The Grange Practice

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 patients in decisions about their care and treatment and provided them with advice and support.

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

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 practice made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patient records we looked at showed they were appropriately coded and flagged to alert staff to individuals’ needs and preferences. Vulnerable groups were proactively invited for health checks, such as carers and those with long term health conditions.

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.

Staff checked patient’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of patient’s wider health and wellbeing.

Staff referred patients with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

There were not established and effective systems in place for the monitoring of some patients with long-term conditions. Our remote clinical searches conducted on 11 September 2025 identified 78 patients diagnosed with hypothyroidism who had potentially not received necessary monitoring in the last 18 months. We reviewed a sample of 5 patient records and found all 5 patients were overdue monitoring tests. After the assessment, the practice reviewed all patients and took action where needed. The provider also told us they developed a new protocol help improve monitoring. However, the system had not yet been fully embedded, so we were unable to assess its impact. This will be reviewed at future assessments once it is fully established.

We also identified there were 15 patients diagnosed with chronic kidney disease stage 4 or 5 who had potentially not received the required monitoring in the last 9 months. We reviewed a sample of 5 patient records and identified 4 patients had not been monitored in line with national guidance. After the assessment, the practice reviewed all patients and took action where required. The provider told us that in some cases, reduced or absent monitoring were due to patients not attending appointments or because clinical decisions had been made to adjust the monitoring schedule based on individual circumstances.

We saw care and treatment was delivered in line with national guidelines for patients diagnosed with diabetes and asthma. For example, we reviewed records for patients diagnosed with asthma who had been prescribed 2 or more courses of rescue steroids in the preceding 12 months and found that care was consistent with recognised clinical standards. We also reviewed a sample of clinical records for patients with a potential diagnosis of diabetes and for patients with diagnosed with diabetes whose recent blood test showed high sugar levels. Records we saw showed that care was delivered in accordance with current clinical guidelines.

The practice worked with other services to ensure continuity of care, including when clinical tasks were delegated to other services, including those who may be vulnerable because of their circumstances. For example, staff described referrals made to a social prescriber to support patients accessing non-clinical support such as housing advice, financial assistance, or community activities.

Staff described positive working relationships and clear communication pathways with community colleagues. For example, escalating safeguarding concerns, which helped ensure concerns were addressed promptly and appropriately.

The practice 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 identified as vulnerable. Staff offered advice and referrals during routine appointments and health checks.

The practice had a system in place to monitor urgent suspected cancer referrals; however, there was no formalised process to ensure consistent, timely follow‑up, tracking, and oversight of these cases. Staff told us they downloaded a list from the clinical system showing patients referred to other services and used this to check whether any urgent suspected cancer referrals had been rejected, taking appropriate action if needed. They also told us they advised patients to contact the practice if they had not received an appointment within 2 weeks so that follow up could be arranged. Following our assessment, the practice introduced a new process to improve monitoring. The practice told us they have strengthened its approach. This will be reviewed at future assessments once fully embedded.

UK Health Security Agency data showed between April 2023 and March 2024, the practice met the national minimum threshold target for 1 out of 5 childhood immunisation indicators, achieving 93%. Performance ranged between 77% and 89% for the remaining 4 indicators, which was below the national target of 95%. The practice demonstrated awareness of the contributing factors and took steps to improve uptake. For example, clinicians proactively contacted patients to address concerns or questions, made use of opportunistic moments to offer and administer vaccinations and offered appointments during the evenings and weekends.

NHS England data showed the practice was performing below the 80% national target for cervical cancer screening uptake as of June 2024. The practice had achieved 71% uptake for the eligible population aged 25 to 49 years and 73% for those aged 50 to 64 years. Unverified data from the practice dated 27 December 2025 showed the practice had achieved 76% uptake for the eligible population aged 25 to 49 years and 79% for those aged 50 to 64 years (unverified data refers to data that has been provided by the practice and has not been published, therefore has not been verified by the data owner, for example, UK Health Security Agency, NHS Digital, NHS England and Improvement). The practice carried out regular recall audits and took steps to improve uptake, including routinely inviting patients, discussing any concerns to provide reassurance and providing self-booking links for appointments and offering evening and weekend appointments to support easier access.

The practice had a programme of targeted quality improvement and used information about patient care and treatment to drive changes. In July 2024, an audit was completed to review the prescribing of blood‑thinning medicines. The audit identified gaps in medication monitoring, including medicines that should have been discontinued remaining active and some treatments continuing beyond their intended duration. As a result, changes to practice policy were implemented, such as documenting the “stop date” within prescription instructions to ensure treatment ended at the appropriate time. We were not provided with information on whether a further scheduled cycle of the audit was conducted.

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

Staff understood and applied legislation relating to consent. A review of a sample of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions found that they were appropriate and made in accordance with relevant legislation and best practice guidance.