Archived: Manor House Surgery - Bridlington

Updated 26 April 2018

Manor House Surgery, Providence Place, Bridlington Humberside YO15 2QW is located in a converted Georgian property in Bridlington. Parking is available at the practice and there are accessible facilities. Consulting and treatment rooms are all on the ground floor. The practice provides services under a General Medical Services (GMS) contract with the NHS North Yorkshire and Humber Area Team to the practice population of 8461, covering patients of all ages. There is a branch site at Flamborough, The Surgery, Chapel Street, Flamborough YO15 1LQ. The Manor House and Flamborough surgeries were visited during the inspection. The practice website can be found by following the link http://www.manorhousesurgery.com/Home

The provider is registered to the provide the regulated activities Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

The proportion of the practice population aged 65 and over age group is higher than the local CCG and England average. The proportion of the practice population in the under 18 years age group is lower than the local CCG and England average. The practice scored three on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have greater need for health services.

The practice has six GP Partners, four male and two female, three work full time and three work part time. There is a full time GP registrar (a Dr who is training to become a GP). There is one full time male advanced nurse practitioner (ANP) and a part time clinical pharmacist. There are four practice nurses, all female, one works full time and three work part time. There are two health care assistants and a phlebotomist, all female and all work part time. There is a practice manager, an assistant practice manager and a team of administration, reception and secretarial staff.

The Manor House Surgery is open between 8am to 6pm Monday to Friday. Appointments with the GPs and ANP are available from 8.30am to 10.40am and 2pm to 5.30pm Monday to Friday. The Monday morning ‘Turbo’ clinic operates with no pre-bookable appointments, patients who need to be seen urgently ring and are given an urgent appointment. The Flamborough site is open from 2pm Tuesday to Friday. There are a small number of GP pre-bookable appointments available and a sit and wait service. A health care assistant attends Flamborough every Tuesday and Friday at 1.30pm for all routine care including bloods, health checks and some injections.

The practice, along with all other practices in the East Riding of Yorkshire CCG area have a contractual agreement for the Out of Hours provider to provide OOHs services from 6.00pm on weeknights. This has been agreed with the NHS England area team.

When the practice is closed patients use the NHS 111 service to contact the OOHs provider. Information for patients requiring urgent medical attention out of hours is available in the waiting area and on the practice website.

Updated 26 April 2018

This practice is rated as Good overall. (Previous inspection June 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

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

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Manor House Surgery on 28 February 2018 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.

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

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

• The senior practice nurse had supported a patient with learning disabilities to access support regarding hair styles and make up to support their lifestyle choices. They had also referred to them to a specialist health professional. We saw evidence from three local care homes thanking the practice for the care and support they provided for patients with learning disabilities. This included home visits and dedicated clinics so patients were seen promptly.

• Changes to the in house diabetes service had resulted in an increase in identifying patients with pre-diabetes and improved control for patients already diagnosed. The practice had identified 1127 patients with pre-diabetes. All the HbA1c diabetes blood test results were reviewed by the lead nurse before they were filed. This meant that if patients had deteriorating diabetes control or if had improved it was being picked up much quicker and enabling staff to make plans to adjust treatment and/or plan the next follow-up in response. The diabetes consultant from the local hospital had visited the practice in February 2018. They reviewed the process and felt it was something that could be shared with other practice teams as not only did it seem to improve patients’ diabetic control but was also more efficient.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 29 October 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management. The practice was taking part in an initiative to run dedicated clinics for patients with two or more long term conditions and included; a pharmacy review, a patient social and health needs self-assessment, blood tests and a GP review of the notes prior to the appointment. The nurse would then undertake a comprehensive review with the patient.

Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. The practice also identified patients who had visited the Accident and Emergency department and reviewed the reasons why to try to minimise further attendances.

Updated 29 October 2015

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. Immunisation rates were good 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 29 October 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services including for dementia. The practice offered home visits and usual doctor appointments to improve continuity of care.

The practice had regular contact with community nurses and participated in meetings with other healthcare professionals to discuss any concerns.

Updated 29 October 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this population group 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, the practice offered access to a GP by telephone if needed. 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 29 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients experiencing poor mental health received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice was part of a CCG scheme to provide detailed screening for patients deemed to be at risk of dementia.

Staff had received training on how to care for people with mental health needs and dementia and had named clinicians who dealt with reviews of patients with dementia or other mental health problems.

Updated 29 October 2015

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 and carried out annual health checks for people in this group. Longer appointments or home visits were available for people with a learning disability.

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.