Shakespeare Surgery

Updated 4 July 2016

Shakespeare Surgery is one of five small practices situated in a modern purpose built community health centre in Poolstock Lane, close to public transport. 3,000 patients are registered and the practice are accepting new patients. They have a larger than average population of patients between the ages of 30 and 40 years. They are overseen by Wigan Borough Council Commissioning Group (CCG) and delivered services under a General Medical Services contract.

The medical team consists of two male and one female GP partners, (all part time) a salaried GP and two GP registrars. A part time practice nurse provides services over five days and the clinical team are supported by a practice manager and four reception/administration staff who all cross-cover each other’s roles. One of the administration team is also trained as a health care assistant and phlebotomist. They are a teaching and training practice offering mentorship to medical students, trainee GPs and student practice nurses. The practice are based in a community centre with access to and close collaboration with the other four GP practices, physiotherapists, health visitors, community midwives and district nurses. There is also a pharmacy on site.

The practice is open every day from 8.15am until 6.30pm every day except Wednesday and appointments are ten minutes in length throughout each day. Appointments can be made in advance, on the day, and in an emergency and the practice offers telephone triage. On Wednesday afternoons patients have access to a GP from one of the five practices who each provide a service on a rotational weekly basis. Extended hours appointments are available from 6.30pm to 8pm weekdays and from 10am to 4pm on Saturdays via the Prime Minister’s Challenge Fund (PMCF) Extended Access Programme.

Updated 4 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shakespeare Surgery on 1st June 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 been trained with 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. There was also easy-read versions with pictures for patients with learning disabilities . 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.
• 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.
• A phlebotomy service was commissioned by the practice for the benefit of all patients but particularly for the benefit of the vulnerable and elderly population.

We saw an area of outstanding practice:

The practice continually monitored, reviewed, learned and changed their working practice to ensure positive outcomes for patients. They did this through regular and open reporting and review of significant events which included all staff, continual audit and reflection, and feedback from staff, students and patients. We saw examples where new protocols and services had been implemented and monitored to ensure they were effective such as the coil and implant service for women.

We saw an area where the practice should make improvement:

The provider should undertake a risk assessment for the mounting of sharps boxes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 4 July 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.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 92% which was higher than the local average of 87% and the national average of 88%.

• Longer appointments and home visits were available when needed and appointments were tailored according to need. For example if the client needed to be seen for multiple conditions then longer appointments were available.

• 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.

Updated 4 July 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. Immunisation rates were relatively high for all standard childhood immunisations.

• Staff demonstrated 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 was 82% compared to 84% locally and 82% nationally.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working and prompt communication with midwives, community matrons, health visitors and school nurses and other services that were situated in the same building.

Updated 4 July 2016

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.

• Staff were able to recognise signs of abuse in older people and knew how to escalate or refer those concerns.

• There was a register of older people who needed extra support and appointments were catered according to the needs of those patients. Care plans, action plans and regular reviews of these patients was demonstrated.

• A phlebotomy service was provided by the practice for the benefit of all patients but particularly for the benefit of the vulnerable and elderly population

Updated 4 July 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.

• Patients of Wigan GP practices had the choice to access GP services during weekends and evenings until 8pm available from two hubs within the borough.

• The practice was closed on a Wednesday afternoon and rather than direct patients to Out of Hours providers, the five practices in the building collaborated together, shared information and offered a shared service on a Wednesday afternoon for all their patients.

Updated 4 July 2016

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

• There was a lead GP for dementia and mental health and patients had a named GP with continuity of care. The practice carried out advance care planning for patients with dementia and staff had a good understanding of how to support patients with mental health needs and dementia.

• 0.47% of the patient population had been diagnosed with dementia. This amounted to 14 patients, 13 of who had received a face to face visit in the last 12 months.This figure was higher than the local and national averages.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.Staff received dementia training and one of the staff was a dementia friend.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 4 July 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. One of the GPs had a particular interest and took the lead role for patients with learning disabilities.Clinical and front line staff had undertaken training to enhance the service offered to this group of patients.

• The practice recognised the needs of this patient group and offered longer (or shorter) appointments according to the patient’s own specific needs.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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. 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.