Princess Road Surgery

Updated 17 November 2017

Princess Road Surgery is based in the culturally diverse area of Withington, Manchester. It is part of the NHS Central Manchester Clinical Commissioning Group (CCG) and has 4500 patients. The practice provides services under a Personal Medical Services contract, with NHS England.

Information published by Public Health England rates the level of deprivation within the practice population group as level one 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 75 years for males and 79 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 practice in England.

The practice has a slightly lower percentage (53%) of its population with a long-standing health condition than the England average (54%). The practice has a lower percentage (59%) 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 (6%) of its population with an unemployed status than the England average of (5%).

Services are provided from a row of converted parade of shops and house with disabled access and on street parking. 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 practice prides itself on having strong links with the University Medical School, with one of the senior partners achieving Best Community Teacher 2014, and regularly facilitating students in their placement studies.

The service is led by three GP partners and one salaried GP, a nurse practitioner and a practice nurse, the practice manager and a deputy practice manager. The team is supported by an administration team including a number of reception/administrative staff who also cover other duties such as dealing with samples and drafting prescriptions.

The practice is open from 6.45am to 6pm Monday, 8am to 6pm on Tuesdays and Fridays and 8am to 7pm on Wednesdays and Thursdays. The surgery is closed for one hour at lunchtime. Extended hours are provided on Monday mornings and Wednesday and Thursday evenings. The practice is also as part of a federation of GP practices who cover 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 17 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Princess Road Surgery on 16 June 2016. At the inspection in June the overall rating for the practice was good, although the key question Safe was rated requires improvement. This was because the arrangements in respect of the management of significant events, recruitment records and staff appraisal all required improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Princess Road Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 27 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 16 June 2016. This report covers our findings in relation to that requirement.

The practice is now rated as good for providing safe services, and overall the practice remains rated as good.

Our key findings were as follows:

• Since the previous inspection the practice had taken action to strengthen the arrangements in response to significant event and incident recording. Logs were maintained of each significant event or incident and these detailed what the issue was, and what action was taken in response to the concern.
• Team meeting minutes showed that significant events and incidents were discussed with staff at these meetings.
• Evidence supplied showed the practice undertook a review of significant events to evaluate the actions that were implemented to ensure these were effective.
• The practice had reviewed its recruitment policy and this was up to date and was supported by a recruitment policy document for clinical staff.
• Evidence supplied demonstrated appropriate recruitment records were obtained for staff recruited since April 2013 and these included a Curriculum Vitae, references, disclosure and barring service checks (DBS), evidence of right to work in this country and proof of address.
• Recruitment records were also now available for locum GPs used by the practice and this included evidence of professional registration and liability insurance.
• Since the previous inspection the practice supplied evidence demonstrating that all staff had received an appraisal and a schedule for future appraisals was recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 August 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 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 96% 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 80% 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 87% 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 80% 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.
• The practice had patient registers with various long term conditions such as diabetes, COPD, asthma, heart disease, hypertension, thyroid disease, cancer, rheumatoid arthritis, stroke and peripheral heart disease.
• The nurse practitioner had a special interest in diabetes care and worked to ensure the practice was providing the best care possible.
• The practice manager and a GP partner became cancer care champions and attended workshops to provide best standards of care, which were recognised by The Christie and resulted in the practice being awarded a certificate.

Updated 11 August 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 81%, which was slightly below the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• 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.
• The partners were working to share the care of expectant mothers with the midwifes from the local Hospital Trust. The GPs carried out eight week mother and baby checks.
• There was an in-house baby immunisation clinic for both scheduled and unscheduled appointments in order to ensure vaccinations were given at the recommended and appropriate intervals.

Updated 11 August 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 had an Avoiding Unplanned Admissions register which allowed them to create personalised care plans for patient’s needs. These were reviewed at regular Multi-Disciplinary meetings, in house weekly meetings and discussed and adapted when the patients attended for an appointment or when requesting a home visit.

Updated 11 August 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.

Updated 11 August 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 hypertension in whom the last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 82%, compared to the national average of 88%.

• 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 92% compared to the national average of 90%.
• The percentage of patients diagnosed with dementia whose care had been reviewed face to face in the preceding 12 months was 93% compared to the national average of 84%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 11 August 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.
• 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.