Archived: Manor Practice Also known as Greenbrook Manor

Updated 23 April 2015

Manor Practice provides NHS primary medical services from Manor Practice, Boston Manor Road, Brentford, Middlesex TW8 8DS. The practice provides primary medical services through a General Medical Services (GMS) contract to approximately 2,100 patients in the local community. The practice is part of Greenbook Healthcare (Hounslow) a provider of primary medical care operating within the Hounslow Clinical Commissioning Group (CCG) area, which is made up of 52 GP practices. Greenbrook Healthcare (Hounslow) was providing five GP practices and five NHS Urgent Care Centres in the West London area.

Three GPs were employed to work at the practice, two female and one male. One GP was designated as the lead GP and was responsible for clinical governance. The practice manager working at Manor Practice also had management responsibility for four other Greenbrook Healthcare practices in the Hounslow locality. The team also comprised of two practices nurses, one healthcare assistant, a phlebotomist and two reception staff.

A GP Medical Director and a quality and governance lead were employed by Greenbrook Healthcare (Hounslow) and were involved in the management of Manor Practice and the other practices provided by Greenbrook Healthcare (Hounslow), in the locality.

The practice offers a range of services including clinics for patients with long-term conditions, blood pressure monitoring, family planning, cervical smears, flu clinics, health checks, child immunisations and a phlebotomy service. The practice opening hours are between 8am and 6.30pm Monday to Friday. The practice has opted out of providing out-of-hours services to its patients and refers patients to the 111 out-of-hours service.

The practice’s patient age distribution was predominantly within the 26 – 45 age group with 39% of patients in this age range The practice was located in an ethnically diverse area with 15% of patients from an Asian community.

The service is registered with the Care Quality Commission to provide the regulated activities of

diagnostic and screening procedures, treatment of disease, disorder and injury, family planning and maternity and midwifery services.

The practice was located in a purpose built Health Centre with two other GP practices. Each practice had a designated reception area. The waiting area for patients was shared, with seating arranged adjacent to each practice reception desk. The Health Centre also accommodated the district nursing service and palliative care team. Building maintenance and health and safety were managed by an external contractor employed by Hounslow and Richmond Community Healthcare.

The CQC intelligent monitoring placed the practice in band 6. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

Updated 23 April 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Manor Practice on 10 November and 26 November 2014. The inspection team was led by a CQC inspector and included a GP specialist advisor. We rated the practice as ‘Good’ for the service being safe, effective, caring, responsive to people’s needs and well-led. We rated the practice as ‘Good’ for the care provided to older people and people with long term conditions and ‘Good’ for the care provided to, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

We gave the practice an overall rating of ‘Good’

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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 then acted on.

There was one area of practice where the provider could make an improvement.

The provider should:

Continue to monitor and review the appointment times for patients who are unable to attend the practice during the day to work commitments.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 April 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care and treatment.

Updated 23 April 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify children who were at risk. Immunisation rates were relatively high for all standard childhood immunisations. 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 offered a full range of immunisations for children, travel vaccines and flu vaccinations in line with current national guidance. According to NHS England data for 2013/14 the percentage of children receiving a vaccination in all of the age categories was above the CCG area for the majority of vaccinations.

Updated 23 April 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 23 April 2015

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. As a result of patient surveys a need had been identified for a further extension of evening appointments. The practice had considered this information but due to the practice size was not currently in the position to change appointment times. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of patients in this age group.

Updated 23 April 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). People experiencing poor mental health all had an agreed comprehensive care plan in their records. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

The practice had participated in a CCG led audit into the records of people with mental ill health. The aim of which was to look at GP patient consultation records and ensure that patients received appropriate advice and treatment.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. People were encouraged to take responsibility for their mental health and were directed to websites which would enable them to read and learn about mental health issues and develop their own action plans.

Updated 23 April 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Translation services were available for patients whose first language was not English to help them with their communication needs. People with drug and alcohol issues were signposted to local support services.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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. 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.