Archived: Bolton General Practice

Updated 4 August 2017

The Bolton General Practice provides primary medical services in Bolton from Monday to Saturday. The surgery is open Monday to Saturday:

Monday, Tuesday, Thursday and Friday 8am to 6:30pm, Wednesday 7am to 6:30pm and Saturday 9am to 12:30pm.

Appointments with a GP are available throughout the opening times Monday to Saturday. A GP is onsite at all times and available to see patients urgently if required. This was in acknowledgement of the number of vulnerable patients registered at the practice who may not be in a position to keep to appointment times. Additionally patients can access GP services in the evening and on Saturdays and Sundays through a local extended hours hub.

Bolton General Practice is situated within the geographical area of Bolton Clinical Commissioning Group (CCG).

The practice has an Alternative Provider Medical Services (APMS) contract. The APMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. It offers direct enhanced services for meningitis provision, the childhood

vaccination and immunisation programme, extended hours access, facilitating timely diagnosis and support for people with dementia, influenza and pneumococcal immunisations, learning disabilities, rotavirus and shingles immunisation and unplanned admissions.

Bolton General Practice is responsible for providing care to 5255 patients. The population experiences higher levels of income deprivation affecting children and older people than the practice average across England. There is a higher proportion of patients aged 5 to 44 (74%) compared to a national average of 52% and a lower average of patients over 65, 2% compared with 17% nationally. There are a high number of patients registered who are from Black and minority ethnic groups (BME), this being 76% compared to 16% nationally. The practice also has 1480 refugees and asylum seekers registered with the practice and approximately 48% patients are non-English speaking.

The practice consists of three GPs, one full time lead GP (male) and two part time GPs (one male and one female). The practice also has bank and locum GPs, a full time practice nurse and a health care assistant. The practice is supported by a practice manager, assistant practice manager, receptionists and administrators.

The practice is part of SSP Health Primary Care Limited, a federated organisation which benefits from support from the leadership and governance teams. The practice has access to support and leadership from, for example a nursing lead and pharmacist as well as access to human

resources, auditing and finance teams. When the practice is closed patients are directed to the out of hours service.

Updated 4 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bolton General Practice on 16 June 2017. 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 employing a patient liaison officer, a weekly ‘Conversation café’ and patients could access free gym facilities at a neighbouring SSP practice.
• Feedback from patients about their care was consistently positive
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice had a diverse population and in order to meet the needs of patients from a different background and those for whom English was not their first language, the practice had multi-lingual literature, attended local community events and worked with local organisations such as the Befriending Refuges and Asylum Seekers (BRASS).

We saw several areas of outstanding practice including:

• The practice were proactive in providing safety nets for vulnerable and at risk patients. For example, the practice initiated a ‘do not allow to DNA’ register. This was created to ensure that vulnerable patients who required follow up, referrals or treatments following consultations were proactively contacted to ensure they attended their appointment. The practice also monitored vulnerable patients on high risk medication who were assessed as being at risk of not complying with their medication. The practice put in place multiple safety nets for these patients.
• The practice recognised the need for advocacy and support services for patients to be provided in house and had a number of initiatives on-going, for example, the practice employed a patient liaison officer to provide advocacy for vulnerable patients especially those for whom English was not their first language and those new to the practice. They acted as a focal point for communication between patients, GPs and other health and social care teams. The practice had also become increasing aware of the impact on patients physical and emotional wellbeing in light of changes to the benefit system and patients being refused asylum. As a result the practice supported patients with legitimate reasons to appeal against these decisions by providing detailed medical letters and reports when required.
• The practice recognised that social isolation was a key issue for some patients and the practice had established a number of services to address this, for example, patients living in social isolation or new to the practice were invited to attend a weekly conversation café. The conversation café was run by the patient liaison worker, attended by staff, voluntary organisations and community workers. Patients could drop in for advice, guidance and support or to meet new people. The practice had also introduced welfare appointments with the health care assistant. These could be accessed by filling in a confidential ‘loneliness slip’ or speaking with a member of staff.

However there was one area of practice where the provider should make improvements:

• Ensure all sharps bins are signed and dated.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2017

The practice is rated as outstanding 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 offered appointments up to 45 minutes for those with multiple long term conditions, offering a holistic review.
• 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.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• For patients with long term and multiple long term conditions the practice was proactive in preventing their condition from worsening.
• 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 medicine needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

Updated 4 August 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that 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 worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• Congratulation letters were sent to parents of new babies and new parents were provided with an early year’s fact sheet, developed by SSP, providing information around vaccination schedules, breast feeding, cervical screening and other health related information.
• Breast feeding facilities were available.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 4 August 2017

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

• 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. All patients aged over 75 years were offered health checks and care plans.
• 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.
• Where older patients had complex needs, the practice shared summary care records with local care services and signposted to relevant social care and voluntary organisations for additional support.
• The practice had a dedicated Carers’ Champion whose role included maintaining the register of carers and signposting to other services. In addition the practice also had champions for palliative care and cancer patients.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 4 August 2017

The practice is rated as outstanding 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 hours included appointments 9am to 12:30pm on Saturdays. The practice also participated in a local extended hours hub where patients could access GP services in the evening and on Saturdays and Sundays.
• 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 consultations were available daily.
• The practice hosted ultrasound clinics on site from other health providers. This enabled patients to access services closer to home preventing them having to travel to access care and treatment.
• The practice had condoms readily available for patients to pick up as and when required.

Updated 4 August 2017

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

• The practice carried out advanced care planning for patients living with dementia.
• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 93% of patients with poor mental health had a comprehensive care plan documented in the record agreed between individuals, their family and/or carers as appropriate.
• 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. Staff signposted patients to the self-referral counselling services Think Positive who provide help for people with anxiety and depression.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 4 August 2017

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

• The practice population experience higher levels of income deprivation affecting children and older people than the practice average across England. The practice supported homeless patients and provided shared care for patients with alcohol/substance misuse problems. The practice also had 1480 refugees and asylum seekers registered and approximately 48% of patients were non-English speaking.

• The practice held a register of patients living in vulnerable circumstances known as the ‘important patient register’ including homeless people, vulnerable adults and those with a learning disability. This ensured the needs of the most vulnerable patients were being met and their care and welfare was monitored.
• The practice has a patient liaison officer to provide advocacy for patients in this population group and acted as a focal point of communication between patients, GPs and other members of the primary health care team.
• The lead GP worked in partnership with the local drug and alcohol team and complex lifestyle team to provide co-ordinated care for patients.
• 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 offered longer appointments for vulnerable patients including those with a learning disability.
• The practice used telephone translation services and routinely offered extended appointments (30 to 45 minutes) to those requiring a translator. The practice also had for example a Welcome pack which explained in various languages about the practice and covered subjects such as the prescribing of antibiotics, cervical screening, childhood immunisations, COPD and Heart Failure.
• The practice recognised isolation was an issue for many vulnerable patients and provided welfare support to those feeling lonely and isolated and also invited people to a weekly drop in conversation café at the practice.
• 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.