Manor House Surgery

Updated 14 December 2018

Manor House Surgery is a GP practice providing primary medical services under a General Medical Services (GMS) contract to around 4,000 patients. This is a contract between general practices and NHS England for delivering services to the local community. The practice is able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy and dispense to over 90% of their patients.

The registered provider of services is Dr MJ Aram & Dr IJ Gordon and they are registered to deliver the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury. The provider is registered with CQC to deliver these services from one location; Manor House Surgery at 1 Mill Lane, Belton, Loughborough, Leicestershire. LE12 9UJ which we visited as part of our inspection.

Belton is a village, seven miles west of Loughborough and the practice serves this and a number of other surrounding villages. The practice is housed in a single storey purpose built property which was refurbished and extended between 2015 and 2016. There is disabled access to the ground floor and a car park which includes designated spaces for the disabled. The practice’s services are commissioned by West Leicestershire Clinical Commissioning Group (WLCCG). The practice is part of North West Leicestershire GP Federation.

The practice population has a lower than local and national average of patients over the age of 75 and a higher than average number of patients aged 65 to 74. The National General Practice Profile states that 98% of the practice population is of white ethnicity. Information published by Public Health England, rates the level of deprivation within the practice population group as eight, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 81years compared to the national average of 79 years. Female life expectancy is 88 years compared to the national average of 83 years.

The practice has two full time GP partners; one male and one female. There are two part-time practice nurses, a health care assistant and a phlebotomist (who also works on reception). There is also a team of dispensers. They are supported by a practice manager, an assistant practice manager and a team of administrative and reception staff.

Manor House Surgery is open from 8am to 12.30pm and 1:30pm to 6:30pm 13.30-18.30 Monday to Friday with telephone lines being manned from8am to 6.30pm each day. Extended hours appointments are also available to all patients at additional locations within the area as the practice is within West Leicestershire CCG area. From 6.30pm to 8am Monday to Friday and all weekend, out of hours services are accessed by calling the NHS 111 service.

The practice website can be found .

Updated 14 December 2018

This practice is rated as Good.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Manor House Surgery on 10 October 2018 as part of our inspection programme.

At this inspection we found:

• There was an effective system in place to deal with safeguarding and staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patient satisfaction with access to care and treatment was considerably higher than average and the practice had significantly reduced avoidable appointments over the last year resulting in increased appointment availability.
• Where relevant patients were given hand held records to keep with them relating to their condition and care plan. These were highly detailed and personalised and demonstrated a commitment to delivering high-quality personalised care.
• The leadership, governance and culture were used to drive and improve the delivery of high quality person-centred care.

The areas where the provider should make improvements are:

• Improve the system for monitoring training to ensure there is oversight of training requirements.
• Continue to monitor the cold chain process to ensure temperatures of vaccine refrigerators are monitored appropriately.
• Develop the system for reviewing policies to ensure they are up to date and reflect current practice.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 14 December 2018

Updated 14 December 2018

Updated 14 December 2018

Updated 14 December 2018

Updated 14 December 2018

Updated 14 December 2018