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Inspection Summary


Overall summary & rating

Good

Updated 6 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 28 July 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.
  • Risks to patients were generally 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.
  • 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.
  • 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.
  • There were areas of outstanding practice observed at the practice:
  • The practice sent a Christmas card with information for older people on how to stay well and how to access services over the seasonal period.
  • The practice produced and distributed a student health survival guide and student mental health guide.
  • There was a “one stop shop” to reduce the number of times patients had to attend for review.

There were areas of practice where the provider should make improvements:

  • Ensure the recruitment of all staff, including locum staff, includes all the necessary pre-employment checks and records are kept of these.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 September 2016

The practice is rated as good for providing effective services.

  • 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.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Effective

Good

Updated 6 September 2016

The practice is rated as good for providing effective services.

  • 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.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 6 September 2016

The practice is rated as good for providing caring services.

  • 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.
  • Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect. The practice was performing better than local and national averages for its satisfaction scores in areas such as:

  • 91% said the GP was good at listening to them compared to the Clinical Commissioning Group (CCG) and national averages of 89%.
  • 87% said the GP gave them enough time (CCG average 85%, national average 87%).
  • 96% said they had confidence and trust in the last GP they saw (CCG average 95%, national average 95%).
  • 88% said the last GP they spoke to was good at treating them with care and concern (CCG average 83%, national average 85%).
  • 92% said the last nurse they spoke to was good at treating them with care and concern (CCG average 88%, national average 91%).

  • 95% said they found the receptionists at the practice helpful (CCG average 86%, national average 87%).
  • 92% said the last GP they saw was good at explaining tests and treatments compared to the CCG average of 85% and national average of 86%.
  • 83% said the last GP they saw was good at involving them in decisions about their care (CCG average 80%, national average 82%).
  • 85% said the last nurse they saw was good at involving them in decisions about their care (CCG average 83%, national average 85%).

Responsive

Good

Updated 6 September 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 Clinical Commissioning Group to secure improvements to services where these were identified.
  • 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 6 September 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 clear about the vision and their responsibilities in relation to this.
  • 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.
  • 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 knowing about 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.
Checks on specific services

People with long term conditions

Good

Updated 6 September 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.
  • Performance for all five of the diabetes related indicators was above the national average.
  • 96% of patients with diabetes had received an influenza immunisation compared to the national average of 94%.
  • A record of foot examination was present for 91% of patients compared to the national average of 88%.
  • Patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 79% compared to the national average of 78%.
  • Patients with diabetes whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 83% compared to the national average of 81%.
  • The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c was 64 mmol/mol or less in the preceding 12 months was 85% compared to the national average of 78%.
  • Longer appointments 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.
  • There was a “one stop shop” to reduce the number of times patients had to attend for review.

  • The practice had a specialist interest in people with HIV as a long term condition and all the staff had received training in this area.

Families, children and young people

Good

Updated 6 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 A&E attendances.
  • 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.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 70%, which was below the national average of 82%. The practice recognised this was low and produced a policy to offer telephone reminders for patients who did not attend for their cervical screening test. The nurses recently implemented a plan to promote cervical screening and to specifically target 25-30 year olds who were the lowest attenders.
  • Childhood immunisation rates for the vaccinations given were comparable to Clinical Commissioning Group (CCG) and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 75% to 95% and five year olds from 83% to 95%.
  • 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.

  • There was a practice protocol for safeguarding young people including monthly checks of the notes of children on the child protection registers.
  • There was a weekly baby clinic.

Older people

Good

Updated 6 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • All elderly patients had been informed of their named GP.
  • The practice offered same day appointments as well as telephone and face to face consultations.

  • All staff in the practice had received training in dementia with patient and carer experience.
  • The practice sent a Christmas card with information for older people on how to stay well and how to access services over the seasonal period.

Working age people (including those recently retired and students)

Good

Updated 6 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 as well as a full range of health promotion and screening that reflects the needs for this age group.
  • Telephone appointments were available if patients wished to discuss test results and urgent concerns and for those who may have difficulty attending surgery due to work commitments.

  • The practice produced and distributed a student health survival guide and student mental health guide.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 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 multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advanced 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 percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record in the preceding 12 months was 87% compared to the national average of 88%.
  • The percentage of patients diagnosed with dementia whose care had been reviewed face to face in the preceding 12 months was 100% compared to the national average of 84%.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • The practice had developed a student mental health leaflet, an eating disorder questionnaire was added to new patient checks and counselling was offered in house.

People whose circumstances may make them vulnerable

Good

Updated 6 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 multi-disciplinary teams in the case management of vulnerable people.
  • 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 and had attended training in how to recognise domestic abuse.
  • 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.
  • Patients were encouraged to participate in health promotion activities, such as breast screening, cytology, blood borne virus screening and vaccination against hepatitis.

  • The practice conducted a homeless audit and developed a leaflet for homeless people to enable them to access care at GP practices. Staff also took part in the “Big Sleep Out” in April 2016 and raised £1300 for Cornerstones (Cornerstones provide refugees and homeless people a safe place to sleep) and were a signatory to the Manchester Homeless Charter.

  • The practice was a designated Food Bank Voucher distribution centre for people struggling to feed themselves.