Manor House Lane Surgery

Updated 19 April 2017

Manor House Lane surgery is based in the South Yardley area of the West Midlands. There are two surgery locations that form the practice; these consist of the main practice at Manor House Lane Surgery and a branch practice at Marston Green Surgery. There are approximately 10250

patients of various ages registered and cared for across the practice and as the practice has one patient list, patients can be seen by staff at both surgery sites. Systems and processes are shared across both sites. The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices

provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some enhanced services such as minor surgery, childhood vaccination and immunisation schemes. The practice runs an anti-coagulation clinic for the practice patients.

There are two male GP partners and three salaried GPs (one male and two female). The nursing team consists of two nurse practitioners, three nurses and one health care assistant. The non-clinical team consists of a practice manager, administrative and reception staff. The clinical staff and some of the reception staff worked across both sites.

The practice serves a higher than average population of people aged 45-54 years. Based on data available from Public Health England, the levels of deprivation (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by Manor House Lane surgery is higher than the national average, ranked four out

of ten, with ten being the least deprived. The practice is open to patients between 8.30am and

6.30pm Monday, Tuesday, Thursday and Friday and 8.30am to 1.30pm on Wednesday. Extended hours appointments are offered 6.30pm to 8pm on Tuesday at Manor House Lane surgery and 6.30pm to 8pm on Monday at Marston Green surgery. Emergency appointments are available daily. Telephone consultations are also available and home visits for patients who are unable to attend the surgery. The out of hours service (including weekdays from 6.30pm to 8.30am) is provided by Badger Out of Hours Service and the NHS 111 service. Information about these services are available on the practice website.

The practice is part of NHS Solihull Clinical Commissioning Group (CCG) which has 38 member practices. The CCG serve communities across the borough, covering a population of approximately 238,000 people. A CCG is an NHS Organisation that brings together local GPs and experienced health care professionals to take on commissioning responsibilities for local health services.

Updated 19 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor House Lane Surgery on 23 June 2016. Overall the practice is rated as good.

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

• There was an effective system in place for reporting and recording significant events.
• The practice had visible clinical and managerial leadership and staff felt supported by management.
• 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.
• 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 premises proved a challenge due to lack of space and limited car parking, which the staff managed well.
• Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. We saw evidence that multidisciplinary team meetings took place every two months.
• The provider was aware of and complied with the requirements of the duty of candour.
• Governance and risk management arrangements were not robust. There were no risk assessments in the absence of disclosure and barring checks (DBS) for members of the reception team who occasionally chaperoned.
• Some staff who acted as chaperones were unaware of the recommended chaperoning guidelines when observing treatments and examinations.

• We found some of the practice policies required reviewing and updating in line with national guidance.
• As tenants of the premises, the provider had not assured themselves that risks to patients, visitors and staff had been appropriately assessed and managed.

• The practice was unable to provide sufficient evidence of seeking appropriate assurances for the employment of staff. For example, Disclosure and Barring Service (DBS) checks had been accepted for nursing staff from their previous employment

The areas where the provider must make improvement are:

• Ensure all staff are risk assessed in the absence of a Disclosure and Barring Service (DBS) check when carrying out chaperoning duties.
• Have a legionella risk assessment in place to mitigate risk and the spread of infection.

The areas where the provider should make improvement are:

• Ensure staff who chaperone are aware of and comply with recommended chaperoning guidelines when observing treatments and examinations.
• Consider how to proactively identify and support carers.
• Review effectiveness of keeping administration staff up to date with no regular meetings taking place.
• Ensure appropriate processes to assess, monitor improvement and mitigate risks in relation to both the safety and quality of the service, for example the use of risk assessment.
• Seek and act on feedback received from patients to demonstrate improvements to services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 September 2016

• 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 and patients who were housebound received reviews and vaccinations at home. For example, blood tests for warfarin monitoring.

• Patients with long term conditions had a named GP and a structured annual review to check their health and medicines needs were being met.
• The practice had successfully taken part in the clinical commissioning group (CCG) pilot for diabetes management and care, which had resulted in a reduction of hospital admissions.
• 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 16 September 2016

• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice held nurse-led baby immunisation clinics and vaccination targets were in line with the national averages.
• The practice’s uptake for the cervical screening programme was 80% which was slightly below the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. Antenatal care was provided by the midwife who held a clinic twice a week at the practice.
• The practice had successfully recruited a young person representative on the patient participation group (PPG).

Updated 16 September 2016

• 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 had systems in place to identify and assess patients who were at high risk of admission to hospital. We saw evidence that all patients had a care plan and were offered same day appointments. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice worked closely with multi-disciplinary teams so patient’s conditions could be safely managed in the community and also offered support to a residential homes in the local area.
• The practice pharmacist carried out medication checks and held regular meetings with the GPs to discuss patient’s needs.

Updated 16 September 2016

• 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.
• The practice provided new patient health checks, and 40-74 year old NHS health checks were carried out, but there was no recording of this on patients’ records due to software issues.
• The practice offered extended hours every Tuesday evening at Manor House Lane surgery and Wednesday evening at the branch surgery in Marston Green
• A health trainer ran weekly sessions at the practice to support patients with weight management and healthier lifestyles.
• Smoking cessation advice was offered by the Health Care Assistant and this was supported by a local stop smoking service.

Updated 16 September 2016

• 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice had 88 patients on their mental health register and 83% had their care plans reviewed in the last 12 months.
• The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• A healthy mind therapist ran regular sessions at the practice to support patients who were experiencing mental health issues.

Updated 16 September 2016

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments and annual health checks for people with a learning disability. There were 66 patients on the learning disability register and 80% had received their annual health checks.
• Home visits were carried out to patients who were housebound and to other patients on the day that had a need.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and offered support to a local learning disability home.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and held monthly meetings with the district nurses and community teams.
• 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 had 49 patients on the palliative care register; all had a care plan in place and received regular face to face reviews.
• The practice held a register of carers which identified 68 carers registered; this represented 0.6% of the practice list. There was a carers' protocol in place and information displayed on the noticeboards in the waiting room to encourage patients to identify themselves as carers. We found the GPs were unsure of the reasons for the low number of carers but they attributed it to incorrect coding.