Marus Bridge Practice

Updated 10 October 2016

Marus Bridge Practice is located in Worsley Mesnes, Wigan. The practice is situated in modern purpose built premises which also hosts another four GP practices.

The male life expectancy for the area is 82 years compared with the CCG average of 77 years and the national average of 79 years. The female life expectancy for the area is 79 years compared with the CCG average of 81 years and the national average of 83 years. The practice is in the sixth most deprived decile. Life expectancy is higher than CCG average and slightly higher than national average.

The practice has five partners in total, four partners are GPs (three male and one female) and one female advanced nurse practitioner partner. There are a further three clinical staff: one nurse prescriber, one practice nurse and a healthcare assistant. Members of clinical staff are supported by one practice manager, an assistant practice manager and administrative staff.

The practice is open between 8am and 6.30 pm Tuesday, Thursday and Friday. Each Monday the practice is open 8am till 8pm. Every Wednesday afternoon from 1pm the practice is closed for staff training events. The four practices in the centre provide an in house urgent care service on Wednesday afternoons. In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are available for patients that need them. Extended hours are offered on Mondays from 6.30pm till 8pm

Patients requiring a GP outside of normal working hours are advised to contact the surgery and they are directed to the local GP out of hours’ service which is provided by Bridgewater NHS Foundation Trust through NHS 111. Additionally patients can access GP services in the evening and on Saturdays and Sundays through the Wigan GP access alliance at locations across Wigan Borough.

The practice has a General Medical Service (GMS) contract with NHS England. At the time of our inspection in total 5188 patients were registered. The practice is a member of Wigan Borough Clinical Commissioning Group (CCG).

The practice is a training and teaching practice for medical students from The University of Manchester. Three GP partners are trainers. The practice is also a multidisciplinary training practice for student nurses, paramedics, physician associates and apprenticeships.

Updated 10 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Marus Bridge Practice on 5 September 2016. Overall the practice is rated as outstanding.

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

• Throughout the inspection the practice demonstrated positive examples of holistic responses to patients’ needs, resulting in positive health and social outcomes.
• All staff fully 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 and transparent throughout the whole partnership.There were strong and visible clinical and managerial leadership and governance arrangements in place to support development and implementation of the learning cycle.
• Throughout our inspection there was a strong theme of bespoke education and training programmes which had been developed to maintain safe processes and align with in-house processes. These were overseen and maintained by all the clinical partners.
• The practice had a programme of continuous quality improvement through clinical and internal audits, and these were used to monitor quality and to make improvements.
• Feedback from patients about their care was consistently positive with many examples of the practice’s caring nature and going above and beyond to help patients.
• Staff were well supported and all felt a strong sense of team work and were very happy.
• The practice used their knowledge of the local community and patient population as levers to deliver high quality and person centred care.

We saw several areas of outstanding practice:

The practice had been heavily involved in embedding training to follow in-house bespoke policies and staff development for non-clinicians and clinical staff, which had been shared with the CCG and rolled out to other practices in the wider area by practice staff. For example:

• The healthcare assistant received training to support the transition from administration to healthcare assistant; training topics included clinical skills and infection control.
• The development and roll out of a training programme designed to support nurses from other care settings transition into primary care.
• Two staff were “vaccinations and fridge champions” and a course was designed to build confidence.

The practice designed several in- house policies to review systems or incidents. For example, a mobile phone policy for teenagers, due to the practice being highly aware of consent and confidentially issues with teenagers’ mobile numbers were documented.

There was a strong focus on clinical IT development which we saw both with GPs and the nursing team. For example, a learning disabilities template was designed; there was a dedicated learning disability champion who was supported by the clinical lead.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 October 2016

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

• Patients with multiple long term conditions were able to attend one 45 minute appointment covering all conditions.
• All long term conditions had bespoke clinical templates to include dementia screening, carers’ information and cancer awareness.
• The practice provided an extra nurse led clinic weekly for all newly diagnosed long term conditions or urgent reviews.
• Rescue packs for children with asthma were provided which were designed for both home and school use.
• 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 10 October 2016

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

• All patients under the age of 25 were invited to a young person’s review, which included vaccination and sexual health advice.
• There was a mobile phone policy for teenagers where opportunistic mobile phone number and contact details were checked.
• There was a robust safeguarding policy which included a bespoke template to record family relationships and schools attended.
• Congratulations letters were sent to new parents which included a reminder of all six week and post-natal checks invitations.
• The practice had a Twitter page to provide updates of their services.
• In the last five years 80% of eligible patients had received cervical screening compared to the clinical commissioning group (CCG) average of 76% and national average of 73%.

Updated 10 October 2016

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

• The practice is located in a multipurpose shared building and we saw that they proactively engaged with other health care professionals. For example we saw evidence of excellent working relationships with district nurses and the community matron.
• The nurse prescriber provided weekly ward rounds to a local nursing home.
• All house bound patients were visited annually and had an individual care plan.
• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• A weekly link worker attended the practice to offer support to patients by providing advice about benefits, housing, bereavement and counselling.

Updated 10 October 2016

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

• The practice offered a late evening nurse-led clinic for patients.
• We saw that the practice was proactive in offering a full range of health promotion and screening services. The practice had a Twitter page to provide updates on their services.
• 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 offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 10 October 2016

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

• The practice’s bespoke template included crisis planning to be included in the care plan, maintained by the clinical lead for the practice.
• 94% patients with a mental health disorder had an annual mental review and annual health review.
• 95% of patients diagnosed with dementia had received a face to face review in the last 12 months, which was higher than the CCG of 92% and national 88%
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• 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 10 October 2016

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example they had developed a single register for at risk patients, and all had individual care plans with a named lead.
• There was a flexible approach to accommodate patients with flexibility to coordinate appointments with the learning disability team.
• The practice adult safeguarding policy extended to include a policy for homeless, drug dependency and other vulnerable adults