Manor Brook PMS

Updated 22 September 2016

Manor Brook PMS (also known as Manor Brook Medical Centre) operates from one site in Blackheath, London. It is one of 42 GP practices in the Greenwich Clinical Commissioning Group (CCG) area. There are approximately 12,453 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning services, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice has a personal medical services (PMS) contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include facilitating timely diagnosis and support for patients with dementia, extended hours access, improving patient online access, influenza and pneumococcal immunisations, learning disabilities, minor surgery, patient participation, remote care and monitoring, risk profiling and case management, rotavirus and shingles immunisation, and unplanned admissions.

The practice has an above average population of male and female patients aged from birth to nine years and from 30 to 44 years. Income deprivation levels affecting children and adults registered at the practice are in line with the national average and below the local CCG average.

The practice is led by three female GP partners and a male GP partner. There is a male locum GP who is due to join the practice on a permanent basis as a partner in July 2016, and there are five female salaried GPs. The GPs provide a combined total of 56 fixed sessions per week.

There are two part-time and one full-time female salaried practice nurses (one of whom is the senior nurse manager), a female health care assistant, and three phlebotomists. The clinical team is supported by an office manager, a finance and premises manager, an information technology manager, a medical secretary, two prescription clerks, three personal assistants and seven reception/administrative staff.

The practice is open between 8.00am and 6.30pm Monday to Friday and is closed at weekends and on bank holidays. Appointments with GPs are available from 8.30am to 11.30am, and from 2.30pm to 6.00pm. Appointments with nurses are available from 8.10am to 11.30am, and from 1.30pm to 6.30pm. Extended hours appointments are offered from 6.30pm to 8.00pm on Mondays and Thursdays.

The premises operates over two floors of a purpose built building which has a lift. On the ground floor there are seven consulting rooms and a treatment room, a waiting area, a baby changing room, a disabled toilet and a baby clinic room used by health visitors. On the first floor there are six consulting rooms and a treatment room and a disabled toilet. There is wheelchair access throughout and disabled parking.

The practice has opted out of providing out-of-hours (OOH) services. Patients needing urgent care out of normal hours are advised to contact the OOH number 111 which directs patients to a local contracted OOH service or Accident and Emergency, depending on the urgency of patients’ medical concerns.

Updated 22 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor Brook PMS on 21 June 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. Analyses of significant events were thorough and learning from them was shared with staff to improve safety.
• 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.
• There was a robust programme of quality improvement; the practice had conducted 32 audits in the previous two years and there was a record of improvements made from completed audits.
• 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 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 and valued by management. The practice proactively sought and acted on feedback from staff and patients.
• The practice had a number of policies and procedures to govern activity, and they held regular governance and clinical meetings.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make improvement is:

• Review how patients with caring responsibilities are identified to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 22 September 2016

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

• In the previous six months, the practice had exceeded its monitoring targets for diabetes, most recently by 50% in May 2016 for the Greenwich Clinical Commissioning Group’s Year of Care scheme.

• The practice offered a limited acupuncture service to patients with musculoskeletal pain. They had conducted a survey in 2015/2016 which showed 90% of patients had found the acupuncture treatments effective at relieving or stopping their symptoms.

• The practice offered 24 hour blood pressure monitoring at the practice for patients with hypertension, which enabled patients to avoid potentially long waits for this service from secondary care.

• Nationally reported data showed outcomes for patients with diabetes were in line with the national average. For example, 79% of patients with diabetes had well controlled blood sugar in the previous 12 months (national average 78%).

• 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 patients with a long term condition had a named GP and most had received a structured annual review to check their health and medicines needs were being met.

• 77% of patients with asthma had an asthma review in the previous 12 months. This was in line with the national average of 75%.

• 95% of patients with chronic obstructive pulmonary disease (COPD) had a review of their condition in the previous 12 months. This was in line with the national average of 90%. Nursing staff provided a spirometry service for patients with asthma and COPD.

• 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 22 September 2016

The practice is rated as good for the care of families, children and young people.

• The practice had received accreditation from Greenwich local authority in March 2015 for being a ‘teen friendly’ practice. This accreditation was awarded from feedback received through mystery shopper visits to the practice conducted by young people in the borough. They had created a practice leaflet for teenagers containing information about the services available to them. The leaflet included sources of information about sexual health testing, avoiding the use of illegal drugs, avoiding drinking and driving and how to access emergency contraception and vaccines.

• Nationally reported data showed performance for cervical screening was above the national average. For example, in the previous five years 92% of female patients aged between 25 and 64 years had received a cervical screening test (national average 82%). An analysis of this service showed the practice was the top performer of all practices in the local Clinical Commissioning Group.

• The practice had created leaflets for young people, pregnant women and women who had just given birth to keep them informed of the services available to them.

• 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.

• 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 attendances to Accident and Emergency.

• Appointments were available outside of school hours and the premises was suitable for children and babies.

• We saw positive examples of joint working with health visitors, and they liaised with midwives on an ad-hoc basis.

Updated 22 September 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. They ran quarterly checks of their register of older people to identify patients aged over 75 years that had not attended the practice for 12 months or more; these patients were invited to receive health checks.

• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs. They also conducted weekly visits to the local Aldington House care home and created personalised care plans for each resident.

• The practice offered joint injections and ring pessary fitting services for older patients, so that they did not have to attend hospital for these treatments. The ring pessary fitting service was funded by the practice and was provided in-house or through home visits.

• Nationally reported data showed outcomes for conditions commonly found in older people were comparable to the national average. For example, in the previous 12 months 83% of patients with hypertension had well controlled blood pressure (national average 84%).

• The practice had created leaflets for older people to keep them informed of the services available to them.

Updated 22 September 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 was proactive in offering online services such as appointment booking and repeat prescription ordering.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group.

• Extended opening hours were available from 6.30pm until 8.00pm two days a week for working patients who were unable to attend the practice during normal opening hours.

Updated 22 September 2016

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

• Nationally reported data showed outcomes for patients with dementia were in line with the national average. For example, in the previous 12 months, 88% of patients with dementia had a face-to-face review of their care (national average 84%)

• Nationally reported data showed outcomes for patients with poor mental health were in line with the national average. For example, in the previous 12 months 85% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in their records (national average 88%).

• 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 and they had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up 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; five of them had received dementia awareness training.

Updated 22 September 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 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 other health care professionals in the case management of vulnerable patients.

• 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.