very close to achieving the targets. 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.

The practice informed us the shortfall in achievement in relation to the children’s immunisations could be attributed to those parents who had opted to not have their children vaccinated. This was despite having been invited on several occasions and having had a discussion with the clinical team about this to enable them to have all the facts in order to make an informed choice. The practice had a robust policy for call and recall of children for immunisations. For failed immunisation attendance the health care assistant (HCA) monitored and invited patients to book them in.

Procedures also included documented conversation for parents with senior nurse/GP to explore their concerns and also liaising with health visitor.

The practice had undertaken a number of interventions to try and increase uptake of cervical smears, these included an offer of appointments with one of the GPs who was well known to a number of the patients for those particularly anxious about having a smear test done and also expanding nursing capacity to include evenings and weekends. The practice also sought feedback from the PPG regarding how it could improve uptake of cancer screening.

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

All staff (Clinical and non-clinical) had completed mental capacity act training. Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. We reviewed 3 (DNACPR) records and found decisions were appropriate and were made in line with relevant legislation.