Archived: The Manor Practice

Updated 19 July 2016

The Manor Practice is part of the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

The practice is registered with the Care Quality Commission to provide primary medical services. The practice has a general medical service (GMS) contract with NHS England. Under this contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care.

The practice is located in a suburban area of Birmingham with a list size of approximately 15,700 patients. Patients can be seen at either the main practice site located in James Preston Health Centre (owned by NHS property services) or at their branch site located at Ashfurlong Medical Centre, 233 Tamworth Road, Sutton Coldfield B75 6DX which is shared with another practice and a private consulting service. The branch surgery is co-owned and shared with another practice. Both the main and branch site premises are purpose built for the purpose of providing primary medical services and have similar numbers of patients in attendance. We visited both sites during our inspection but spent the majority of the time at the James Preston Health Centre.

Based on data available from Public Health England, the practice has lower than the national average levels of deprivation in the area.

Practice staff work flexibly across the provider’s two sites (James Preston Health Centre and Ashfurlong Medical Centre). Altogether the staff team consists of five partners (2 male and 3 female), 4 salaried GPs (2 male and 2 female), 8 nurses (including four independent prescribers), 2 health care assistants, a practice manager and a team of administrative staff.

Both sites are open from 8am to 6.30pm Monday to Friday. In addition the Ashfurlong Medical Centre is open 6.30pm to 8.15pm on a Monday and between 8am and 12.30pm on a Saturday for extended opening. When the practice is closed the provision of primary medical services are subcontracted out to an out of hours provider (BADGER).

The practice was a training practice for qualified doctors training to become GPs. The practice also supported military trainee doctors and final year medical students. More recently the practice has provided placements for student nurses.

The practice has not previously been inspected by CQC.

Updated 19 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Manor Practice on 24 May 2016. The practice consists of two sites located at James Preston Health Centre (Main site) and Ashfurlong Medical Centre (branch site). 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. These were used to support learning.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff received appropriate training and support for their roles to ensure they had the skills, knowledge and experience to deliver effective care and treatment.
• The practice performed well against national indicators for patient outcomes. The practice was participating in innovative schemes to improve outcomes and reduce unplanned admissions in their older population.
• 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.
• Patients said they found it easy to make an appointments. Patients with urgent needs were able to obtain same day consultations.
• 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 areas of outstanding practice:

The practice was participating in innovative schemes in collaboration with local practices to secure positive outcomes for older people and reduce the need for unplanned admissions.

The elderly care support nurse pilot project was a collaboration between three practices running between September 2015 and September 2016. An elderly care support nurse has been employed to review all patients over 75 years on the practice list to identify, assess and help address any unmet care and support needs. Over 300 patients from across the participating practices have benefited to date receiving care and support from a range of services including NHS, local authority, third sector and voluntary organisations.

The areas where the provider should make improvement are:

• Review and implement ways in which the identification of carers might be improved so that they may receive support.
• Ensure greater involvement of clinical staff in complaints investigations and responses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 July 2016

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Nursing staff involved in the management of long term conditions had received appropriate training.
• Performance for diabetes related indicators was 100% which was higher than the CCG average and national average of 89%. (Exception reporting for diabetes related indicators was 15% which was slightly higher than the CCG average of 10% and national average 11%).
• Longer appointments and home visits were available for those who needed them due to their clinical needs.
• Patients had a named GP and a structured annual review to check their health and medicines needs were being met. For some conditions these were undertaken as a home visit if the patient was unable to attend the practice due to clinical reasons.
• 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 range of services to support the diagnosis and management of patients with long term conditions for example insulin initiation, electrocardiographs (ECGs), ambulatory blood pressure monitoring and spirometry.

Updated 19 July 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.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 78% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Priority for appointments was also given to sick children.
• Both premises had baby changing facilities and offered a breast feeding friendly service.
• The practice carried out combined six week baby checks and postnatal appointments for convenience.
• The practice worked with midwives, health visitors and school nurses to support and safeguard children and young people.

