Queensview Medical Centre

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• 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. People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people took decisions in people’s best interests where they did not have capacity. There was evidence of effective systems to monitor and support patients with long term conditions. This key question has been rated as good.

This service scored 71 (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. Feedback from people using the service was predominantly positive. Results of the national GP patient survey (published in July 2025) showed 83% of patients felt their needs were met during their last GP appointment compared to the national average of 90%. 89% of patients felt the healthcare professional they saw had all the information they needed about them during their last appointment compared to the national average of 92%. Leaders and staff told us the practice used codes and alerts on the patient’s record to highlight special needs and requirements. Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The practice had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The practice planned and delivered people’s care and treatment with them, including what was important and mattered to them. Meetings were held to ensure staff were updated with the latest information, guidance and changes within the practice.  

The clinical searches we undertook of the practice’s clinical records system showed the monitoring of people with long-term conditions was largely in line with National Institute for Health and Care Excellence (NICE) recommendations. For example, one of our clinical record searches reviewed the number of patients with asthma who had been prescribed two or more courses of rescue steroids in the last 12 months. We identified a total of 39 patients and reviewed a random sample of 5 patient records. We found that not all patients had been reviewed in a timely manner after an exacerbation to check their response to the treatment. Following our feedback, leaders developed a standard operating procedure for asthma exacerbation follow-up. This included initiation of a follow up pathway and completion of an assessment questionnaire.

We reviewed patients with chronic kidney disease (CKD) stages 4 or 5 to check they had the appropriate monitoring was being undertaken. We found all patients were receiving appropriate monitoring.

We reviewed monitoring of people with hypothyroidism (when the thyroid gland does not produce enough thyroid hormone that can lead to tiredness and weight gain). Our search identified 360 patients, all of whom had received appropriate monitoring in the preceding 18 months.

We reviewed the monitoring of diabetes care and found that 123 patients appeared to have not been reviewed despite having HbA1C levels of 75mmol or more. (HbA1C is a blood test that measures the average blood glucose levels over a period of 2 to 3 months). We reviewed a random sample of 5 patients and found no concerns with the management of their care.

The practice held registers for patients and provided annual health checks for those with learning disabilities, people with severe mental health conditions and palliative patients. There was a dedicated team supporting patients with learning disabilities to ensure they received continuity of care and were supported in accessing services. The practice shared evidence of clinical audits undertaken to effectively improve patient care. For example, the practice shared an audit undertaken to improve the quality and consistency of paediatric safety netting for acute presentations in children under the age of 5 years. Cycle 1 (data gathered June to July 2025) found that whilst 82% of consultations had documented evidence of safety netting advice, only 41% contained advice that was specific and clear and only 1 of the 64 consultations reviewed provided written/ digital take home advice. Cycle 2 (data gathered September to October 2025) found an increase to 99% of consultations having documented evidence of safety netting advice, with 87% containing specific and clear detailed advice. 63% of consultations (83 reviewed) provided written or digital take home advice.

The practice worked well 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 practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. The processes in place enabled staff to liaise regularly with community teams such as district nurses, health visitors, and palliative care nurses. Staff told us and we saw evidence of regular multi-disciplinary team meetings that were held with external agencies where vulnerable people were discussed and actions recorded. The practice regularly discussed patients receiving end-of-life care. We saw evidence of regular clinical, department and practice meetings.

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. Staff focused on identifying risks to people’s health, including those who are (or might be) vulnerable such as 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 delivered patient education sessions to support patients with specific health conditions or concerns. Leaders advised they had facilitated a session on hypertension and a session about menopause. Both these sessions were well attended and received positive feedback from patients. Those that required further follow up and additional support had appointments arranged for them.

The practice coordinated visits from facilitators working for a chronic respiratory support group, Breathing Space, to coincide with a dedicated Chronic Obstructive Pulmonary Disease (COPD) and asthma clinic, transforming the waiting room into a proactive intervention space to meet patient need. Patients attending with COPD and asthma were therefore already present in the surgery, allowing facilitators to engage directly with them. While patients waited for their appointments, Breathing Space staff initiated informal, supportive conversations around breathlessness, inhaler use, anxiety management, and lifestyle changes, and offered immediate signposting, leaflets or referral into ongoing support programmes. This improved patient care by removing the need for separate referrals or additional appointments, the practice maximised an existing touchpoint to deliver preventative care and assess patient willingness to engage with community-based support as they were also able to speak with patients with other respiratory conditions. The service was then integrated into the practice’s care delivery as they informed patients about self-referral services.

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.

At the time of our assessment, the latest published information from the UK Health Security Agency (UKHSA) showed that the practice did not meet the World Health Organisation minimum target of 90% for the number of children immunised against various infectious childhood diseases for all age groups. This was for the period April 2024 to March 2025. Whilst they had achieved the target for children aged 1, they had not achieved the target for children aged 2 and 5 years. For children aged 2 years the practice had achieved between 74% and 81% uptake. For those aged 5 years the practice had achieved 74% uptake. Leaders and staff advised they were continuously working to improve uptake, through patient education, opportunistic discussions and improved flexibility with appointment booking. Leaders advised they had seen an improvement in uptake for childhood immunisations since taking control of the booking system. They advised parents were sent a booking link and able to book appointments at suitable times, rather than having appointments allocated to them by the national childhood health programme. They were confident the overall uptake of immunisations would improve as a result.

The latest published information available to the CQC from NHS Digital (June 2024) showed the practice’s uptake for cervical cancer screening for women aged 25 to 49 years old was below the 80% national target and was observed at 59.8%. The practice’s uptake for cervical cancer screening for women aged 50 to 64 years old was also below the 80% national target and was observed as 64.8%. Leaders advised they had undertaken targeted work to improve cervical cancer screening uptake, with dedicated support from their care coordinator. This included advertising information on screening in the waiting room and sending information in different languages to patients. They were able to share unverified data for the period ending March 2026. This showed the practice’s uptake for cervical cancer screening for women aged 25 to 49 years old was 75.5%. The practice’s uptake for cervical cancer screening for women aged 50 to 64 years old was 86.6%.  Staff told us they were actively engaging with patients to increase these figures and had plans to participate in targeted work with patients of Asian ethnicity who were still reluctant to attend for screening.

The practice told people about their rights around consent and respected these when delivering person-centred care and treatment. People we spoke with and the evidence we reviewed did not raise any concerns around consent. People understood their rights about consent to the care and treatment they were offered. Clinicians understood the requirements of legislation and guidance when considering consent. Clinicians supported people to make decisions ensuring their views and wishes were considered during care planning. Assessments of mental capacity were carried out when needed and were decision specific. Staff told us they were able to adapt or translate information about care and treatment so that people could understand, to support them making informed decisions. All staff we spoke with had completed relevant training and were able to discuss how to gain informed consent for treatment. We reviewed a random sample of staff training records which showed almost all staff had up-to-date training on informed consent, the 2005 Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). We saw that consent was documented and processes were in place for chaperones to be present if requested.

In line with locality requirements, the practice was transitioning from the use of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions to Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms. Records we reviewed demonstrated these were appropriate, regularly reviewed, and made in line with current legislation and professional standards.