Fernclough Surgery

Updated 8 June 2017

Fernclough Surgery is located close to Manchester City centre. The small practice is situated on a housing estate on the outskirts of Manchester, in an area called Harpurhey. All services are delivered on the first floor of the building.

At the time of our inspection there were 2056 patients registered with the practice. The practice is a member of Manchester Health and Care Commissioning. The practice delivers commissioned services under the General Medical Services (GMS) contract with NHS England.

The male life expectancy for the area is 73 years compared with the CCG average of 73 years and the national average of 79 years. The female life expectancy for the area is 79 years compared with the CCG average of 78 years and the national average of 83 years.

The practice is situated in an area at number one on the deprivation scale (the lower the number, the higher the deprivation). People living in more deprived areas tend to have greater need for health services. The majority of patients are white British with the practice seeing an increase in patients from Eastern European countries. The practice is in an area which sees a higher than average health problems relating to drug and alcohol addiction and a range of mental health issues.

The practice consists of one single handed male GP and a female regular locum GP who attends once a week. There is one Advanced Nurse Prescriber (ANP) and two practice nurses .Members of the clinical team are supported by a practice manager and reception staff.

The practice is open the following hours :

Monday 9am - 6pm

Tuesday 9am – 7.30pm

Wednesday 9am -1pm (half day closing)

Thursday 9am – 6pm

 Friday 9am - 5pm

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. Extended hours are offered every Tuesdays until 7.30pm.

The practice has been seeking to move or extend the premises since 2014. They have been in contact with local council, Manchester Health and Care Commission and NHS England to help address concerns. The GP felt the facilities were extremely small and not large enough to meet practice demands and growth the practice seeing. We saw evidence of letters and meetings asking for funding or permission to extend the premises.

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 a neighbourhood access scheme which offers Sunday appointments between the hours of 10am and 6pm.

The practice is registered to deliver the regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury.

Updated 8 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fernclough Surgery on 8 May 2017. Overall the practice is rated as good.

Our key findings from the inspection were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events with learning outcomes documented.
• The practice had a robust safeguarding process. Staff provided various scenarios where they had supported patients and their families.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. Staff told us morale was good.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain were available. Improvements were made to the quality of care as a result of complaints and concerns. However, verbal complaints were not recorded.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• The provider should collate verbal complaints and responses.
• The provider should put a process in place, to review non collected repeat prescriptions.
• The provider should record actions taken from patient/medical alert.
• The provider should review and increase the carers numbers in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 June 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• 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.
• 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 8 June 2017

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

• 72% of patients with asthma had an asthma review completed in the preceding 12 months, compared to the CCG average of 75% and national average of 76%.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice worked with midwives, health visitors and school nurses to support this population group.
• 72% of eligible women had received a cervical screening test in the preceding five years, compared to the CCG average of 78% and national average of 81%.
• Appointments were available outside of school hours. Baby changing facilities were available and a room could be made available for women wishing to breast feed their babies.

Updated 8 June 2017

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

• The practice had identified 2% of patients at higher risk of unplanned admission to hospital, and each of these patients had a care plan in place which was regularly reviewed.
• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• 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.

Updated 8 June 2017

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

• 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.
• There was additional out of working hour’s access to meet the needs of working age patients with extended opening hours every Tuesday from 7am.
• 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 8 June 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average 87% and the national average of 84%.
• 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.

Updated 8 June 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.
• 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 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.