Manor Medical Practice

Updated 2 February 2017

Manor Medical Practice is located in Offerton, Stockport, Greater Manchester. The practice was providing a service to approximately 9,000 patients at the time of our inspection. A branch practice was located at 56 Higher Lane, Hillgate SK1 3PZ and we also visited this as part of the inspection.

The practice is part of Stockport Clinical Commissioning Group (CCG). The practice is situated in an area with higher than average levels of deprivation when compared to other practices nationally. The percentage of patients with a long standing health condition is 58% which is higher than the national average of 54%.

The practice is run by two GP partners. There are an additional three salaried GPs (three male and two female). There are four practice nurses, two of whom are nurse practitioners, one assistant practitioner, one health care assistant, a practice manager and team of reception and administrative staff.

The practice is open from 7.30am to 7pm on Mondays, Thursdays and Fridays, 7.30am to 8.30pm on Tuesdays and 7.30am to 8pm on Wednesdays. Saturday morning appointments are also available from 9am to 11.30am once per month.

When the surgery is closed patients are directed to the GP out of hours service provider ‘Mastercall’ by contacting NHS 111.

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice provides a range of enhanced services, for example: extended hours, childhood vaccination and immunisation schemes and avoiding unplanned hospital admissions.

The practice hosts third and fourth year medical students.

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor Medical Practice on 23 November 2016. Overall the practice is rated as good. Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Significant events had been investigated and action had been taken as a result of the learning from events.

• Systems were in place to deal with medical emergencies and staff were trained in basic life support.

• There were systems in place to reduce risks to patient safety. For example, infection control practices were good and there were regular checks on the environment and on equipment used.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Feedback from patients about the care and treatment they received from clinicians was very positive. Patients told us they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• The appointments system was flexible to accommodate the needs of patients. Urgent appointments were available the same day and routine appointments could be booked in advance.

• The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

• Information about services and how to complain was available. Complaints had been investigated and responded to in a timely manner.

• The practice had a clear vision to provide a safe and high quality service.

• There was a clear leadership and staff structure and staff understood their roles and responsibilities.

• The practice provided a range of enhanced services to meet the needs of the local population.

• The practice sought patient views about improvements that could be made to the service. This included the practice having and consulting with a patient participation group (PPG).

Areas where the provider should make improvement are:

• Improve the systems in place for ensuring medicines reviews are carried out at appropriate intervals.

• Ensure staff who are responsible for providing chaperone duties have undergone all required employment checks.

• Review the handling of complaints to ensure complainants are informed of the second stage of the complaints process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 February 2017

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

• The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required regular checks received these.

• Regular, structured health reviews were carried out for patients with long term conditions.

• Data from 2014 to 2015 showed that the practice was performing lower than other practices locally and nationally for the care and treatment of people with chronic health conditions such as diabetes.

• Patients with diabetes were referred to a six session educational programme.

• The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

• Regular clinical meetings were held to review the clinical care and treatment provided and ensure this was in line with best practice guidance.

• One of the practice nurses had undertaken a Macmillan cancer course to better support patients with a diagnosis of cancer. They were also looking to develop the services provided to patients diagnosed with cancer.

• Longer appointments and home visits were available for patients with long term conditions when these were required.

• Patients with multiple long term conditions were offered a single appointment to avoid multiple visits to the surgery.

Updated 2 February 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 those who were at risk, for example, children and young people who had a high number of A&E attendances.

• A GP was the designated lead for child protection.

• A regular safeguarding meeting was held with relevant professionals to discuss child protection concerns.

• Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.

• Child surveillance clinics were provided for 6-8 week olds.

• Immunisation rates were comparable to the national average for all standard childhood immunisations. Opportunistic immunisations were given to encourage uptake.

• The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report any concerns they had identified to relevant professionals.

• Babies and young children were offered an appointment as priority and appointments were available outside of school hours.

• The premises were suitable for children and babies and baby changing facilities were available.

• Family planning and contraceptive services were provided.

Updated 2 February 2017

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

• The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population.

• Registers of patients with a range of health conditions (including conditions common in older people) were maintained and these were used to plan reviews of health care and to offer services such as vaccinations for flu.

• The practice provided an enhanced service to prevent high risk patients from unplanned hospital admissions. This included these patients having a care plan detailing the care and treatment they required.

• GPs and practice nurses carried out regular visits to a local care home to assess and review patients’ needs and to prevent unplanned hospital admissions.

• A practice nurse contacted patients following discharge from hospital to check they had the support they required.

• Home visits and urgent appointments were provided for patients with enhanced needs.

• The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.

• Monthly multi-disciplinary meetings were held to discuss the care and treatment for patients with complex needs.

Updated 2 February 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.

• Telephone consultations were provided and patients therefore did not always have to attend the practice in person.

• The practice provided extended hours appointments and was open from 7.30am Monday to Friday, late appointments were provided two evenings per week and Saturday mornings appointments were available once per month.

• Patients could also access appointments for health screening or chronic disease management at evenings and weekends provided by Stockport CCG’s out of hours provider ‘Mastercall’.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group. Screening uptake for people in this age range was comparable to or below national averages.

• The practice was proactive in offering online services including the booking of appointments and requests for repeat prescriptions.

Updated 2 February 2017

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

• The practice held a register of patients experiencing poor mental health and these patients were offered an annual review of their physical and mental health.

• The practice referred patients to other services such as psychiatry and counselling services.

• The practice worked with multi-disciplinary professionals including in the case management of patients experiencing poor mental health.

• A system was in place to follow up patients who had attended accident and emergency and this included where people had been experiencing poor mental health.

• Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

• Two staff were ‘dementia friends’ and one of these attended dementia meetings held in a local community centre.

• The practice provided primary care to patients living in a local care home for people with dementia.

Updated 2 February 2017

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

• The practice worked with relevant health and social care professionals in the case management of vulnerable people.

• 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.

• The practice was accessible to people who required disabled access and facilities such as a hearing loop system (used to support patients who wear a hearing aid) were available.

• Information and advice was available about how patients could access a range of support groups and voluntary organisations.

• One of the GPs had a lead for supporting patients with drug and alcohol issues.

• The practice provided primary care to people living at a local women’s refuge.