Archived: Manor House Surgery

Updated 7 March 2017

Dr Michael Duggan also known as Manor House Surgery provides a range of primary medical services to the residents of Stevenage. The practice has been at its current location of Manor House Surgery, Emperor’s Gate, Stevenage, SG2 7QX since 1989.

The practice population is pre-dominantly white British with a higher than average number of patients below five years and between the ages of 25 and 54 years. National data indicates the area is one of low deprivation. The practice has approximately 5,650 patients with services provided under a General Medical Services (GMS) contract, a nationally agreed contract with NHS England.

The practice is led by a principal male GP and has five long-term locum GPs, three male and two female. The nursing team consists of two nurse practitioners and a practice nurse. There is a team of reception and administrative staff led by a practice manager. The practice is a training practice and currently has one GP trainee and a student nurse.

The practice is open from 8am to 6.30pm Monday to Friday and offers extended opening hours from 6.30pm to 7.30pm on Tuesdays, 7am to 8am on Thursday, and 10am to 12pm on the first Saturday of each month.

When the practice is closed, out-of-hours services are provided by Herts Urgent Care and can be accessed via the NHS 111 service.

Updated 7 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Michael Duggan on 1 December 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 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.
• The practice had identified approximately 4% of their list as carers.
• Members of the patient participation group (PPG) we spoke with were positive about the practice and the care provided.
• The practice met regularly with the PPG and responded positively to proposals for improvements.
• 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.
• 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 two areas of outstanding practice:

• There was a carers champion who offered assistance and advice on the financial support available. Patients were able to book time with the carers champion so that they could complete applications for financial support and blue badge parking permit applications together. This service was available at time to suit the carer including in the extended opening hours. We saw that three carers were in receipt of financial support that they would otherwise not have been aware of. There were comments made by patients that by receiving this advice from the carers champion they had avoided a long wait for help from external advice agencies and received support sooner.
• The carers champion and locality carers lead had arranged a carers event at the practice in September 2016. Invitations and SMS text messages were sent to all patients that had been identified as carers. Guest speakers attended the event to give advice. For example, a local travel agent attended and gave a talk on taking holidays, travel insurance and types of holiday packages that were available for people with disabilities. The event was also attended by a representative from Stevenage Borough Council and Herts Healthy Hub. Over 30 carers attended and gave positive feedback. They had asked for further events and another had been planned for March 2017.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 March 2017

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 diabetes related indicators was similar to the local and national averages. For example, the percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification was 93% compared to the CCG average of 89% and the national average of 89%.
• 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.
• The practice regularly reviewed their QOF achievement to identify if there were any areas which required additional focus, particularly for those patients with long-term conditions. These reviews were led by one of the nurse practitioners with the support of the practice manger and discussed at the practice clinical meetings.

Updated 7 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.
• Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. For example, the practice achieved a 90% target for childhood immunisation rates for the vaccinations given to under two year olds compared to the national average score of 90%.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 83% and the 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 and health visitors.

Updated 7 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.
• A vaccination programme was in place for older people including, seasonal flu jabs, shingles and pneumococcal vaccinations. The practice informed us that 85% of patients over the age of 65 years had received these vaccinations.
• Patients aged over 75 years were offered an annual health check. The practice had completed 134 checks in the preceding year, which equated to 74% of this age group.

Updated 7 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.

• Extended opening hours were offered from 6.30pm to 7.30pm on Tuesdays, 7am to 8am on Thursday, and 10am to 12pm on the first Saturday of each month. This was especially useful for working patients who could not attend during normal opening hours.

• 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. For example,

  • 60% of females, aged 50-70 years, were screened for breast cancer in last 36 months compared to the CCG average of 72% and the national average of 72%.

  • 54% of patients, aged 60-69 years, were screened for bowel cancer in last 30 months compared to the CCG average of 60% and the national average of 58%.

• Patients who had not attended for bowel screening were offered an appointment at the practice to discuss the service and its benefits to increase awareness and acceptance of the screening.

• Students attending university were able to register as a temporary patient, if required, during the holidays.

Updated 7 March 2017

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

• 93% of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting in the last 12 months, compared to the CCG average of 86% and the national average of 84%.
• Performance for mental health related indicators was similar to the local and national averages. For example, 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 91% compared to the CCG average of 92% and the national average of 89%.
• 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 support groups and voluntary organisations. Counselling sessions for patients were offered weekly by a visiting Well Being Team.
• 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. All staff were in the process of completing Dementia e-learning to reinforce dementia awareness.

Updated 7 March 2017

The practice is rated as outstanding for the care of people who circumstances may make them vulnerable.

• The practice had identified approximately 4% of their list as carers and offered them flexible appointment booking, health checks and flu vaccinations. The carers champion offered assistance and advice on the financial support available. Patients were able to book time with the carers champion so that they could complete applications for financial support and blue badge parking permit applications together. This service was available at time to suit the carer including in the extended opening hours.
• The carers champion and locality carers lead had arranged a carer’s event at the practice in September 2016. Guest speakers attended the event to give advice. For example, a local travel agent attended and gave a talk on taking holidays, travel insurance and types of holiday packages that were available for people with disabilities. Another had been planned for March 2017.
• 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. Patients with learning disabilities were offered an annual health check. The practice had completed health checks for all 15 patients they had on their learning disability register in the previous 12 months.
• 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 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.