You are here

Archived: Manningham Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manningham Medical Practice on 25 October 2016. Overall the practice is rated as good.

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

  • The safety of staff and patients was a priority of the practice and there was an effective system in place for reporting and recording significant events. These were reviewed within the practice and by the provider.
  • Risks to patients were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff were encouraged to attend additional training and the practice supported the learning and development of all staff.
  • Patients said they were treated with compassion, dignity and respect.
  • 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.
  • Patients said they did not find it easy to make an appointment with a named GP and there was not always continuity of care. Urgent appointments were available with both GPs and nursing staff the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • A health advisor was available for one afternoon per week. The practice also offered access to an in-house benefits advisory service every Monday, where patients could get help with benefits, claims, forms, immigration and debt issues.
  • We saw that the practice carried out comprehensive checks for locum GPs and had recently implemented “end of shift” forms. These tick lists encouraged locum GPs to review their responsibilities and work load and were handed to the practice manager prior to leaving the practice. The practice also provided a one page quick reference guide for locums and a more detailed file was kept in each clinic room which would assist with referrals, protocols and contacts for example.
  • There was a clear and effective leadership structure. Staff felt very supported by the management in the practice and also by the wider management team. 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 practice had a patient engagement lead and an active Patient Participation Group (PPG).

The areas where the provider should make improvement are:

The practice should review the results of patient satisfaction surveys, including the GP patient survey and ensure that it can meet the needs of their patient population in the future and improve access.

Review their arrangements for clinical audit at the practice. Clinical audits should be clearly linked to patient outcomes, monitored for effectiveness and be comprised of two or more cycles to monitor any improvements made to patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 November 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events, these were reviewed within the practice and by the provider.
  • We saw evidence that lessons were shared to make sure action was taken to improve safety in the practice. For example, we saw that a sample handling protocol had been reviewed following an incident.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again. The practice did not formalise near misses for example, incidents where patients were abusive to staff. We discussed this with the team who told us that although these were well managed, it reduced the opportunity for the wider team to learn from these incidents.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse, there was an identified safeguarding lead at the practice and further support available from the corporate team.
  • Safeguarding training included relevant issues such as forced marriage, information regarding female genital mutilation and Prevent training. (This offers an introduction to the Prevent duty, and explains how it aims to safeguard vulnerable people from being radicalised to supporting terrorism or becoming terrorists themselves).
  • Risks to patients were assessed and well managed.
  • We saw that the practice carried out comprehensive checks for locum GPs and had recently implemented “end of shift” forms.
  • Non-clinical staff used a clinically developed protocol to assist them to prioritise patient requests for appointments.

Effective

Good

Updated 25 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance, we saw clear processes which ensured that staff were aware of these. For example, clinical and staff meetings and a monthly corporate bulletin.
  • We did not see that audits undertaken at the practice demonstrated improvements in patient care. The practice said they would review their audit processes.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of annual appraisals and personal learning and development plans for all staff, which were carried out by suitably trained individuals.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • Unplanned admissions were followed up by the clinical team and patients were invited for reviews if necessary.

Caring

Good

Updated 25 November 2016

The practice is rated as good for providing caring services. We observed a strong patient-centred culture:

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • The practice viewed themselves as a holistic community resource which was valued by the patients.
  • The practice was fully understanding of the needs and diversity of the patient population and we were told that they would often translate letters for patients from other agencies and make appointments for those who could not speak English. For example, for dental appointments.
  • We saw staff treated patients with patience, kindness and respect, and maintained patient and information confidentiality. Calls to the practice were answered at a remote central location by call handlers.
  • A health advisor was available for one afternoon per week  and worked alongside the diabetic nurse. The practice also offered access to an in house benefits advisory service every Monday where patients could get help with benefits, claims, forms, immigration and debt issues.

Staff had completed customer care training and conflict resolution. We observed staff treated patients and each other with dignity and respect.

Responsive

Good

Updated 25 November 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Bradford City Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. The provider encouraged the practices they managed to meet regularly and discuss issues such as significant events and review best practice.
  • Patients said they did not find it easy to make an appointment with a named GP.
  • Urgent appointments were available the same day with GPs and nursing staff. We saw evidence that patients requiring blood tests could be accommodated almost immediately.
  • Patients said they did not find it easy to get through to the surgery by telephone.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • There was a patient suggestion box and an electronic tablet in the waiting area to encourage patients to leave their feedback. The reception area also displayed information for patients regarding a number of conditions, support which was available to patients and information from the patient participation group.
  • In response to increased demand for vaccinations at the time of the annual Hajj pilgrimage, (the annual Islamic pilgrimage to Mecca), the practice told us that they offered more appointments and had a flexible approach to clinics to allow patients to attend after work.
  • Consideration was given to the languages spoken by the staff team and rota’s ensured that the staff on duty could speak the languages reflective of the local population including Bengali, Punjabi, Urdu and English. One member of staff told us they were learning some basic Urdu so that they could communicate better with the patients.

Well-led

Good

Updated 25 November 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were committed to the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt very supported by the practice management and the wider corporate management team. The practice had a number of policies and procedures to govern activity and held regular governance meetings. Staff also attended ‘sharing meetings’ with other practices run by the provider.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The practice engaged constructively with the staff team and they were supported to develop their roles and competencies, we were told of high levels of staff satisfaction.
  • The provider was aware of and complied with the requirements of the duty of candour. The provider encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous development, learning and improvement at all levels.
  • The provider arranged quarterly ‘away days’ for staff which included training, updates and the opportunity to network with their other practices.
Checks on specific services

People with long term conditions

Good

Updated 25 November 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The practice held a diabetes clinic weekly where the practice nurse was supported by a health advisor who was fluent in three languages relevant to the patient population. On alternate weeks this clinic would also include a dietician and blood glucose levels could also be assessed and reviewed.
  • Longer appointments and home visits were available when needed. For example, reviews for diabetic patients were 30 minutes long and would include demonstrations of how to carry out chair exercises for the less mobile.
  • The practice population was identified as being at risk of developing diabetes. The practice participated in CCG led initiatives and the HCA had developed a basic “Are you at Risk?” pack which was available in reception and gave patients some basic information regarding diabetes.
  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice offered ECG’s, 24 hour blood pressure monitoring, Doppler tests (an ultrasound test that uses high frequency sound waves to measure the amount of blood flow through your arteries and veins), and spirometry testing. (Spirometry is a test that can help diagnose various lung conditions, most commonly chronic obstructive pulmonary disease (COPD). Spirometry is also used to monitor the severity of some other lung conditions).

Families, children and young people

Good

Updated 25 November 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. Immunisation rates were comparable to CCG and national averages for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Urgent appointments were available the same day.
  • The percentage of women aged between 25 to 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 79% which was in line with the CCG average of 76% and national average of 81%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw the practice offered access to midwives, health visitors and school nurses. A joint clinic conducted by the practice nurse, health visitor and a GP was held every week.
  • The practice maintained close links with the district nursing and health visiting teams. The midwifery team were situated in the same building.

Older people

Good

Updated 25 November 2016

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population and liaised with the community matron to manage their needs.
  • The practice was responsive to the needs of older people, and offered home visits for urgent needs, health monitoring and flu vaccinations. An interpreter would be taken on a home visit if required.
  • There were urgent appointments for those with enhanced needs.
  • All the patients in this age group had a named GP.

Working age people (including those recently retired and students)

Good

Updated 25 November 2016

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

  • The needs of the working age population, those recently retired and students 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 held an extended hours clinic on a Monday until 7.30pm and patients could access GP and nursing appointments from 8.10am.
  • Patients could book appointments up to two weeks in advance and on line services were available.
  • Text message reminders were sent to patients to remind them to attend their booked appointments.
  • The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 November 2016

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

  • 88% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average of 86% and national average of 84%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 12 months was 97% compared to the CCG and national average of 89%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and were offering physical health checks for patients with severe mental illness.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia. Opportunistic dementia screening was carried out as appropriate and any concerns were referred to the GP.
  • The practice had identified a low prevalence of dementia within their population and were being more proactive to identify those at risk.

People whose circumstances may make them vulnerable

Good

Updated 25 November 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 living in vulnerable circumstances including those at risk of unplanned hospital admissions, travellers and those with a learning disability.
  • The practice had identified 18 patients with a learning disability and offered longer appointments, care plans and annual health checks for these patients. The team had recently met with the local learning disability community team to update their knowledge
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations for example, carers’ support.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were clear with regards to their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
  • A health advisor was available for one afternoon per week and the practice offered access to an in house benefits advisory service every Monday where patients could get help with benefits, claims, forms, immigration and debt issues.