Haltwhistle Medical Group

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 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 provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. The provider supported people to live healthier lives and where possible, reduce their future needs for care and support. Leaders and staff had taken time to learn the needs of the population. This included a large number of elderly people with a high prevalence of long term conditions. The provider had employed a care co-ordinator who worked closely with the local community. This included a clinic which patients could request an appointment in. Examples of positive outcomes include, helping patients set up the NHS App.

The provider carried out a scheduled search on those patients over 75 years old who had not contact with the practice for 3 years. Any patients identified were contacted by the care co-ordinator. In 2025 the provider identified 14 patients who met this criteria. In 2026 there was 4 patients identified. We reviewed evidence which demonstrated positive outcomes for patients, specifically those who lived in hard-to-reach areas. We saw an example of a patient who despite efforts from the practice had not had any clinical input for close to 5 years. We reviewed a 2 year timeline of this patient’s care, which indicated they had been diagnosed, given a medication plan and had further input with clinicians booked.

The local area was rural with no access to a local care home. Practice staff visited the community hospital twice a day to provide care to patients who were on an admission avoidance ward, or receiving end of life care. The provider offered home visits to all patients who requested them.

Staff focussed on identifying risks to people’s health, including those in the last 12 months of their lives and those with caring responsibilities. Staff ensured when implementing an emergency healthcare plan, that admission to the local hospital was clearly documented if the patient requested it. This helped to promote long-term continuity of care for patients.

Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. The provider recognised that due to the rural area, attending support groups could be challenging for patients. They had therefore made it possible for patients to access weight loss and diabetic support groups online. Staff were also able to signpost patients to a local stop smoking support group. The provider also contributed articles twice a year for a local newsletter. The most recent of these discussed the NHS App, the benefits of patients using it and invited patients to come into the practice if they needed assistance with it.

The provider identified shift workers as a hard to reach group and had a date planned to go into the local factory on all 3 shift patterns to offer on the spot monitoring and screening for conditions such as high blood pressure and pre-diabetes. This work will take place in Autumn 2026.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive, consistent and met the expectations of people themselves.

The provider met national targets for the uptake of childhood immunisations as well as cancer screening programmes, including screening for breast, bowel and cervical cancer. The practice had a structured approach to engaging with people who may experience barriers in accessing healthcare. These patients were offered an appointment with the care-coordinator to discuss concerns around cancer screening. We reviewed 2 examples whereby patients had an appointment with this member of staff and went on to receive appropriate screening.

The provider offered adjustments for patients with a learning disability At the time of inspection the provider had completed annual reviews for 86% of this cohort of patients. Four patients were awaiting review, and these were planned to take place when they were due.

The had a structured recall plan to reach patients who previously had not attended an appointment.

We reviewed evidence which indicated the provider monitored patient outcomes using 2 cycle audits. A recent audit looked at contraception recall for women. It initially identified a number of coding issues. As a result a new system was implemented which would alert staff if women needed to make an appointment for contraception to be changed. All staff were made aware of this, and the system was embedded in practice.

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.