Island 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 regularly assessed, and care and treatment were delivered in line with current legislation and evidence-based guidelines. The service had a programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. Staff worked collaboratively and with other organisations to deliver care and treatment.

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 systems in place ensured patients’ assessments were kept up to date, and staff had a clear understanding of their current health and care requirements. Patients were referred appropriately to ensure further evaluation and support where necessary. The service had mechanisms to identify and prioritise care for its most vulnerable individuals. For example, all patients with a learning disability were offered an annual health check, and reasonable adjustments were considered to support attendance. A register was maintained for patients with caring responsibilities, and the service worked closely with an on-site social prescriber to help them access community-based support. The service ensured care and treatment were effective by regularly reviewing people’s health, wellbeing, and communication preferences. Feedback from service users was positive, with many feeling involved in their assessments and confident that staff understood their personal and cultural circumstances. Reception staff were familiar with the local community and used digital flags in the care record system to highlight specific requirements, such as the need for longer appointments or interpreter support. Health reviews included checks on physical and emotional wellbeing, and clinical staff used structured templates to guide holistic assessments. The provider had systems to identify previously undiagnosed conditions, and staff referred individuals with social challenges, such as isolation or housing issues, to a social prescriber.

The service planned and delivered care and treatment with patients, focusing on what was important to them. Care was provided in line with legislation and current evidence-based practice and standards.Systems were in place to ensure staff remained up to date with guidance and legislation. Clinical records reviewed demonstrated that care was delivered in accordance with current guidance.

The most recent GP patient survey results indicated that patients felt they received effective care. A review of five patient records coded with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) showed that not all decisions were appropriately applied and documented. Two records did not include the DNACPR form in the clinical documentation. In one case, a patient was coded as DNACPR but had a resuscitation notice in their record, and another patient, initially coded as DNACPR, was later determined, upon further investigation, not to be a DNACPR patient. There was evidence of a multidisciplinary approach to the decision in one record. In February 2025, the provider introduced a DNACPR coding and record-keeping audit to assess compliance with appropriate coding and documentation processes. The audit highlighted areas which required improvement. The provider intends to conduct the audit at intervals ranging from six to twelve months.

The service worked effectively across teams and services to support patients. Staff ensured that people only needed to tell their story once by sharing assessments when patients moved between services.

Staff had access to all necessary information to deliver safe care and treatment. Clear policies and procedures were in place and readily available. Systems for sharing information with staff and external agencies supported safe care delivery. Staff liaised regularly with community teams, including health visitors, and mental health practitioners. Referrals to specialist services were documented, contained the required information, and were monitored to prevent delays.

The service supported people to manage their health and wellbeing, promoting independence, choice, and control. Staff helped people live healthier lives and, where possible, reduce future care needs.Staff focused on identifying health risks, including for patients in the last 12 months of life, those at risk of developing long-term conditions, and those with caring responsibilities. Staff supported national initiatives to improve population health, such as smoking cessation and tackling obesity.

Leaders used computer software to monitor weekly patient uptake for long-term condition reviews. Audits were conducted in areas identified for quality improvement, and findings were regularly discussed in clinical team meetings.

The service used EMIS searches to support continuous monitoring and improvement. Weekly clinical meetings were held to review patient outcomes, and findings were shared with the local Integrated Care System.

Clinical audits focused on prescribing safety, medicines management, and health condition monitoring, all aimed at improving patient outcomes. The provider also reviewed uptake rates for childhood immunisations and cervical screening.

Island Medical Centre was situated in an area where vaccine hesitancy was notably high among some minority ethnic communities. Between 1 April 2023 and 31 March 2024, the service did not achieve the WHO national target of 95% for five key childhood immunisation indicators. Uptake ranged from a high of 89% to a low of 78%.

Similarly, the national target of 80% for cervical screening uptake (based on NHS Digital data dated 30 May 2023) was not met.

In response, leadership acknowledged these shortfalls and implemented a targeted action plan. This included appointing a dedicated staff member to manage the recall system, which involved sending text messages containing information and a self-booking link to encourage participation.

Although the data for the following year was unverified and not directly comparable to nationally validated figures, early indications suggested the service was on track to meet its targets.

Clinicians understood the requirements of legislation and guidance when considering consent and decision-making. Consent was documented, and clinicians supported patients in making informed decisions. Where appropriate, mental capacity assessments were carried out and recorded.

A review of five DNACPR decisions confirmed they were made appropriately and in line with legislation. Most staff had completed training on the Mental Capacity Act.