The Doc's Surgery Also known as The Docs

Updated 25 August 2016

The Doc's Surgery is located in the heart of Manchester and has been established since 1993. At the time of the inspection 259 people living with the HIV virus were registered at the practice. We were told currently the largest number of patients in one practice currently in the UK.

Being located in the gay community the practice treats a higher percentage of patients from the lesbian gay bisexual and transgender (LGBT) community, whilst also treating high numbers of young workers and students. This results in a high turnover of patients seen within the practice.

The practice has a varied population group, the main population group being aged between 18- 64 years which accounts for 90.4% of the practice population. Only 4.3% of patients are aged 65 years and over.

The practice is a three storey building. The entrance has full disabled access which leads to a seated reception area. The GP consulting rooms are all located on the first floor where another smaller waiting area was located which was fully accessible by stairs or by lift. The second floor holds all staff offices. There is a disabled toilet on the ground floor, which has baby changing facilities. All staffing areas are closed off to the public with a key pad entry system.

The male life expectancy for the area is 75 years compared with the CCG average of 74 years and the national average of 79 years. The female life expectancy for the area is 85 years compared with the CCG averages of 79 years and the national average of 83 years. They have a higher than average patients group between the ages of 20 and 55 years and much fewer than average patients between the ages of 60 and 85 years, with a low number of children.

The practice has three GP partners (two males and one female) and one trainee GP, one nurse prescriber, and two practice nurses. Members of clinical staff are supported by a practice manager and a data manager with reception and administrative staff.

The practice is open between 8.30am and 6 pm Monday, Tuesday, Wednesday and Friday. Each Thursday the practice is open 8.30am till 1pm. Extended hours appointments are offered between 6 pm and 8pm on Wednesday. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are available for patients that need them.

When the practice is closed patients are advised, via the practice website, that all calls will be directed to the out of hours service. Out of hours services are provided by NHS 111. The surgery is part of Prime Ministers GP Access scheme offering extended hours and weekend.

The practice has a General Medical Service (GMS) contract with NHS England. At the time of our inspection in total 6933 patients were registered.

The practice is a teaching and training practice providing placements for training GPs and medical students from The University of Manchester, whilst also providing mentor support to other practices in the area.

Updated 25 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Doc's Surgery on 21 June 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice developed a Caldicott Guardian role responsible for all patient information requests, to ensure all summary care record and HIV (HIV means Human Immunodeficiency Virus, which attacks the body's immune system) positive patients were dealt with in a timely and effective manner.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met local patients’ needs. For example the practice treated a small number of older Chinese patients and forged close working with a local organisation to help with translation services and support network.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. This included clinical discussions daily every lunch time and formal clinical meetings.
• The practice had an established partnership with multiple healthcare professionals and research projects to facilitate and improve patient outcomes. For example the practice had been involved in the research into primary care missed diagnostic opportunities.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Feedback from patients about their care was consistently positive.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

We saw areas of outstanding practice including:

• The practice offered a full in-house sexual health clinic to registered and non-registered patients. This included same day results for HIV testing and a full screening and treatment service, something which is normally offered in sexual health clinic. The practice had the highest number of patients with HIV in the UK. It had established close links with one of the HIV consultant at North Manchester Hospital and a joint clinic was held once a month. The practice had developed a “Man fact sheet” on raising the awareness of Human Papilloma Virus (HPV is the name for a group of viruses that affect your skin and the moist membranes lining your body).This was already showing to be a positive tool in raising awareness. One example, saw a high risk patient receiving the full course of vaccines so far. There was also an expressed interest in being involved in a pilot project at primary care level.
• The GP partner had started an emotional wellbeing initially called “yoga on prescription” scheme to help support the high number of patients who suffered from acute illness such as stress, anxiety, low mood and generalised pain. . Between February and June 2016 there had been 27 patients issued a yoga prescription. The lead GPs presented the scheme to the House of Lords on 27th June 2016.
• The GP partners had been using supervision meetings every 6-8 weeks for many years, which are held as counselling sessions. This had been an invaluable tool to help shape and develop strong clinical support and manage the successful business side of the practice. Any new partners must agree to attend these meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 August 2016

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

• The practice tailored care to suit the population and had a locally commissioned service, treating 259 HIV positive patients – the highest number in one practice in the UK.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Prevalence was lower for many diseases monitored due to the population.
• 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.
• Longer appointments and home visits were available when needed.

Updated 25 August 2016

The practice is rated as outstanding 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.
• Cervical screening was 80.6%, which was higher than local and national average.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 25 August 2016

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

• The practice believed in continuity of care with all older people having a named GP.
• Support to the elderly Chinese population was witnessed, with the reception staff attending language classes at the Wai Yin local centre, to help patients feel more included. One family member commented on the excellent care provided to their mother.
• The practice offered proactive, personalised care to meet the needs of the older people in its population. This resulted in 100% over 75 year old patients having a care plan in place which was reviewed annually.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 25 August 2016

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

• The practice had a range of services offered to patients to help treat social phobias and stress.
• 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. For example a full sexual health clinic and treatment service was available.
• 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.

Updated 25 August 2016

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

• The practice had a system and checks in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Emotional wellbeing initially called the “yoga on prescription” scheme was available to all patients.
• The practice had initiated in house sessions with local a Manchester based charity called Moodswings, helping people recover from mood problems and the severe emotional distress.
• 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 website had a range of signposting services for mental health services and local help groups.
• Staff demonstrated clearly awareness of individual patient needs.

Updated 25 August 2016

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

• There was raised awareness for same sex relationships domestic violence training to help support patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, with Broken Rainbow and Survivors for sexual abuse organisations.
• There was access to sexual health testing for registered and non-registered patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and had formed close link with one of the HIV consultants in the area.
• 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.
• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.