Gorton Medical Centre

Updated 2 May 2018

Gorton Medical Centre is located in a purpose built building at 46 Wellington Street

Gorton, Manchester, M18 8LJ. The practice is part of the NHS Manchester Clinical Commissioning Group (CCG). The practice provides services under a General Medical Services contract with NHS England and has 8384 patients on its register. More information about the practice is available on its website address: www.gortonmedicalcentre.nhs.uk

The practice is situated close to a busy road and a range of shops. The service is provided from a double storey older style building. The ground floor had recently been adapted to provide better disability access. The practice has a number of consulting and treatment rooms used by the

GPs, nursing staff and visiting health care professionals. Three GP consulting rooms are situated up a set of stairs on the first floor. Clinicians on the ground floor see patients with mobility issues. There is no on site car parking available.

There are three GP partners, one salaried GP, a practice manager, a case manager, a pharmacist and medicines lead, a nurse, two healthcare assistants, as well as a number of reception and administrative staff.

The practice is open Mondays to Fridays from 8am to 6pm, and closes at lunchtime between 12 and 1pm. During this time, patients are directed to the out of hours service (OOH). Patients can access Out of Hours services by contacting a telephone number displayed on the practice website.

Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The male practice population have lower life expectancy at 74 years compared to the CCG average of 75 years and England average of 79 years. Similarly, female life expectancy is lower at 79 years compared with the CCG average of 80 years and the England average of 83 years. The practice has a slightly higher number of patients under the age of 18 years, 27% compared with the CCG average of 24% and England average of 21%. Similarly, there is a higher number of patients over the age of 65 years (14%) compared with the CCG average (10%).

The practice has 53% of its population with a long-standing health condition, which reflects the CCG and the England average. Unemployment at 12% is higher than the CCG average of 9% and England average of 5%.

Updated 2 May 2018

This practice is rated as Good overall. (Previous inspection March 2017 – Good)

We carried out an announced comprehensive inspection on at Gorton Medical Centre on 27 March 2017. The overall rating for the practice was good with key question Well Led rated as requires improvement. At that inspection we found improvements were needed in the practice systems for the monitoring of incidents and significant events, and where learning and improvement were identified these were not always shared effectively. We issued a requirement notice in respect of good governance, as further improvements were required We identified other areas of improvement including undertaking full cycle clinical audits and monitoring and sharing patient safety alerts as part of the practice’s quality improvement programme and listening to patient feedback, developing the patient participation group and maintaining a carer’s register.

The full comprehensive report on the March 2017 inspection can be found by selecting the ‘all reports’ link for Gorton Medical Centre on our website at www.cqc.org.uk

This inspection was a focused visit to the practice on 4 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 27 March 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

This focused inspection visit identified improvements had been made in service delivery for key question Well Led and this is now rated good.

Our key findings were as follows:

•At our previous inspection in March 2017 we found some records of significant event investigations did not contain all the required information and evidence that the findings from investigations was shared with staff was limited. At this inspection visit, both practice full team meeting and clinical meeting minutes showed the significant events were discussed and evidence was available to demonstrate improvements were made and learning from these was shared.

•Since the previous inspection, the practice had reviewed how it ensured patient safety alerts were shared with the staff team and had introduced a system to ensure these were acted upon as required.

•The practice had introduced a range of clinical searches on a variety of patient health care conditions. These searches were allocated to GPs who undertook relevant clinical audit and re-audit to evaluate the effectiveness of the actions the practice had implemented to improve patient outcomes.

•The practice had introduced a carer’s information pack and referral process. It had made some headway in building a carer’s register. However there were still low numbers of patients’ identified as carer’s.

•The practice had implemented a patient survey and initial results had indicated patients were satisfied with the service. The practice manager had identified areas requiring action as a result of patient feedback.

•The practice continued to promote their patient participation group and held regular practice meetings

The areas where the provider should make improvements are:

Continue to develop the practice carer’s register and the patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 6 June 2017

The provider was rated as good for this population group.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• 71% of patients with diabetes, on the register, who had IFCCHbA1c of 64 mmol/mol or less in the preceding 12 months (01/04/2015 to 31/03/2016) compared to the CCG and national average of 75% and 78% respectively.

• 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.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• 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 6 June 2017

The provider was rated as good for this population group.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, 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.
• The practice worked with midwives, health visitors and school nurses to support this population group.
• The practice’s uptake for the cervical screening programme was 83% (2015/2016), which was better than the CCG average of 78% and the national average of 81%.

Updated 6 June 2017

The provider was rated as good for this population group.

• Staff were able to recognise the signs of abuse in older patients and described the process for how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population. The practice participated in the nursing home project and worked closely with a local nursing home with the aim of minimising unnecessary hospital admissions.
• 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. It 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.
• Where older patients had complex needs, the practice shared summary care records with local care services. For example; district nurses and social and health care partners involved with the nursing home project.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible such as; healthy eating and keeping active.

Updated 6 June 2017

The provider was rated as good for this population group.

• 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 and Saturday appointments.
• 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 6 June 2017

The provider was rated as good for this population group.

• The practice carried out advance care planning for patients living with dementia.
• 69% of patients diagnosed with dementia whom had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG and national average 89% and 84% respectively.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example a nominated GP from the practice visited a local residential home twice a week.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 76% of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (01/04/2015 to 31/03/2016) which was lower than the CCG and national average of 89% and 89% respectively.
• 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.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 6 June 2017

The provider was rated as good for this population group.

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