Manor Practice

Updated 1 June 2017

Manor Practice is a large practice based in Wallington, south London. The practice list size is 8600.

The practice has a Personal Medical Services (PMS) contract and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include meningitis provision, childhood vaccination, extended hours access, dementia diagnosis and support, flu and pneumococcal immunisation, learning disabilities, minor surgery, patient participation, rotavirus and shingles immunisation, and unplanned admissions.

The practice has a larger than average population of patients aged between 35 and 55 years, and a higher than national and CCG average representation of income deprived children and older people. Life expectancy is 79 for males and 84 for females, which are similar to the national average life expectancies of 79 for males and 83 for females.

The practice operates from two branches; the main practice is in a converted residential building on Manor Road, with a branch in the purpose built Roundshaw Health Centre on Mollison Drive, both in Wallington. All patient facilities are wheelchair accessible and there are facilities for wheelchair users including an accessible toilet. The practice did not have hearing loops installed at either location.

The Manor Road practice has access to six consulting rooms and one treatment room on the ground floor. The Roundshaw branch has access to five consultation rooms over one floor, increasing to eight upon completion of refurbishment work.

Opening hours at the main site are between 8.00am and 6.30pm weekdays. Appointments are available throughout the day when the practice is open. Opening hours at the Roundshaw branch site are from 8.30am to 12.30pm and from 2.00pm to 6.30pm Monday to Wednesday, and from 8.30am and 12.30pm only on Thursday and Friday. There are extended opening hours until 8.00pm, switching between each site on alternate Tuesdays, and from 9.00am to 11.30am on Saturday at the main site.

The practice clinical team is made up of four male GP partners and two female salaried GPs providing 40 GP sessions per week, a physician associate, a nurse practitioner, two practice nurses and two healthcare assistants. The clinical team is supported by a practice manager, an assistant practice manager and 16 reception/administrative staff members. The practice is a training practice with an active teaching programme for both undergraduate medical students and post graduate doctors pursuing higher vocational training to become specialists in general practice.

The partnership is registered to carry on the regulated activities of diagnostic and screening procedures, maternity and midwifery services, surgical procedures, family planning and treatment of disease disorder or injury.

Updated 1 June 2017

Letter from the Chief Inspector of General Practice

Following a previous comprehensive inspection of Manor Practice on 6 January 2015 the practice was given an overall rating of requires improvement. Requirement notices were set for regulations 9 (care and welfare of people who use services) and 21 (requirements relating to workers) of the Health and Social Care Act 2008.

Subsequent to the 6 January 2015 inspection we carried out an announced comprehensive inspection at Manor Practice on 27 April 2017. The practice had addressed the requirements arising from the earlier inspection and overall the practice is now rated as good.

Our key findings across all the areas we inspected were as follows:

• Previous breaches of regulation in respect of recruitment checks had been addressed by the practice - all staff who acted as chaperones were trained for the role and had received a Disclosure and Barring Service (DBS) check in accordance with practice policy.
• Previous breaches in regulation in respect of patient specific directions (PSDs) had been addressed – PSDs were now in place for healthcare assistants to administer vaccines, and for the nurses to administer certain medicines such as birth control injections.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The provider had responded to failings identified at the previous CQC inspection by appointing an experienced practice manager, committing to more clinical and financial investment from the partners, and the development of a comprehensive business development plan with input from the whole staff team.

The areas where the provider should make improvements are:

• Ensure that systems are in place to check the expiry dates of disposable equipment.
• Continue to monitor and take action to improve patient satisfaction with the practice opening hours.
• Install hearing loops in the reception areas at both sites.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 June 2017

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

• The nurse practitioner had a lead role in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The national Quality and Outcomes Framework (QOF) data showed that 67% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%.
• The national QOF data showed that 76% of patients with asthma in the register had an annual review, compared to the CCG average of 72% and the national average of 76%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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.

Updated 1 June 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 80%, which was in line with the Clinical Commissioning Group (CCG) and national averages of 82%; the practice had a designated administrative staff who monitored cervical screening uptake and results.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice provided support for premature babies and their families following discharge from hospital.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of weekly ante-natal and post-natal clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 1 June 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice had recruited a new GP starting in May 2017 with an interest in mental health and care of older people.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible

Updated 1 June 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments. The practice had conducted a survey to determine when their extended hours would be most beneficial.
• 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.

Updated 1 June 2017

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

• The practice carried out advance care planning for patients living with dementia.
• The number of patients with dementia who had received annual reviews was 96% which was higher than the Clinical Commissioning Group (CCG) average of 86% and national average of 84%.
• 95% of 100 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average of 91% and national average of 89%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 1 June 2017

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 (who were also referred to a local homeless charity), travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.