Manston Surgery

Updated 27 March 2017

Manston Surgery is located in Cross Gates Medical Centre on Station Road, Leeds, LS15 8BZ. The practice also has a branch site at 96 Main Street, Scholes, Leeds, LS15 4DR. The branch site is situated in a more rural location and as such is a dispensing site. We visited both sites as part of our inspection.

The practice is part of the Leeds South and East Clinical Commissioning Group and serves a population of approximately 7272 patients. The service is provided by four GP partners (two male and two female). The partners are supported by two salaried GPs (female), two practice nurses and two health care assistants. The clinical staff are supported by an experienced team of administration staff.

The practice is classed as being in the one of the lesser deprived areas in England, being in the sixth decile on a scale of one to ten (where the tenth decile is classed as being least deprived).

Patients can access a number of clinics for example; asthma and diabetes, smoking cessation and baby clinics. The practice also offers services such as childhood vaccinations and cervical smears.

Manston Surgery is open as follows:

Crossgates location:

Monday – Friday from 8am until 6pm

Saturday from 8am until 11am

Scholes location:

Monday, Wednesday and Friday from 8am until 12pm and 3pm until 6pm

Tuesday and Thursday from 8am until 12pm

When the practice is closed out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

Services are provided under a personal medical services (PMS) contract. This is the contract held between the practice and NHS Commissioners. They also offer a range of enhanced services such as influenza, pneumococcal and childhood immunisations.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. The third sector includes a diverse range of organisations including voluntary and community groups.

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manston Surgery on 27 April 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However; documented learning from incidents was limited.
• There were issues identified in the dispensary at the branch site. For example; staff did not keep a ‘near-miss’ record (a record of errors that have been identified before medicines have left the dispensary), standard Operating Procedures only covered basic aspects of the dispensing process and were limited in scope and detail and staff did not routinely check stock medicines were within expiry dates.
• The staff we spoke with told us that regular checks were carried out to ensure the oxygen and defibrillator had been carried out. However, saw there was no formal record documenting these checks.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure dispensing standard operating procedures are fit for purpose and cover all required processes.
• Ensure there is a system in place for identifying and sharing learning from medicines management incidents.
• Ensure that there are documented checks and records relating to medicines management to ensure the quality and safety of services

The area where the provider should make improvement are:

• Manage controlled drugs in accordance with the relevant legislation

Keep a documented record of when checks are carried out on the oxygen and defibrillator.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 September 2016

The practice is rated as good for the care of people with long-term conditions.

• All these patients had a structured review to check that their health and medicines needs were being met. This review was undertaken on an annual basis or more often when required.
• The practice nurses had lead roles in the management of long term conditions.
• The practice worked closely with other services in the management of housebound patients who had complex long term conditions, to ensure they received the care and support they needed. For example; the community matron, heart failure and respiratory nurses.

• The practice was participating in the ‘Year of Care’ programme. This approach encouraged patients to understand their condition and have a more active part in determining their own care and support needs in partnership with clinicians.
• The practice offered spirometry screening for all smokers with the aim of early diagnosis of Chronic Obstructive Pulmonary Disease (COPD).
• The practice were involved in the winter pressures scheme and reviewed all patients with a long term condition within three days, following non elective discharge from hospital.
• 95% of patients with diabetes, on the register, had a record of a foot examination and risk classification; which was higher than the CCG average 88% and England average 88%.
• 100% of patient with diabetes, on the register, had received an influenza immunisation in the preceding seven months; which was higher than the CCG average 96% and England average 94%.
• 87% of patients diagnosed with asthma had received an asthma review in the last 12 months; which was higher than the CCG and England averages of 75%.

Updated 14 September 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
• Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours. All children who required an urgent appointment were seen on the same day as requested.
• The practice worked with midwives, health visitors and school nurses to support the needs of this population group.
• The practice hosted on site midwifery clinics.
• The practice had a dedicated GP specialising in paediatrics.
• The practice had a GP with special interests in contraception (including implants).
• There was dedicated health information in the waiting room for teenagers.
• Cervical screening, sexual health and contraceptive services were provided at the practice.

100% of eligible patients had received cervical screening compared to the CCG average of 99% and national average of 98%.

Updated 14 September 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice was participating in a scheme which helped reduce avoidable unplanned admissions for vulnerable patients, at high risk of hospital admission. Dedicated GP led clinics were held to review these patients.
• Patients were signposted to other services for access to additional support, particularly for those who were isolated or lonely.
• The practice conducted a full review of all nursing home patients as part of the extended nursing home scheme, ensuring effective working relationships with local residential and nursing homes.
• The practice nurses and health care assistants worked with the district nursing team to provide influenza vaccinations for all eligible patients, including housebound and care home patients.
• The practice offered home based phlebotomy and health care assistant checks for elderly housebound patients.

Updated 14 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of these patients had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice provided extended hours appointments from 8am to 11am on Saturday mornings. In addition the practice also provided services from 11am to 3pm during winter months.
• Telephone consultations were available if appropriate for patients at work
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.
• The practice offered work related medical assessments.

Updated 14 September 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team. Patients and/or their carers were given information on how to access various support groups and voluntary organisations, such as Carers Leeds.
• The practice participated in the directed enhanced service for dementia which aimed at ensuring patients received timely diagnosis and access to appropriate treatment, care and support.
• 96% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, had a comprehensive, agreed care plan documented in their record in the preceding 12 months (CCG and national averages 88%).
• Staff could demonstrate they had a good understanding of how to support patients with mental health needs or dementia.

Updated 14 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients with a learning disability.
• Patients who had a learning disability had an annual review of their health needs and a health action plan in place.
• Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• We saw information displayed in the practice about various local support groups and voluntary organisations, which patients could access as needed.
• The practice carried out regular reviews of care home patients.
• Carers information was available in the waiting room for patients or their carers to access.
• The practice had applied to join the Leeds Safe Place Scheme which is aimed at providing support to adults with learning disabilities cope with any incident that takes place whilst they are out and about.