The Robert Darbishire Practice

Updated 16 March 2017

The Robert Darbishire Practice (Rusholme Health Centre, Manchester, M14 5NP) serves the local population in Rusholme. It is part of the NHS Central Manchester Clinical Commissioning Group (CCG) and provides services to approximately 21673 patients under a Personal Medical Services contract with NHS England. Rusholme is an inner city area which is close to two Universities with a number of international students. The area has seen several waves of migration and has a diverse community with an increasing population.

Information published by Public Health England rates the level of deprivation within the practice population group as level one on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest. Male and female life expectancy in the practice geographical area is 75 years for males and 80 years for females, both of which are below the England average of 79 years and 83 years respectively. The numbers of patients in the different age groups on the GP practice register is generally similar to the average GP practices in England although the practice has a greater number of 15 to 29 year olds.

The practice has a lower percentage (45%) of its population with a long-standing health condition when compared to the England average (53%). The practice percentage (70%) of its population with a working status of being in paid work or in full-time education is above the England average (63%). The practice percentage (11%) population with an unemployed status is significantly above the England average of (4%).

Services are provided from a purpose built building, with disabled access and some parking. The practice has a number of consulting and treatment rooms used by the GPs and nursing staff as well as visiting professionals such as health visitors.

The practice is managed by a board of directors, there are no partners. The organisation is a not for profit set-up and all the surplus income is retained and reinvested within the practice to provide further services.

The service has 15 GPs equating to 9.5 whole time equivalents (WTE), six nurse practitioners (5.4 WTE including two trainees), five practice nurses (3.6 WTE) and 16 reception staff (13.1 WTE). The practice is also part of a group with The Whitswood Practice and shares four healthcare assistants (3.1 WTE), five management staff (4.6 WTE) and 10 admin staff (8 WTE) between both sites. This is a training practice and as such also has trainee medical staff. The practice is a teaching practice with five GP trainers and had a commitment to teaching at all student levels.

The surgery is open from Monday to Friday 8:30am to 6:30pm and on Saturdays between 9am and midday. There is an emergency service between 8am and 8:30am. The phones are closed between 12:30pm and13:30pm and every Tuesday the practice hosts a practice development meeting whereby the practice closes between 12:30pm and 14:30pm. Patients are also able to attend appointments at a small number of local health centres as part of the practice’s membership of a federation of GP practices who provide extended hours cover for a number of practices in the area up to 8pm, Monday to Friday, as well as up to 4pm on Saturday and Sundays. Out of hours cover is provided by the NHS 111 service and Go to Doc.

Updated 16 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Robert Darbishire Practice on 3 November 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice had good policies for the recruitment of staff.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• 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 and complied with the requirements of the duty of candour.

We saw the following areas of outstanding practice:

• The Quality Improvement Programme Manager who had created “QOF packs” for GPs. The pack was designed to give GPs better oversight over their administration role and allow better time management. Each GP was given a list of their patients who were missing clinical targets that made up the QOF. The GPs were instructed to review each patient’s record and decide on the best way forward and the Quality Improvement Programme Manager followed up all the actions on a monthly basis.
• A weekly clinic was set up for drug users. There were named lead staff with specialist training in partnership with the Community Drug Team. Staff had identified common issues in this patient cohort such as low screening and uptake of immunisations and due to the chaotic lives, this particular group of patients did not attend appointments. The practice staff had created a “one-stop shop” with a dedicated GP, nurse and healthcare assistant to provide a holistic approach.
• The practice was innovative and looking for ways to interact with the local communities and ran a number of projects such as for the local university population. The practice had liaised with the counselling services, was working to have a student Mental Health Forum and employed additional staff to register students at peak times. The practice participated in Arts projects to involve local schools and people and were looking to initiate a “Walking group” in association with Macmillan Cancer, the Ramblers association and local walking club Manchester Giants.
• A privacy slip was available at the reception for patients to complete discretely and present to the reception staff if they did not want to speak to the reception staff.

There was one area were improvement should be made:

• Consideration should be given to the improvement of activity undertaken to identify and register carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 March 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 79% compared to the national average of 78%.
• Patients with diabetes whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 87% compared to the national average of 80%.
• A record of foot examination was present for 90% of patients compared to the national average of 89%.
• 98% of patients with diabetes had received an influenza immunisation compared to the national average of 95%.
• The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c was 64 mmol/mol or less in the preceding 12 months was 84% compared to the national average of 78%.

• Longer appointments and home visits were available when needed.

• 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 had a system in place to identify patients on repeat medication that enabled medication review requirements to be identified and planned up to six weeks in advance.
• The percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 82%, compared to the national average of 83%.

Updated 16 March 2017

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, for example, children and young people who had a high number of A&E attendances.
• 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.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years (2015/16) was 82%, which was above the local CCG average (78%) and similar to the national average of 81%. The practice had recognised deficiencies due to the high turnover of patients, especially the students and non-English speakers. The practice had produced a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 63% to 92% and five year olds from 60% to 94%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 16 March 2017

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

• 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. For example the practice set up a visiting service that provided healthcare visits to housebound elderly patients up to three times a year.
• All elderly patients had been informed of their named GP.
• The practice offered same day appointments by telephone as well as via face to face consultations.
• Health assessments and checks available to patients aged over 75 years included screening for dementia and depression.

Updated 16 March 2017

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

• 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.
• Telephone appointments were available if patients wished to discuss test results and urgent concerns and for those who may have difficulty attending surgery due to work commitments.

Updated 16 March 2017

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

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advanced 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 percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record in the preceding 12 months was 96% compared to the national average of 89%.
• The percentage of patients diagnosed with dementia whose care had been reviewed face to face in the preceding 12 months was 81% compared to the national average of 84%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 16 March 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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 and had attended training in how to recognise domestic abuse.
• 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 has been asked to be the first practice to be accredited as a “Surgery of Sanctuary” for refugees and asylum seekers.
• A weekly clinic was set up for drug users. There were named lead staff with specialist training in partnership with the Community Drug Team. Staff had identified common issues in this patient cohort such as low screening and uptake of immunisations and due to the chaotic lives, this particular group of patients did not attend appointments. The practice staff had created a “one-stop shop” with a dedicated GP, nurse and healthcare assistant to provide a holistic approach.
• The practice had worked with the local Somali community and had initiated clinics with interpreters, a Somali Health Advocate as well as employing a Somali-speaking receptionist.
• The practice worked with a charity partnership called “Yaran” (a Farsi speaking counselling group for victims of torture) but had recently lost the funding for this.