Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Manor Surgery on 26 January 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• The practice used clinical audits to review patient care and took action to improve services as a result.
• The practice scored consistently above average in the GP patient survey, especially in patient care, with 100% of patients stating they had confidence and trust in the last GP they saw
• Information about services and how to complain was available. The practice sought patients’ views about improvements that could be made to the service directly and through an active patient participation group.
• 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.
• 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 practice worked effectively with the wider multi-disciplinary team to plan and deliver high quality and responsive care to keep vulnerable patients safe.
• The practice had an active Patient Participation Group (PPG) and worked with them to review and improve services for patients.

We observed areas of outstanding practice:

• The practice staff spent time identifying and supporting carers, a high proportion of carers were registered on the practice list.
• Reception and administrative made every effort to make sure information was communicated in an appropriate way and often went out of their way to help patients attend the practice.
• Care was provided to patients during the end of their life, often outside of practice hours, to ensure continuity of care and support to relatives.

The areas where the provider should make improvements are:

• Ensure the systems for monitoring prescriptions is robust and there is effective management of their distribution.
• Ensure staff appraisals are carried out in accordance with practice policy to ensure opportunities for development and training are highlighted.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection 26/01/2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) – Outstanding

We carried out an announced inspection at The Manor Surgery on 27 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• The practice used information about care and treatment to make improvements.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Staff had the skills, knowledge and experience to carry out their roles. Lead roles were shared amongst all GPs in the practice.

• The practice understood the needs of its population and tailored services in response to those needs. Patients were able to access care and treatment from the practice within an acceptable timescale for their needs through a variety of methods.

• There was a strong focus on continuous learning and improvement at all levels of the organisation. This included the sharing of policies, significant events and clinical audits with other practices within the CCG using the shared eHealthscope system and practice group meetings. As a result, some practices implemented the audits and adopted the same approach to improving the quality of care across the whole CCG.

We saw some areas of outstanding practice:

• The practice was proactive in identifying and supporting with long term conditions. This included carrying out opportunistic pulse rhythm checks on people aged 65 years old and over to identify who have atrial fibrillation, increased screening for diabetes and improving bowel cancer screening. We found evidence of improved outcomes for some patients who received treatment.

• Leaders used their skills and capabilities to promote continuous improvement and innovations. For example, they created alerts and templates on their IT clinical system to support GPs; promoting referrals to national diabetes prevention programmes and to psychotherapy services. All of these have been shared across the CCGs in Nottinghamshire.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice