The Range Medical Centre

Updated 11 April 2018

The Range Medical Centre (121 Withington Road, Manchester, M16 8EE) is part of the NHS Manchester Clinical Commissioning Group (CCG) and provides services to approximately 8128 patients under a General Medical Services contract with NHS England.

Information published by Public Health England rates the level of deprivation within the practice population group as level one on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest. Male and female life expectancy in the practice geographical area is 74 years for males and 80 years for females, both of which are below the national average of 79 years and 83 years respectively. The number of patients in the different age groups on the GP practice register is generally similar to the average GP practice in England.

The practice has a lower percentage (44%) of its population with a long-standing health condition when compared to the England average (54%). The percentage of the practice population with a working status of being in paid work or in full-time education is similar to local and national averages (65%). The practice has a higher percentage (10%) of patients designated unemployed when compared with the national average of 4%.

Services are provided from a purpose built building, with disabled access and some parking. The practice has a number of consulting and treatment rooms used by the GPs and nursing staff as well as visiting professionals such as health visitors.

The service is led by four GP partners and two salaried GPs who are supported by a team of nurses, including a healthcare assistant. There is a practice manager as well as an administration team who also cover other duties such as drafting prescriptions. This is a training practice and as such also has trainee medical staff.

The surgery is open from 8am until 6pm daily with early morning appointments available on a Thursday and Friday from 7.30am and evening appointments available on alternate Tuesdays and Thursdays between 6.30 and 7.30pm. The practice is also a part of a federation of GP practices that provides extended hours cover for a number of practices in the area between 6pm and 8pm, Monday to Friday, as well as on Saturday and Sunday mornings. Patients are also able to attend appointments at a small number of local health centres as part of this arrangement. Out of hours cover is provided by the NHS 111 service and Go to Doc.

Updated 11 April 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Range Medical Centre on the 24 November 2016. At the inspection in November 2016 the overall rating for the practice was good, although the key question safe was rated requires improvement. We found improvements were needed in relation to staff recruitment, systems to monitor expiry dates of vaccines, information governance in relation to locum staff and the management of some risks in relation to Control of Substances Hazardous to Health (COSHH) regulations. In addition we identified that not all staff files demonstrated evidence that an induction had been completed.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for The Range Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on the 16 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the two breaches in regulation that we identified in our previous inspection on 24 November 2016. This report covers our findings in relation to those requirements.

The practice is now rated good for all key questions and the overall rating remains good.

Our key findings were as follows:

• At our previous inspection in November 2016 we found some staff files did not contain all the required recruitment documentation. The practice supplied evidence to demonstrate all staff recruitment files had been reviewed and a matrix of records held for each staff member was established.
• The practice had introduced induction training record sheets for both clinical and non clinical staff and completed copies of these for both a GP and non clinical staff member were provided to demonstrate their use.
• Systems had also improved to ensure locum GPs had specific logins and passwords to use on the patient electronic record system.
• Data sheets were now available at the practice for all substances such as cleaning agents used at the practice. This ensured compliance with COSHH regulations.
• At the previous inspection in November 2016 we noted six vaccines, held in one of the practice’s vaccines fridges had passed their expiry date. The practice had reviewed their policy on the monitoring of vaccines and had improved how expired vaccines were disposed of. Records supplied demonstrated the practice’s policy was implemented appropriately.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 February 2017

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.
• Patients with diabetes whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 77% compared to the national average of 81%.
• 83% of patients with diabetes had received an influenza immunisation compared to the national average of 94%.
• The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c was 64 mmol/mol or less in the preceding 12 months was 66% compared to the national average of 78%.
• A record of foot examination was present for 80% of patients compared to the national average of 88%.
• Patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 70% compared to the national average of 78%.
• The percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 84%, compared to the national average of 84%.
• 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.

Updated 3 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 who were at risk, for example, children and young people who had a high number of A&E attendances.
• 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.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years (01/04/2015 to 31/03/2016) was 71%, which was significantly below the national average of 81%. The practice had recognised the low figures and had produced a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 60% to 96% and five year olds from 65% to 93%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 3 February 2017

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.
• All elderly patients had been informed of their named GP.
• The practice offered same day appointments as well as telephone consultations.

Updated 3 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.
• 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.
• Telephone appointments were available if patients wished to discuss test results and urgent concerns and for those who may have difficulty attending surgery due to work commitments.

Updated 3 February 2017

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

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advanced 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 percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record in the preceding 12 months was 70% compared to the national average of 88%.
• The percentage of patients diagnosed with dementia whose care had been reviewed face to face in the preceding 12 months was 95% compared to the national average of 84%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 3 February 2017

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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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 and had attended training in how to recognise domestic abuse.
• 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.