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Inspection Summary


Overall summary & rating

Good

Updated 22 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor Brook PMS on 21 June 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. Analyses of significant events were thorough and learning from them was shared with staff to improve safety.
  • 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.
  • There was a robust programme of quality improvement; the practice had conducted 32 audits in the previous two years and there was a record of improvements made from completed audits.
  • 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 had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported and valued by management. The practice proactively sought and acted on feedback from staff and patients.
  • The practice had a number of policies and procedures to govern activity, and they held regular governance and clinical meetings.
  • The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make improvement is:

  • Review how patients with caring responsibilities are identified to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 September 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • 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 22 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with or above local and national averages.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • The practice had an established programme of clinical audits, several of which were initiated by the practice. They had conducted 32 audits over the previous two years; those we reviewed demonstrated quality improvement to outcomes for patients, such as for those with febrile illness, patients with atrial fibrillation and those taking anticoagulant medicines.

  • 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 22 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in January 2016 showed patients rated the practice in line with local and national averages 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 22 September 2016

The practice is rated as good for providing responsive services.

  • The practice had a proactive approach to understanding the needs of different groups of patients; they delivered care to meet those needs and to promote equality.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. They had leaflets dedicated to family planning, older people, young people, pregnant and new mothers, carers and people living with depression. They also had a practice newsletter which was regularly updated to keep patients informed of any changes and useful contact numbers and websites.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. They participated in Greenwich CCG’s Year of Care scheme with an aim to improve the management and outcomes for patients with chronic obstructive pulmonary disease, diabetes, heart disease and hypertension. An analysis of the scheme showed the practice had exceeded its monitoring targets over the previous six months by up to 50%.

  • 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.

  • Data from the national GP patient survey published in January 2016 showed patients rated the practice in line with local and national averages for accessibility.

  • The practice offered arrange of services such as acupuncture, ring pessary fitting and 24 hour ambulatory blood pressure monitoring which had either significantly improved patients’ conditions or enabled them to avoid potentially long waits for these services from secondary care.

  • 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 22 September 2016

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

  • The practice had a clear vision and strategy to deliver high quality person-centred care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • There was a clear leadership structure and staff felt supported and valued by management. They had submitted suggestions for improvements which practice leaders had implemented.

  • The practice had a number of policies and procedures to govern activity, and they held regular governance and clinical meetings.

  • 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.

Checks on specific services

People with long term conditions

Good

Updated 22 September 2016

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

  • In the previous six months, the practice had exceeded its monitoring targets for diabetes, most recently by 50% in May 2016 for the Greenwich Clinical Commissioning Group’s Year of Care scheme.

  • The practice offered a limited acupuncture service to patients with musculoskeletal pain. They had conducted a survey in 2015/2016 which showed 90% of patients had found the acupuncture treatments effective at relieving or stopping their symptoms.

  • The practice offered 24 hour blood pressure monitoring at the practice for patients with hypertension, which enabled patients to avoid potentially long waits for this service from secondary care.

  • Nationally reported data showed outcomes for patients with diabetes were in line with the national average. For example, 79% of patients with diabetes had well controlled blood sugar in the previous 12 months (national average 78%).

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Longer appointments and home visits were available when needed.

  • All patients with a long term condition had a named GP and most had received a structured annual review to check their health and medicines needs were being met.

  • 77% of patients with asthma had an asthma review in the previous 12 months. This was in line with the national average of 75%.

  • 95% of patients with chronic obstructive pulmonary disease (COPD) had a review of their condition in the previous 12 months. This was in line with the national average of 90%. Nursing staff provided a spirometry service for patients with asthma and COPD.

  • 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.

Families, children and young people

Good

Updated 22 September 2016

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

  • The practice had received accreditation from Greenwich local authority in March 2015 for being a ‘teen friendly’ practice. This accreditation was awarded from feedback received through mystery shopper visits to the practice conducted by young people in the borough. They had created a practice leaflet for teenagers containing information about the services available to them. The leaflet included sources of information about sexual health testing, avoiding the use of illegal drugs, avoiding drinking and driving and how to access emergency contraception and vaccines.

  • Nationally reported data showed performance for cervical screening was above the national average. For example, in the previous five years 92% of female patients aged between 25 and 64 years had received a cervical screening test (national average 82%). An analysis of this service showed the practice was the top performer of all practices in the local Clinical Commissioning Group.

  • The practice had created leaflets for young people, pregnant women and women who had just given birth to keep them informed of the services available to them.

  • 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.

  • 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 attendances to Accident and Emergency.

  • Appointments were available outside of school hours and the premises was suitable for children and babies.

  • We saw positive examples of joint working with health visitors, and they liaised with midwives on an ad-hoc basis.

Older people

Good

Updated 22 September 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. They ran quarterly checks of their register of older people to identify patients aged over 75 years that had not attended the practice for 12 months or more; these patients were invited to receive health checks.

  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs. They also conducted weekly visits to the local Aldington House care home and created personalised care plans for each resident.

  • The practice offered joint injections and ring pessary fitting services for older patients, so that they did not have to attend hospital for these treatments. The ring pessary fitting service was funded by the practice and was provided in-house or through home visits.

  • Nationally reported data showed outcomes for conditions commonly found in older people were comparable to the national average. For example, in the previous 12 months 83% of patients with hypertension had well controlled blood pressure (national average 84%).

  • The practice had created leaflets for older people to keep them informed of the services available to them.

Working age people (including those recently retired and students)

Good

Updated 22 September 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 was proactive in offering online services such as appointment booking and repeat prescription ordering.

  • The practice offered a full range of health promotion and screening that reflected the needs for this age group.

  • Extended opening hours were available from 6.30pm until 8.00pm two days a week for working patients who were unable to attend the practice during normal opening hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 September 2016

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

  • Nationally reported data showed outcomes for patients with dementia were in line with the national average. For example, in the previous 12 months, 88% of patients with dementia had a face-to-face review of their care (national average 84%)

  • Nationally reported data showed outcomes for patients with poor mental health were in line with the national average. For example, in the previous 12 months 85% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in their records (national average 88%).

  • 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 and they 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; five of them had received dementia awareness training.

People whose circumstances may make them vulnerable

Good

Updated 22 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 living in vulnerable circumstances including homeless people, travellers 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.