Cockfosters 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 practices to achieve this.

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

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 practice made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.The practice operated a hybrid triage system for patients contacting the practice for an appointment. This was achieved by using structured care navigation, information collection from patients and appointment management processes to ensure patients were directed to the most appropriate clinician.Reception staff were trained in care navigation and used defined in-house guidance, to signpost patients appropriately. Consultation requests submitted using the practice’s website were reviewed daily and actioned within 48 hours. Staff checked people’s health, care, and wellbeing needs during health reviews and consultations. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.We looked at several medication reviews undertaken by the practice and found all reviews had been completed in line with national guidelines.The practice had systems to identify people with previously undiagnosed conditions. For example, people whose blood tests results showed they had pre-diabetes were offered appointments to advise them how they could prevent it developing into diabetes.The practice used digital flags within their care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

The practice 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 that overall care was delivered in line with current guidance. Staff had access to local and national guidelines which could be accessed easily through online platforms with links to guidance also available through clinical systems. We viewed the clinical meeting minutes of the last six months and saw shared learning during these meetings. Discussions related to clinical learning was recorded.

Overall, staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. However, we identified during our remote clinical records review that appropriate monitoring for patients diagnosed with chronic kidney disease (CKD) was not consistently being undertaken in line with national guidance. We identified five patients (out of 43) who had not had a blood test within national timeframe standards. We spoke with the practice regarding this and emphasised the importance of maintaining regular monitoring and testing of patients on this medicines and asked them to take action.

We also reviewed clinical records for patients diagnosed with diabetes whose last recorded blood glucose level readings were above 75mmol. Our search identified 40 patients who were within the search criteria. We reviewed 5 patient records and found that they were monitored in line with national guidance.

Staff told us they held clinics to support people with long term conditions such as asthma, diabetes and chronic heart disease. They told us they used local and national guidelines and kept up to date through training and updates circulated within the practice.

The practice worked well across teams and practices 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 practices. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. Referrals to secondary care, community practices, and social care were made using standardised electronic referral pathways to ensure timely and accurate transfer of clinical information.

The practice worked with other practices to ensure continuity of care, including where clinical tasks were undertaken by other practices. People had access to practices provided by the primary care network (PCN) such as extended access appointments, social prescribers, social workers and community nursing team.

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.

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 practice 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.

Similarly, national data collected on 31 March 2025 showed the practice did not meet the minimum recommended level of 95% for all 5 childhood immunisation indicators. The practice achieved above 80% uptake for 4 of the indicators but less than 90%, with 1 indicator showing the practice as achieving less than 80% uptake. The practice provided us with unverified data for the uptake of childhood vaccinations up to the end of March 2026 which showed an increase in uptake of childhood vaccinations.

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

Patients on the palliative care register had individualised care plans on the practices clinical system. Relevant patients also had a copy of their care plan, which included clear escalation instructions in the event of an acute medical event, advance care planning decisions and guidance on how to contact the practice, out-of-hours practices, or emergency practices.

Where appropriate, patients were offered a chaperone for care and treatment. During our site visit we saw chaperone posters were displayed to inform patients of this practice. Staff providing this practice had completed relevant training.