Fell Tower 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. 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 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 service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing. During the assessment we reviewed five patients for potential missed diagnosis. Three out of the 5 patient records reviewed revealed missed diabetes diagnoses, confirmed by two consecutive raised HbA1c readings. This coding omission presented a significant risk to patient follow-up care. Following the identification of these cases, the practice undertook a review of all patients on the 'missed diagnosis' list and scheduled the necessary appointments to address these oversights.
A clinical search identified that 9% of patients on thyroxine were overdue for monitoring. A subsequent review of 5 patient records confirmed this issue, revealing that the last blood tests had been performed between February 2023 and January 2024. No recent reminders were documented in the files for these patients. After the practice was informed of these findings, staff corrected the relevant coding and arranged for repeat blood tests for the affected individuals.
However, feedback from people using the service was positive. According to the National GP Patient Survey carried out between January and April 2025, 80% of respondents described their overall experience of this GP practice as good. This was above the local and national averages which stood at 79% and 75% respectively. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. Reception 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 or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews. For example, staff could refer people with social needs, such as those experiencing social isolation or housing 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 that in most cases care was provided in line with current guidance such as from the National Institute for Health and Care Excellence (NICE). NICE guidelines provide evidence-based recommendations for healthcare professionals to ensure high-quality, effective, and cost-effective care for patients.
 

The service 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 service supported people to manage their health and wellbeing to maximise their independence, choice, and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.
Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

The service 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.
The practice met national targets for screening and immunisations. For example, the percentage of children aged 1 who had completed a primary course of immunisation for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b and Hepatitis B was 98.3%. The World Health Organisation (WHO) recommends a rate of 95% for all routine childhood vaccinations. Those practices achieving this level will be considered as performing for this indicator and are an example of good practice. From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

In most cases the service told people about their rights around consent and respected these when delivering person-centred care and treatment. Records also showed that staff had also received the necessary chaperone training to ensure safe delivery of care.
However, a review of 3 DNACPR records identified a documentation gap. Although a capacity assessment had been carried out during a home visit, this had not been recorded on the patient file.