Sutton Manor Surgery

Updated 9 November 2016

Sutton Manor Surgery has three GP partners and a salaried GP. All GPs are female and provision for patients who required a male doctor was available through a long-term locum based in the practice. Two practice nurses and a healthcare assistant worked full time and were supported by a team of administrators, receptionists and IT and data staff.

This is a dispensing practice and a training practice, with regular FY2-grade doctors and registrars based in the practice. There is a private pharmacy in the same building.

The practice is accessible by patients who use a wheelchair and has baby-changing facilities. A self-service check-in machine with multiple language options is available.

A private room is available adjacent to the reception desk, which patients can use to request a confidential discuss with staff.

The practice serves a patient list of 7467 people, including 66 patients who are registered carers and is in an area of high levels of deprivation.

Appointments are from 8am to 6.30pm Monday to Friday.

Updated 9 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sutton Manor Surgery on May 27 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.
• 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.
• There was continuity of care, with 50 urgent appointments available throughout the week although the practice faced challenges in meeting demand for appointments.
• 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 consistent focus on reducing the risk of social isolation in patients who were vulnerable, had mental health needs or whose age restricted their access to social activities. This included supporting patients to access a local time bank and a back to work scheme. Both schemes supported patients to reduce social isolation and to build the skills needed to rejoin the workforce. A weekly 'social prescribing' session enabled patients to access a counsellor who could signpost them to local social activity groups as a strategy to reduce isolation.
• The practice employed a pharmacist to provide a rapid response to patient questions about medication, to improve the management of repeat prescriptions and to provide oversight of the practice prescribing formulary.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 November 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.
• 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 offered a number of monitoring services, including spirometry, 24 hour blood pressure monitoring and 24 hour echocardiogram monitoring. Retinal screening facilities were also available.
• The practice monitored patients at risk of developing lifestyle-related diabetes and promoted testing for prediabetes that helped staff to provide health promotion and wellbeing advice.

Updated 9 November 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. Immunisation rates were relatively high for all standard childhood immunisations.

• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with district nurses and health visitors.
• The practice offered dedicated antenatal and postnatal clinics and prioritised continuity of care for parents during this period.
• A play area was available in the waiting area for young children.
• GPs and nurses offered long-term reversible contraception options.
• Sexual health screening for young people was available, including take-away chlamydia screening packs and HIV testing.

Updated 9 November 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. This included telephone appointments, support to access community associations and support to access appropriate transport to and from appointments.
• The practice environment included resources for older people. This included a hearing loop and high-backed chairs in the waiting area. A book library was available in the waiting area, which also acted as a strategy to encourage people to socialise. This formed part of a wider programme to reduce social isolation, including participation in a local time bank scheme.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Patients were offered longer appointments to make sure they had enough time to talk to the doctor or nurse.
• Social isolation and loneliness were recognised as key risk factors in this population group. The practice encouraged patients to take part in a local ‘time bank’ programme to encourage them to spend time socially and also provided signposting and referrals to community groups.

Updated 9 November 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. This included flexible appointment times, telephone consultations and health screening for those over 40 years old.
• The practice recognised that musculoskeletal problems disproportionately affected this population group. To address this, a senior physiotherapist attended the practice weekly and offered assessments, physiotherapy and interventions. An occupational health team was also available in the practice.
• 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. This included e-mail appointment reminders.

Updated 9 November 2016

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

• A separate waiting room was available for patients who were anxious and preferred a quiet space.
• 96% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months. This is better than the Clinical Commissioning Group average of 86% and better than the national average of 84%.
• 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 that included an annual review and cognitive screening.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, including a back to work scheme. A specialist dementia advisor visited the practice fortnightly to provide support to staff.
• The practice had recently established a system monitor 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, including urgent referrals to crisis teams.
• Staff were trained in dementia care and members of the patient participation group had been given dementia awareness training.

Updated 9 November 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 those with a learning disability and had links with local services for drug and alcohol rehabilitation.
• 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. This included twice-weekly GP visits to a local hospice and support for patients to use a back to work scheme.
• 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, including in urgent crisis situations.
• Staff demonstrated an understanding of the vulnerability of relatives following a bereavement and sent a condolence card out as well as offered a meeting to give people the chance to ask any questions. The practice provided an informative and sensitively-worded leaflet that provided structured support for patients or relatives who were grieving and needed emotional support.