Cornbrook Medical Practice

Updated 6 September 2016

Cornbrook Medical Practice was formed in April 2011 by the merger of two smaller practices in the Hulme area of Manchester. The main site is based at City Road whilst the second location is based at Booth Street. It is part of the NHS Central Manchester Clinical Commissioning Group (CCG) and provides services to approximately 11,000 patients under a General Medical Services contract, with NHS England.

Hulme is a deprived, inner city ward in Manchester which is undergoing significant regeneration. There is a diverse patient population with students and residents reflecting many years of immigration including Irish, Afro-Caribbean, Somalian, Eastern European, Afghan and Iraqi patients.

Information published by Public Health England rates the level of deprivation within the practice population group as level two on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest. Male and female life expectancy in the practice geographical area is 74 years for males and 80 years for females, both of which are below the England average of 79 years and 83 years respectively. The numbers of patients in the different age groups on the GP practice register were generally similar to the average GP practices in England with the exception of having a greater number of patients aged between 20 to 34.

The practice has a similar percentage (51%) of its population with a long-standing health condition when compared to the England average (54%). The practice has a higher percentage (73%) of its population with a working status of being in paid work or in full-time education than the England average (62%). The practice has a higher percentage (9%) of its population with an unemployed status than the England average of (5%).

Services are provided from a purpose built building with disabled access and a private car park. The practice has a number of consulting and treatment rooms used by the GPs and nursing staff as well as visiting professionals such as health visitors.

The service is led by five GP partners (two male and three female) who are supported by a team of nurses, a practice / business manager as well as an administration team including reception team leaders and a number of reception/administrative staff who also cover other duties such as drafting prescriptions.

The City Road practice is open from 8:30am to 6pm Mondays, Tuesdays, Fridays, from 8.00am to 6.00pm on Thursdays and from 8.30am to 1pm on Wednesdays. The practice is also a part of a federation of GP practices who provide extended hours cover for a number of practices in the area between 6pm and 8pm, Monday to Friday, as well as on Saturday and Sunday mornings. Patients are able to attend appointments at a small number of local health centres as part of this arrangement. Out of hours cover is provided by the NHS 111 service and Go to Doc.

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

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.

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.

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.

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.

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.

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.