Archived: Manor Oak Surgery

Updated 10 July 2017

Manor Oak Surgery is a practice offering general medical services to the population of Horam and Heathfield in East Sussex. There are approximately 3,600 registered patients.

The practice population has a higher number of patients between over 45 years of age than the national and local clinical commissioning group (CCG) average. There are a similar number of patients with a longstanding health condition of 54% compared to the CCG average of 57% and national average of 54%. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for both the CCG area and England.

Manor Oak Surgery is run by four partner GPs (two male and two female). Currently only one of the partners provides regular consultation sessions at this practice. The practice is also supported by a salaried GP (female), an advanced nurse practitioner, three practice nurses, a healthcare assistant, a team of administrative and reception staff, and a practice manager.

The practice runs a number of services for its patients including asthma clinics, diabetes clinics, coronary heart disease clinics, minor surgery, child immunisation clinics, new patient checks and travel vaccines and advice.

Services are provided from one location:

• Manor Oak Surgery, Horebeech Lane, Horam, East Sussex TN21 0DS

Opening hours are Monday to Friday 8.30am to 6.00pm Monday to Friday. The practice is closed between 1pm and 2pm each day. However, there is a telephone access number for patients who need to speak to staff during this time. The practice has also made arrangements with the out of hours provider to cover 8.00am to 8.30am and 6.00pm to 6.30pm. During the times when the practice is closed, arrangements are in place for patients to access care from IC24 which is an Out of Hours provider.

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Manor Oak Surgery in Horam, East Sussex on 10 January 2017 we found a breach of regulation relating to the provision of effective services. The overall rating for the practice was good. Specifically, the practice was rated requires improvement for the provision of effective services and good for the provision of safe, caring, responsive and well-led services. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Manor Oak Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 27 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Our key findings were as follows:

• The practice had implemented a system for completing a wide range of clinical audits including a clinical audit schedule with the view to increase the level of clinical audit activity, ensuring quality improvement. We saw all clinicians (GPs and nurses) were now actively involved in completing clinical audits. Furthermore, we saw audits had been completed which reviewed clinical intervention against national and local guidelines and established best practice.

• Patient satisfaction was closely monitored through a series of patient surveys. The practice proactively sought patients’ feedback and engaged patients in the delivery of the service. For example, with a view to improve patient satisfaction levels in relation to opening hours there was a patient consultation to review the current opening times and existing extended opening hours. This consultation aimed to ensure the practice, the opening times and extended opening hours met patient needs.

• Further steps had been taken to reinstate their website. Although not yet live, we saw the prototype website contained information about the practice and various articles from the patient participation group (PPG). Until the website was live (no date confirmed), the practice ensured the practices profile on NHS Choices website was up to date.

• Arrangements for handling complaints and concerns had been strengthened. The complaints procedure was now in line with recognised guidance and contractual obligations for GPs in England. This now included information about how to escalate concerns if the complainant was not satisfied with the response from the practice.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). Various actions had been taken to improve areas of low performance. We saw these actions had been successful as the most recent results indicated performance for the vast majority of diabetes related indicators had improved when compared with the previous year’s performance. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 87%. This was a 16% improvement on the previous year’s performance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 16 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.
• Performance for diabetes related indicators was below the local and national average in some areas and higher in others. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 64% compared to the clinical commissioning group (CCG) average of 75% and national average of 78%. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 98 % compared to the CCG average of 87% and the national average of 88%.
• 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 16 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. Immunisation rates were relatively high for all standard childhood immunisations.
• 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 practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 16 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.
• The practice has regular meetings with the Proactive Care Team to help avoid admissions. The practice provided an enhanced service for unplanned admissions – a register of the most vulnerable patients - with care plans and reviews following any unplanned hospital admissions.

Updated 16 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.

Updated 16 February 2017

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

• 84% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 83% and the same as the national average of 84%.
• Performance for mental health related indicators was better than the CCG and national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 94% compared to the CCG and national average of 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.
• The practice 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.
• Facilities were provided on site for a specialist counsellor who undertook weekly sessions for patients who were referred from the practice.

Updated 16 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 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.