Heathfielde 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 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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Feedback from people using the service was positive. Reception staff used codes and alerts within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing, but during our discussions with the provider, we were unable to gain assurance that all clinical staff used templates. We spoke with two partners at the service about the use of templates as part of patient care reviews and we received differing answers to our question.

People presenting with symptoms which could indicate serious illness were followed up in a timely way. The service offered telephone, face-to-face and home visits to patients. We viewed the appointment diary and saw appointments were available to book the same day for urgent appointments and in the following days for non-urgent appointments. Patients contacting the service were triaged to a telephone consultation with a clinical member in the first instance, unless they required a non-urgent face-to-face appointment.

Results from the 2025 GP Patient Survey for the service showed that 90% of respondents (a 25% completion rate for the service), felt that their needs were met at their last appointment, which was the same as the national average. This score was in contrast to the score of 35% of respondents who found it easy to contact the service by telephone.

Staff could refer people with social needs, such as those experiencing social isolation or other social difficulties, to a social prescriber.

The service 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 care was provided in line with current guidance, on most occasions. Staff had access to local and national guidelines which could be accessed easily through online platforms with links to guidance also available through their clinical system. Clinical meeting minutes provided to us by the provider, showed discussions amongst members of the clinical team referencing local guidelines relating to the provision of patient care.

We conducted remote clinical searches of the provider’s clinical records and identified that the provider was assessing needs of most patients routinely. As part of these searches, we looked at several patient records who had been recorded as having a recent medication review. We reviewed (in depth) 5 patient records out of the 459 recent medication reviews undertaken by the provider and found no issues with the reviews undertaken by the provider. We also reviewed 5 patient records of the 7 identified for patients who were being prescribed 10 or more medicines. On this review, we identified that 2 of the 5 patient records had been coded as having a review, but there were no written notes by a clinical member of staff to indicate what the review consisted of.

A clinical audit conducted by the provider relating to patients on hormone replacement therapy (HRT) with clinical histories of two specific gynaecological conditions, evidenced that the service incorporated using evidence-based care into patients ongoing care and treatment.

The service worked across teams and services 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 services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support.

The provider worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. Referrals to other services were audited to ensure that appointments were created for people in a timely manner, for example, when people were referred for suspected cancers. The provider followed up with people referred to this service that they had received an appointment from the hospital.

The provider informed us that they engage with several community care services, but that the engagement was usually conducted ad-hoc (either by telephone or email), and not often in a formal setting of a meeting.

We viewed a set of internal meeting minutes where staff reviewed palliative care patients to ensure that the most appropriate care was being provided.

The provider supported people to manage their health and wellbeing to 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.

Staff we spoke with 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 from within the service, the local Integrated Care Boards (ICB) and their professional body for example the General Medical Council (GMC).

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. National priorities and initiatives to improve population health, including stopping smoking and tackling obesity were supported by the provider. There was a phlebotomy service at this location.

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

The service did not meet all the five national targets for childhood immunisations. National data collected on 31 March 2024 showed 4 indicators for childhood immunisations were below the 95% World Health Organisation (WHO) based target for uptake and not above the 90% minimum uptake expected for these immunisations. We spoke with the staff at the service about this and saw that there were effective systems in place to follow up people who failed to attend for these appointments.

Appointments were arranged around the convenience of service users to encourage attendance with appointments being available throughout the day and after work.

From the clinical notes we reviewed, people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

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

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded.

The service had effective processes for recording consent within the medical record and guidance was accessible on the service’s website.

The staff had good knowledge of gaining and assessing consent options allowing the delivery of person-centred care and treatment which was in the person’s best interest. This included young people and people who did not have capacity to consent to care and treatment.

We reviewed two records which showed Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.