Archived: Jolly Medical Centre

Updated 5 September 2017

The Jolly Medical Centre is located close to Manchester city centre. The practice is situated in a double mid terraced house in the residential area in Crumpsall, Manchester. Disabled parking was available directly at the front of the practice, with on the road parking also available for patients.

The practice is in a highly deprived area of Manchester and treats a varied and ethnically diverse population group, mainly of South East Asian origin. Many of the patients (over 70%) did not speak English as a first language and a high proportion of patients were illiterate.

At the time of our inspection there were 3,368 patients registered with the practice. The practice is a member of Manchester Health and Care Commissioning. The practice delivers commissioned services under the General Medical Services (GMS) contract with NHS England. The practice is a training practice.

The practice consists of one single handed male GP and a salaried male GP. The practice also offers a weekly clinic with a locum female GP. There are two practice nurses and members of the clinical team are supported by a practice manager and reception staff.

The practice is open between 8am and 6pm Tuesday to Friday. Each Monday the practice was open 8am until 8.15pm. Extended hours appointments are offered between 6pm and 8pm on Monday. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were available for patients that needed them.

Patients requiring a GP outside of normal working hours are advised to contact the surgery and they will be directed to the local out of hour’s service which is provided by NHS 111 . The surgery is part of a neighbourhood access scheme which offers Sunday appointments between the hours of 10am and 6pm. Dedicated appointments for carers are available on Sundays.

Updated 5 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Jolly Medical Centre on 18 July 2017. Overall the practice is rated as good.

Our key findings were as follows:

• The practice used their knowledge of the local community and patient population as levers to deliver high quality and person centred care.
• The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvements and staff were actively engaged in monitoring and improving patient outcomes as a result.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events with learning outcomes documented.

• The practice had completed two in-house surveys in the last two years in order to understand and improve their patient satisfaction survey results.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. Staff told us morale was good.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw several areas of outstanding practice including:

• The practice identified all house bound patients in the practice and offered to arrange a free fire safety check at their home. Ten referrals were arranged by the practice through the local fire department, who arranged to visit patients and offered safety and fire detectors checks. This action resulted from a learning point from an incident relating to a housebound patient.
• The practice designed a confidential request slip to support patients who wanted to be seen by a GP confidentially or without extended family members present. The slip was submitted by the patient informing the practice to arrange this appointment. The practice made contact with the patient and a general appointment for them to attend the practice alone was arranged. The practice was seeing an increased number of patients, mainly female accessing appointments through the request slip.
• The practice had difficulty in patient’s uptake for bowel screening. The practice approached the Bowel Screening programme department, to ask for help and support to increase the practice figures. Educational sessions were presented by the GP to patients with great success. This work had resulted in significant improvements in patient numbers attending for screening. The work the practice had implemented had been recognised by the Bowel Screening programme team, who would like the practice to help support peers.

The areas where the provider should make improvements are :

• Review and improve the access arrangements to the building for less mobile patients.
• Continue to work on improving patient satisfaction rates with the care and services provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 September 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All these patients had a named GP and there was a system to recall patients for 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 5 September 2017

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

• 72% of patients with asthma had an asthma review completed in the preceding 12 months, compared to the CCG average of 75% and national average of 76%.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice worked with midwives, health visitors and school nurses to support this population group.
• 72% of eligible women had received a cervical screening test in the preceding five years, compared to the CCG average of 78% and national average of 81%.
• Appointments were available outside of school hours. Baby changing facilities were available.
• The practice worked with an outside agency to care for young and vulnerable patients in the practice aged between 16 and18

Updated 5 September 2017

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

• The practice had identified 2% of patients at higher risk of unplanned admission to hospital, and each of these patients had a care plan in place which was regularly reviewed.
• The practice had identified all house bound patients and offered to arrange a free fire safety check at their home. The practice arranged 10 referrals for fire department to visit these patients and offer safety and fire detector checks ensuring housebound patients were safe at home.
• The practice had identified a higher number of patients who were at greater risk of developing a long term condition due to the ethnicity of the patient population. As a result, the practice had reduced the age of health reviews from patients aged 75 years to 60 years.
• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 5 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.
• There was additional out of working hour’s access to meet the needs of working age patients with extended opening hours every Monday till 8.15pm.
• 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.

Updated 5 September 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average 87% and 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 living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 5 September 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice regularly worked with other healthcare professionals in the case management of vulnerable patients. For example they had developed a comprehensive single register for all vulnerable or at risk patients.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability and provided home visits for reviews where required.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.