Florence House Medical Practice

Updated 24 September 2015

Florence House is a long established family practice. Three generations of GPs from the same family have provided medical care to the residents of Higher Openshaw, Manchester, over a period of 80 years. They are based in an area of high deprivation with a growing practice list of 8130 patients offering services to a multi-cultural population with many asylum seekers. There are three male GPs and one female GP. Two new female GPs were recently recruited to serve the growing population. (At the time of inspection they had not started their employment).

Other staff include a full time and part time practice nurse, a part time assistant practitioner and a part time health care assistant. There are staff dedicated to specific roles such as discharge care co-ordinator and cancer champion, clinical coder and prescription manager. There is a practice manager and deputy practice manager along with several other reception and secretarial staff. The practice will also begin training junior doctors in August 2015.

The practice is open to patients from 8am until 6pm Monday and Friday, 7.30am till 5.30pm on Tuesday and 7.30am until 7.30pm on Thursday. On Wednesdays they open at 8.30am and close at 1pm unless for baby clinics which are held until 4pm. The practice have adjusted their appointment system so that working patients can be seen outside of working hours. All consultations are by appointment. When the surgery is closed patients are signposted to the GP out of hours services.

Clinics and services include consultations for long term conditions, contraceptive care, antenatal, postnatal and children’s care, immunisations and vaccinations. District nurses, health visitors and midwives are attached to the surgery. The practice also offer travel advice and travel vaccinations and prescriptions can be requested online and obtained at a pharmacy of choice.

Updated 24 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Florence House Medical Practice on 11th June 2015. Overall the practice is rated as good. Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well led services. Services for the population groups were also good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed appropriately.
• Systems to assess and manage patient safety and effectiveness were appropriate with the exception of those to identify and recall patients who did not attend for follow up appointments.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff received adequate support and training appropriate to their roles as well as additional support and training which enabled them to progress in their roles and in their careers.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs. A discharge co-ordinator/cancer champion and a carer support group was available for patients who could benefit from this service.
• The practice had a high percentage of asylum seekers who received appropriate advice, care and treatment.
• Information about services and how to complain was available and easy to understand.
• Some patients said they found it difficult to make an appointment with a named GP in a timely manner. However they said there was continuity of care, with urgent appointments available the same day.
• The practice proactively sought feedback from staff and patients, which it acted on.
• There was a newly embedded leadership structure and staff felt very supported by management. There was a family-orientated ethos which was emulated by all the staff.

We saw some areas of outstanding practice including:

• The practice ran a bi-monthly carer support group which brought carers together for support and discussion. Members of the group reported the positive impact on their lives.
• The practice established “Singing for the Brain”; a weekly singing session to help patients with memory problems and dementia. This was run by a singing music therapist offered to patients from other local practices.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Introduce an effective system to identify and recall patients who do not attend for scheduled and follow up appointments such as health checks, repeat blood tests, cervical smears and immunisations.

• Review and introduce an effective system to show that all information required, in line with legislation, is available in respect of each person employed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 September 2015

The practice was rated as good for the care of patients with long term conditions. Clinical staff had the knowledge skills and competencies to respond to the needs of patients with long term conditions such as asthma, chronic obstructive pulmonary disorder (COPD) and heart disease. Longer appointments were arranged and the GPs and nurses offered home visits for review of housebound patients. All patients with long term conditions were on a recall register and invited in for review appropriate to their condition to ensure their health and medicine needs were met in a structured review. However, the practice recall system had recently broken down and patients were not being routinely called for follow up appointments. There were no diary reminders and there was the possibility that patients who required follow up appointments or repeat blood tests could slip through the net .

Updated 24 September 2015

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 disadvantaged children and those at risk. Accident and Emergency (A&E) and Out of Hours (OOH) reports were followed up to identify if review was necessary. A leaflet was devised to offer advice regarding the appropriate use of A&E and what to do when the practice was closed. Alerts were placed on patient records to offer a same day urgent appointment if requested and required. Child clinics were held on protected days which had proved positive for mums with babies and small children. An information pack had been produced for new mums regarding common conditions. Dedicated appointments were available for under 5s and after school appointments for over 5s.

Updated 24 September 2015

The practice is rated as good for the care of older patients. Every patient over 75 had a named GP. Vulnerable older patients had been identified and individual care plans had been developed to support their relevant care needs. Those care plans were shared with the out of hours provider and discussed in multi-disciplinary team (MDT) meetings with patients’ consent. Flu, pneumonia and shingles vaccinations were offered in accordance with national guidance. Named GPs were responsible for relevant care homes and carried out visits when requested. Monthly MDT meetings were held to ensure integrated care for older people with complex care needs. Rapid access and dedicated appointments during lunchtimes and daylight hours (if necessary) were available for elderly patients with complex care needs.

Updated 24 September 2015

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. Dedicated appointments had been made available at 7:30am and 6:30pm for working patients. A self-care room had been introduced and a full range of health promotion, screening and continuity of care has been promoted. On line appointments, ordering of repeat prescriptions and access to records were available for patients with computer access.

Updated 24 September 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). They regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia and carried out advance care planning for patients with dementia. The practice had introduced “Singing for the Brain” which had positive benefits for patients with dementia and this was being offered to patients at other practices. Medicine changes were acted upon promptly and daily/weekly prescriptions were in place for patients at risk.

The patients at the practice had access to the Community Mental Health Team who were based upstairs in the practice premises. Although the service was available to all patients in North Manchester , patients from this practice felt encouraged to attend appointments due to the location which was convenient and familiar to them.

Updated 24 September 2015

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 such as those with a learning disability who received regular follow up and annual health checks.

Longer appointments were offered and support was provided through care plans which they were involved in agreeing. These were reviewed annually or more frequently if required. Interpreters were available for all patients who required it, with double appointments when necessary. Condolence letters were sent to patients relatives following bereavement, followed up with a phone call from a GP. Clinical, medical and administration staff provided many examples where vulnerable people had been assisted to achieve positive outcomes.