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Inspection Summary


Overall summary & rating

Good

Updated 20 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manchester Medical Moss Side Health Centre, Monton Street, Moss Side, Manchester, M14 4GP on 10 January 2017. 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.

  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • 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.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice offered patients consultations via skype. The patients we spoke with told us the service had improved access to consultations and enhanced overall access to a GP.

  • The practice held a face to face GP led triage service every morning Monday to Friday. This was evaluated highly by patients and we were told all patients attending this service would be seen. Patients told us the GPs responded compassionately when they needed help and provided support when required.

  • 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.

We saw areas of outstanding practice:

The practice team was forward thinking and part of local and national pilot schemes to improve outcomes for patients. For example:

  • The practice offered patients consultations via skype. The patients we spoke with told us the service had improved access to consultations and enhanced overall access to a GP.

  • The practice held a dedicated clinic held each Thursday afternoon for young people leaving care.

  • One of the GPs was a former clinical commissioning lead and was instrumental in developing locally commissioned services. For example: the introduction of community intravenous therapy service. This service enabled patients who required intravenous (IV) antibiotics to be treated in the community rather than in hospital. This pilot scheme had been successful and was subsequently commissioned across the CCG area.

  • Another GP was Deputy Clinical Director for Central Manchester CCG.

  • Medication reviews were conducted six weeks before the month of Ramadan for those patients with diabetes who identify as Muslims, to ensure safety during fasting. Some Muslim diabetic patients did not wish to have blood tests during Ramadan and diabetic reviews were arranged outside of this month.

The areas where the provider should make improvement are:

  • Retain interview notes within staff recruitment files.

  • Improve the recording of significant events to demonstrate actions and learning to be able to identify trends more easily.

  • Continue to identify and support those young patients who were also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events (SE). However, the practice did not produce an overview of all SEs that would enable them to identify themes/trends and take action to prevent recurrence.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • 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 had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 20 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were below average compared to the national average. However the practice provided unverified data to show improvements over the last eight months.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 20 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • 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.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 20 March 2017

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 Clinical Commissioning Group to secure improvements to services where these were identified. The practice had introduced an innovative approach to providing integrated patient-centred care. The GPs had developed a skype appointment system in addition to telephone consultations and a GP lead face to face triage system which enhanced overall access to a GP.
  • One of the GPs was a former clinical commissioning lead and was instrumental in developing locally commissioned services. For example: the introduction of community intravenous therapy service. This service enabled patients who required intravenous (IV) antibiotics to be treated in the community rather than in hospital. This pilot scheme was successful and commissioned across the CCG area.
  • The practice had introduced an after school clinic to ensure there was minimal disruption to children’s education. The practice worked closely with Barnardo’s and provided a young people leaving care primary medical care service with a dedicated clinic held each Thursday afternoon. The practice also provided a free phone for patients to access the citizens advice bureau (CAB) for support and advice.
  • The practice was participating in the Manchester Primary Care Standards Scheme. This aims to improve access and outcomes for patients with long term health conditions.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • 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.

Well-led

Good

Updated 20 March 2017

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 clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • 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 provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured 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 learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 20 March 2017

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

  • Nursing and clinical pharmacy staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Longer appointments were available as standard and home visits were available when needed.
  • 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 percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 67% which was below the CCG and national average of 82% and 80% respectively.
  • 59% of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months (01/04/2015 to 31/03/2016) which was below the CCG and national average of 89% and 90% respectively. During the inspection the practice provided unverified data to demonstrate this had increased to 81%.
  • The practice conducted medication reviews six weeks prior to the month of Ramadan to ensure safety during fasting. Some Muslim diabetic patients did not wish to have blood tests during Ramadan and diabetic reviews were arranged outside of this month.

Families, children and young people

Good

Updated 20 March 2017

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 A&E attendances. Immunisation rates were relatively high 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.
  • 61% of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2015 to 31/03/2016) which was below the CCG average of 78% and national average of 81%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 20 March 2017

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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had reviewed the needs of the older population and carers and introduced late lunch clinics from 3pm onwards, with longer appointments.

Working age people (including those recently retired and students)

Good

Updated 20 March 2017

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 was proactive in offering online services as well as 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 20 March 2017

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

  • 67% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months (2015/2016), which was worse than the CCG and national average of 89% and 84% respectively.

  • 56% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months (01/04/2015 to 31/03/2016) which was significantly lower than both the CCG and national average of 89%.

  • 46% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate. This was well below the CCG and national average of 89% and 88% respectively.

During the inspection the practice provided unverified data to demonstrate that the number of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record had increased to 71%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 20 March 2017

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 homeless people and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • 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.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.
  • The practice had high rates of female genital mutilation (FGM) and had good reporting mechanisms in place.

  • The practice accepted registrations from patients who were homeless, of refugee status or recently released from secure institutions.

  • The practice held a dedicated clinic held each Thursday afternoon for young people leaving care. This service provided support and advice regarding healthy living, sexual health and how to access health care services.