Middlestown Medical Centre Also known as Dr Swan and Partners

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. We found that 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.

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.

Patient feedback from the 2025 National GP Patient Survey indicated that satisfaction with how the practice worked with them to assess their needs was generally above local and national averages. For example, 91% of respondents reported that the healthcare professional they saw or spoke to was good at listening to them at their last general practice appointment compared to the local and national average of 87%. This was confirmed when we spoke with a representative of the practice’s Patient Participation Group who told us that staff worked closely with them to assess needs and also explained treatment options with them.

The provider had adopted detailed care navigation and clinical triage processes and used these processes to initially assess need and decide on appropriate treatment pathways. Senior managers told us that they gave patients time to fully discuss their needs, and during appointments patients were not limited to raising single concerns. The provider’s flexible access and appointment processes supported this approach.

The provider had effective systems to identify patients with previously undiagnosed conditions. Our remote clinical searches showed that patients with long-term conditions such as asthma received regular reviews, and that care and treatment followed national guidelines.

The practice held registers of patients who were vulnerable or needed enhanced care and support such as palliative care patients, or those patients with a learning disability. They used these registers to effectively manage their care in coordination with other services. During the weekly clinical meeting held at the practice, clinicians and others had the opportunity to discuss patients with complex needs, and we saw that the practice held regular meetings with other stakeholders to coordinate care for those with additional needs.

The provider planned and delivered patient’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

Clinical records we reviewed during our CQC remote clinical searches showed that care was provided in line with this guidance. Patients with chronic kidney disease, asthma, and diabetes for example were well managed and patients were regularly monitored and reviewed.

We examined the potential for missed diagnosis of conditions such as diabetes and chronic kidney disease. In sample records we looked at we found no major concerns; however, it was noted that whilst patients at risk of diabetes or pre-diabetic were regularly monitored, they had not all been coded as such. We discussed this with the provider who informed us that they were aware of past coding issues and had measures in place to identify and reduce these. A significant action to tackle this had been the recent purchase and use of a software platform that automated patient monitoring and management processes, and supported the practice to track long-term conditions, manage and code patient treatment, and proactively recall patients for reviews and monitoring tests.

The practice had systems and processes in place to support the delivery of evidence-based care and treatment. This included the use of clinical templates which were regularly updated and aligned with guidance.

The practice used clinical audits and ran regular safety searches to assess compliance and drive quality improvement. These were shared along with other important developments and changes to guidance at weekly clinical meetings.

The service worked well across teams and services to support patients. They shared comprehensive assessments of needs when patients moved between different services to ensure appropriate care and treatment was provided.

Clinical staff had access to the information they needed to appropriately assess, plan, and deliver care, treatment, and support. This work was facilitated by the use of standardised clinical templates, and the ability of their clinical system to be accessed by stakeholders.

We heard how the practice worked closely with others such as health visitors, midwives, and palliative care teams and delivered services in conjunction with their primary care network.

The provider supported patients to manage their health and wellbeing to maximise their independence, choice, and control. The practice supported patients 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 who were at risk of developing a long-term condition, and supporting those with caring responsibilities.

The provider delivered a range of health assessments which included NHS health checks, new patient health assessments, serious mental illness checks, and learning disability health checks. Specific health clinics and services were available to patients which included well women clinics and joint injection services.

During our CQC remote clinical searches we saw evidence that processes were in place to diagnose and support patients at risk of developing conditions such as diabetes and hypothyroidism.

Senior clinicians told us that overall, they felt that the practice population was well informed of health issues. This was supported by the work of the practice, and we saw during our site visit that materials were displayed in the practice premises promoting health improvement. In addition, the Patient Participation Group took an active role in health improvement, and for example, had included an awareness raising article in their newsletter regarding dementia.

Clinical and front-facing non-clinical staff had been trained and could refer or signpost patients with specific needs to other organisations. As part of their primary care network, the provider had access to other health and care services such as social prescribers and care coordinators. In addition, we saw that the practice hosted and brought specialist community services into the practice, an example being the hosting of screening for abdominal aortic aneurysms (which checked for swelling in the aorta).

The practice routinely monitored people’s care and treatment to continuously improve it. They sought to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We saw that overall, patients with long-term conditions had been well managed and that processes were in place to identify, recall, and monitor such patients. As an indication of this, we found during our remote clinical searches that asthma patients had been reviewed regularly and received support when their condition worsened. Clinical audit was used to support improvement and quality assurance activity, and ensured treatment and outcomes were assessed in line with guidance. For example, the provider had undertaken a 2-cycle audit into complications following intrauterine contraceptive insertions (both IUS and IUD). Results showed low complication rates. Any learning points recognised were incorporated into future care planning to improve services.

The provider met national targets for child immunisations and vaccinations with 4 measures used to assess compliance being above the 90% minimum target and 1 measure above the 95% World Health Organisation target. The latest published data for mid-2024 showed that cervical screening rates were slightly above the national target of 80%. At 80.9% of 25- to 49-year-olds, and 83.9% of 50- to 64-year-olds. Practice staff told us that they worked hard to achieve targets and had effective recall procedures in place, including directly contacting patients to encourage participation, or through opportunistic interactions with patients.

Staff actively supported vulnerable patients for health checks and screening. For example, we saw that the practice had delivered learning disability health checks to 94% of patients on their learning disability register. The provider kept a register of carers and had identified 191 at the time of our assessment (around 2% of the practice population). Carers were offered additional service such as flu vaccinations.

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

The practice had developed and adopted a consent policy which had last been reviewed in July 2025. The policy outlined the practice’s approach to consent processes, including the practice approach to implied and expressed consent, and for dealing with consent for patients under 16 years old. Staff we spoke with had a good understanding of consent, including care which would require more detailed written consent, and the need to assess the mental capacity of patients in relation to their ability to give consent. To support this latter point we saw that staff had received appropriate training in the requirements of mental capacity legislation and best practice principles.

We examined 4 patient records and found that ReSPECT forms (Recommended Summary Plan for Emergency Care and Treatment – a document which holds personalised recommendations for a person's clinical care in an emergency), which included decisions related to Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were both accessible, and had been completed thoroughly in line with relevant legislation. ReSPECT forms completion was supported by a dedicated policy, and those completed by the provider were subject to audit. The last audit undertaken in October 2025 showed good overall performance with some minor learning points.