Dr Cunningham and Partners

Updated 10 November 2016

Dr Cunningham and Partners (The Vallance Centre, Manchester, M13 9UJ) is based in the Ardwick area of Manchester. It is part of the NHS Central Manchester Clinical Commissioning Group (CCG) and provides services to approximately 6850 patients under a General Medical Services contract, with NHS England.

Ardwick is a deprived, inner city ward in Manchester which is undergoing significant regeneration. 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 72 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 were generally similar to the average GP practices in England with the exception of having a greater number of patients aged 20 to 24 years.

The practice has a higher percentage (72%) of its population with a long-standing health condition when compared to the England average (54%). The practice percentage (46%) of its population with a working status of being in paid work or in full-time education is below the England average (62%). The practice has a higher percentage (19%) of its population with an unemployed status than the England average of (5%).

Services are provided from a purpose built building, maintained by NHS Property Services, 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 building also has other GP practices and community services based within it.

The service is led by four GP partners (two male and two female) who are supported by a team of nurses, two practice managers as well as an administration team who also cover other duties such as drafting prescriptions.

The practice is open from 8.30am to 6pm on Mondays, Tuesdays, Thursdays and Fridays and from 8.30am to 4:30pm on Wednesdays. The practice is also a part of a federation of GP practices who provide extended hours cover for a number of practices in the area between 6pm and 8pm, Monday to Friday, as well as on Saturday and Sunday mornings. Patients are also able to attend appointments at a small number of local health centres as part of this arrangement. Out of hours cover is provided by the NHS 111 service and Go to Doc.

Updated 10 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Cunningham and Partners on 25 August 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• 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 one area of outstanding practice:

• The practice was responsible for a 60 bedded care home. The home had a bypass number to call the surgery and one of the GPs’ home and mobile number. The practice had installed a terminal at the home to access resident’s records when visiting. As well as ad hoc visits, a GP had a full morning at the care home each Thursday.

There were areas of practice where the provider should make improvements:

• Ensure the recruitment folders of all staff, including locum staff, include all the necessary pre-employment checks and records are kept of these.
• Consider the need for comprehensive complaint records to be maintained to support learning and improvement.
• Consider the privacy needs of the patients as some patient conversations could be overheard at the reception counter and in the shared administration area.

Consider a system to monitor the storage and usage of prescription pads and paper.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 November 2016

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.
• Performance for one of the five diabetes related indicators was above the national average, three indicators were in line with the national average and one indicator was below the national average:
• Patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 86% 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 82% compared to the national average of 81%.
• 93% of patients with diabetes had received an influenza immunisation compared to the national average of 94%.
• 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 78% compared to the national average of 78%.
• A record of foot examination was present for 68% of patients compared to the national average of 88%.
• 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.
• There was a “one stop shop” to reduce the number of times patients had to attend for review.
• The practiced worked with the home treatment teams for chronic obstructive pulmonary disease (COPD) and antibiotics to try to reduce unnecessary admissions.

Updated 10 November 2016

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 record that a cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 86%, which was in-line with the national average of 82%. 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 Clinical Commissioning Group (CCG) and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 80% to 94% and five year olds from 90% to 99%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 10 November 2016

The practice is rated as outstanding 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.
• All elderly patients had been informed of their named GP.
• The practice offered same day appointments as well as telephone and face to face consultations.
• The practice was responsible for a 60 bedded care home. The home had the bypass number to call the surgery and one of the GPs’ home and mobile number. The practice had installed a terminal at the home to access resident’s records when visiting. As well as ad hoc visits, a GP had a full morning at the care home each Thursday.

Updated 10 November 2016

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 10 November 2016

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 hypertension in whom the last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 80%, compared to the national average of 84%.
• 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 87% compared to the national average of 88%.
• The percentage of patients diagnosed with dementia whose care had been reviewed face to face in the preceding 12 months was 83% compared to the national average of 84%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 November 2016

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.