Updated 19 July 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Older patients were allocated a named GP to support their needs.
• The practice worked collaboratively with other practices locally to provide innovative and proactive services to meet the needs of this population group, improve outcomes and reduce unplanned admissions to hospital. The elderly care support nurse pilot project which started in September 2015 and runs until September 2016 is designed to identify and support previously unrecognised need. The elderly care support nurse was reviewing all patients over 75 years to identify, assess and help address any unmet care and support needs. Over 300 patients from across the participating practices have benefited to date receiving care and support from a range of services including the NHS, local authority, third sector and voluntary organisations. The elderly support nurse told us that the majority of patients were from The Manor Practice as the largest of the three participating practices. The unplanned admission scheme (a collaboration between six local practices) employs three community matrons to review admissions for patients over 70 years and facilitate early discharge where appropriate by putting in place appropriate support and care arrangements. There had been a large reduction in hospital bed days compared to non-participating practices as well as a reduction in the number of hospital deaths. The practice joined the scheme in February 2016. Data available from the community matron showed that since the practice joined 24 admissions have been avoided and 17 re-admissions prevented by putting in place appropriate supporting interventions.
• The practice regularly worked with other health professionals to review and ensure those with the most complex care needs were being met. For example, patients with end of life care needs or had unplanned admission to hospital.
• Both practice sites were accessible to patients with mobility difficulties. There was a practice wheelchair available if needed.
• The practice undertook home visits and telephone consultations for patients who would otherwise have difficulty attending the practice due to their clinical condition. It also undertook weekly visits to a local nursing home where there was a number of practice patients resident. We received positive feedback about the practice from this home.
• The practice website could be adjusted in font size and colour for easier viewing.
• The practice’s adult safeguarding lead had undertaken additional training in the care of older adults who were vulnerable.

Updated 19 July 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 offered extended opening hours at Ashfurlong Medical Centre on a Monday until 8pm and on a Saturday Morning 8am to 12noon for patients who were unable to attend due to work or other commitments during normal opening hours.
• Telephone triage service also enabled patients who were unable to attend the practice easily to seek clinical advice.
• The practice was proactive in offering online services for booking appointments and ordering repeat prescriptions.
• Text messaging was used to remind patients of appointments and improve attendance.
• The practice provided a range of health promotion and screening that reflected the needs of this age group including NHS health checks. The uptake of nation screening programmes was higher than CCG and national averages.
• The practice offered virtual membership to its patient participation group to encourage feedback from this group of patients.

Updated 19 July 2016

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

• Nationally reported data for 2014/15 showed 72% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG average 82% and national average 84%.
• National reported data for mental health outcomes (2014/15) was 100% which was above to the CCG average 92% and national average 93%. Exception reporting was comparable to CCG and national averages.
• The practice had a named nurse for mental health reviews who would also follow up those who did not attend.
• Some of the reception staff at the practice had been trained as dementia friends to ensure a better understanding and support for patients with dementia.
• There was a well-established acute referral pathway for the local mental health teams.
• The practice website contained details of mental health support available and easily accessible self-referral forms.
• The principal GP told us that they contacted patients who had attended hospital through alcohol.
• Information was displayed in the waiting area about support available for patients with dementia.

Updated 19 July 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 and those with caring responsibilities. For example, carers and those with a learning disability.
• The practice offered health reviews for patients with a learning disabilities provided by a named nurse. These would be carried out at learning disability units, where appropriate, at times agreed so that patients could still attend their daily activities and routines. The practice had 79 patients registered with a learning disability and 94% had received an annual health reviews in the last 12 months.
• Patients with a learning disability held patient passports which provided important information about them, including their likes and dislikes should they move between services.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Noticeboards displayed information for vulnerable groups on carers, drugs and alcohol misuse and safeguarding support.
• 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.
• New patients were asked about any specific needs as part of the registration process so that it could be taken into account when providing care and treatment.