Archived: New Islington Medical Practice

Updated 27 June 2016

New Islington Medical Practice is located close to Manchester City centre.

The practice is a large three storeys building which provides multiple services in the community and has community teams based there, which include: district nursing, a community active case dentist and a pharmacy. There was also a second GP surgery based in the building.

The ground floor had full disabled entrance access with a large seated reception area; which was a shared space. The GP consulting rooms were all located on the ground floor with a private room behind reception for patients needing to have a confidential discussion/conversation. There were disabled toilets on both floors, however patients were asked by the community not to use the toilets situated in the waiting area. There were baby changing facilities and a breast feeding room which patients were able to use. All staffing areas were closed off to the public with a fob card entry system.

At the time of our inspection there were 4185 patients registered with the practice. The practice is overseen by North Manchester Clinical Commissioning Group (CCG). The practice delivers commissioned services under the Primary Medical Services (PMS) contract.

The practice is in a highly deprived area of Manchester and has an ethnically diverse population group.

The practice consists of one male GP and two salaried GPs (male). There are two practice nurses and one healthcare assistant. Members of clinical staff are supported by a practice manager, office manager and reception staff. The practice is a teaching practice.

The practice is open from 8am until 6pm Monday to Friday. Appointment times are between 9am and 5.30pm. There are extended hours every Thursday evening between 6.30pm and 8.30pm.

Patients requiring a GP outside of normal working hours are advised to call “ Go-to- Doc” using the usual surgery number and the call is re-directed to the out-of-hours service. The surgery is part of the Prime Ministers GP Access scheme offering extended evening and weekend appointments to patients.

Updated 27 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at New Islington Medical Practice on 3rd May 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• The practice did have arrangements in place to safeguard children and vulnerable adults from abuse. However there was inconsistency with clinicians on the understanding of Deprivation of Liberty Safeguards (DOLS).
• Risks to patients were not fully assessed, for example there was no clear process in place for the Patient Directions Group (PGD enable the nurses to administer vaccinations safely to patients).
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure that all potential risks are assessed and managed appropriately, specifically in relation to emergency medicines and staffing.
• The provider must ensure all staff receive training which includes Deprivation of Liberty Safeguards (DOLS). A clear record of all mandatory training for staff must be kept.
• The provider must ensure all policies and protocols are in place and up to date so they can be assured all clinicians and staff follow the same procedure.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 June 2016

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

This is because the concerns identified in relation to how safe, effective and well led the practice was impacted on all population groups. However:

• 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 97.6%.This was better than the national average of 89%.
• 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.
• The practice worked with an Expert Patients Group who were based at Manchester University. The programme supported patients with long-term conditions to regain as much control over their physical and emotional well-being as possible.

Updated 27 June 2016

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

This is because the concerns identified in relation to how safe, effective and well led the practice was impacted on all population groups. However:

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

Updated 27 June 2016

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

This is because the concerns identified in relation to how safe, effective and well led the practice was impacted on all population groups. However:

• 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.
• Patients living in residential or nursing homes had individual care plans that were regularly reviewed.

Updated 27 June 2016

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

This is because the concerns identified in relation to how safe, effective and well led the practice was impacted on all population groups. However:

• 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.
• 100% of appointments were accessible to patients online.
• Individual, personalised messages were sent by text to patients to relay information such as blood test results.

Updated 27 June 2016

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

This is because the concerns identified in relation to how safe, effective and well led the practice was impacted on all population groups. However:

• 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 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, with all staff were trained as a Dementia Friend.

Updated 27 June 2016

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

This is because the concerns identified in relation to how safe, effective and well led the practice was impacted on all population groups. However:

• The practice held a register of patients living in vulnerable circumstances including homeless people and those 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.