Manor Primary Care

Updated 8 November 2016

Manor Primary Care is located on Tanhouse Road, one of the main roads circling Skelmersdale, Lancashire. The large modern purpose built health centre is near to the centre of the town and is owned by NHS Property Services. There is easy access to the building and disabled facilities are provided. There is a large car park on the site. The building is shared with a pharmacy, a Childrens and Adolescent Mental Health Service (CAMHS) and community matrons, district nurses, midwives and dieticians all provide services.

The practice holds a General Medical Services (GMS) contract with NHS England and forms part of West Lancashire Clinical Commissioning Group.

There are three GPs working at the practice, two of whom are partners. Both of the partners are male and the salaried GP is female. There is no use of locum GPs however local GPs from neighbourhood practices assist with sessions during periods of staff absence. There is a total of 2.5 whole time equivalent GPs available. There are two female nurses (one full time Advanced Nurse Practitioner and one part time practice nurse), and one female part time Health Care Assistant ( HCA). There is a full time practice manager, a medicines management coordinator, a reception coordinator and a team of administrative staff.

The practice opening times are 8am until 6pm Monday to Friday. Appointments are available 8.30am to 2pm and 2.30 to 5.30pm Monday and Friday, 9am to 2pm, 2.30 to 6pm Tuesday, 8.30am to 12.30pm Wednesday and 8.30 to 2pm and 2.30 to 6pm Thursday.

Patients requiring a GP outside of normal working hours are advised to call the 111 service who will transfer them to Out of Hours West Lancashire GP Service, an out of hours service provider, call an ambulance or suggest they attend Accident and Emergency. There are 5257 patients on the practice list. The majority of patients are white British with a small population of patients from Eastern Europe. There are a high number of patients with chronic disease prevalence. On the Index of Multiple Deprivation the practice is in the first most deprived decile.

This practice offers placements to student nurses and was about to offer placements to medical students.

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor Primary Care on 17 August 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 the services provided 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.
• Patients 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 and complied with the requirements of the duty of candour.

We identified the following two areas of outstanding practice:

• The practice had approached EMIS administrators to create a new alert for a “Looked After Child” and this had been implemented nationally. This alert enabled staff to support the families more effectively.

• The practice reported on work practices which they identified as “Above and Beyond” .For example a patient on low income told staff they could not afford to travel to the surgery for appointments and maintain his food intake. The community matron was involved and helped to improve the patient’s social and financial circumstances by referring to appropriate agencies. In another case a child had refused to take medicine for a chest infection and the ANP saw the family each day to encourage the child’s compliance . Another patient had been in urgent need of a prescription but could not collect it at the surgery due to mobility problems. A member of staff delivered it to a pharmacy near to the patients home where it could be collected by a neighbour.

The areas where the provider should make improvements :

• Record learning outcomes following the analysis of complaints and serious events at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 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 including asthma, Chronic Obstructive Pulmonary Disease (COPD) and diabetes. Patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was better than the national average.
• 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.
• There was local access to community specialist teams (heart failure, respiratory, diabetes, anticoagulation, palliative) and practice representation at CCG level was focussed on increasing local provision..
• One of the GP partners had a special interest in gastroenterology. They provided a weekly clinic at an adjacent location and regular teaching and updates for staff at the practice.

Updated 8 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, for example, children and young people who had a high number of A&E attendances and those who did not attend secondary care appointments.

• Immunisation rates were relatively high for all standard childhood immunisation programmes achieving up to 98% on 2014/15 figures compared to a CCG maximum of 96%. These were provided both at immunisation clinics and by appointment.

• 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.

• 80% of women aged 25-64 are recorded as having had a cervical screening test in the preceding 5 years. This compared to a CCG average of 82% and a national average of 82%.

• We saw positive examples of joint working with midwives, health visitors and school nurses and the Children and Adult Mental Health Service (CAMHS) was based in the same building which meant that multidisciplinary support could be accomplished easily.

• All parents/guardians calling with concern about a child under the age of 10 were offered a same day appointment with urgent after school appointments set aside for afternoon booking.

• The practice was involved with “CCNOT pilot” (via Ormskirk Hospital) to try and reduce children hospital admissions and provide care for children closer to home.

• The practice was developing links with community voluntary services including “Well Skelmersdale”, a social prescribing project aimed to boost self-management, capacity and services close to home.

Updated 8 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided a visiting service to three local care homes and offered organisational and clinical support as part of the intermediate care service at one of them.

• The practice worked to reduce the number of patients who accessed hospital care unneccesarily by reviewing the list of those patients at risk and informing patients about their same-day telephone appointment access and putting plans put in place to reduce the risk of emergency health need. There was a system whereby people discharged from hospital on this list were flagged by named administrative staff, contacted and further review arranged where necessary. This system was overseen by one of the GP’s.

• Electronic prescribing was encouraged if convenient including repeat dispensing. Repeat prescriptions could also be ordered by telephone and the attached pharmacy provided home delivery.

• Patients reported liking the “family feel” of being known to two generations of doctors at the surgery.

Updated 8 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 appointments rolled out all day so that patients could attend from 8.30 am, at lunchtime and until 6pm two days each week. The practice was considering extended hours opening and this was likely to be a focus for collaborative working within the Skelmersdale Federation which was at planning stage.

• The practice was proactive in offering online services including electronic prescriptions as well as a full range of health promotion and screening that reflected the needs for this age group. .

• GPs performed joint injections, reducing patient waiting times and local secondary care burden.

• Travel health and vaccination services were offered and language line was available for those of all ages who did not speak English .This catered to the (mainly) young working eastern-european population.

Updated 8 November 2016

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

• 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This compared favourably with a CCG average of 86% and a national average of 88%. Safety measures such as shorter prescription length were used where there was high risk of self harm.

• 97% of patients with mental health conditions had their alcohol consumption recorded in the preceding 12 months. This compared well with a national average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. This included CAMHS, Drug and Alcohol services and the community matron service.

• The practice carried out advance 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 practice referred to the local psychological services and also offered lifestyle advice including self-help guidance, exercise as a tool for improving mental health and local well-being services.

Updated 8 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.Alerts for direct access to GPs or nursing staff were added to records of these patients.

• The practice offered longer appointments for patients with a learning disability or those with English as a second language.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients including hospice staff, palliative care nurses and district nurses. This included multidisciplinary gold standard palliative care framework meetings to ensure palliative care patients received safe, effective and responsive care.

• 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. Concerns had been raised regarding effective information systems between social services and primary care. Action aimed to create local change and a success has been the creation of a “Looked After Child” alert which had been accepted by EMIS administrators as a valuable new alert and enabled the practice to offer families more targeted support.

• Practice staff maintained a register of carers. Information for carer’s was maintained in the waiting room including N Compass (a local voluntary sector agency which offered both individual and group support). All carers were offered the influenza vaccination.

• All patients who experienced hospital discharge, attended the Accident and Emergency Department or contacted the out of hours service were reviewed via the alerts system. These were shown directly to the safeguarding lead to decide on further action.