Garswood Surgery

Updated 7 January 2016

Garswood Surgery is based in a purpose built building in a residential area of Wigan close to local amenities. The building is also occupied by other community healthcare services managed by the community trust and district nurses and community trust staff. There were 4570 patients on the practice list at the time of inspection. The average male life expectancy for the practice was 78 years compared to the National average of 79 years. The average female life expectancy for the practice was 82 years compared to the National average of 83 years. 70.5% of patients were in paid work or full-time education compared to the practice averages across England which was 60.2%. The practice has three partners, two of whom are male GPs and one female GP, one salaried female GP, one practice nurse, a health care assistant, a practice manager, reception and administration staff. The practice was a teaching practice that facilitated doctors in training including undergraduates, junior doctors and postgraduate GP training.

The practice is open Monday to Friday from 8am to 6.30pm with extended hours each Monday from 6.30-7.30pm. Patients requiring a GP outside of normal working hours are advised to contact the surgery and they will be directed to contact the local out of hours service. Outside of this time the practice uses St Helens Rota. This is a conglomerate of GPs who provide out of hours cover.

The practice has a Personal Medical Services (PMS) contract. In addition the practice carried out a variety of enhanced services such as: avoiding unplanned admissions to hospital.

Updated 7 January 2016

We carried out an announced comprehensive inspection at Garswood Surgery on the 3rd November 2015. Overall the practice is rated as good.

Our key findings were as follows:

• There were systems in place to mitigate safety risks including analysing significant events and safeguarding. Staff understood and fulfilled their responsibilities to raise concerns and report incidents.

• The practice was clean and tidy. The practice had good facilities in a large purpose built building with disabled access and a lift to the first floor.

• The clinical staff proactively sought to educate patients to improve their lifestyles by regularly inviting patients for health assessments.

• There was a robust system in place to undertake audits at the practice and improve patient care.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.

• Patients spoke highly about the practice and the whole staff team. They said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was consistent and strongly positive.

• The practice sought patient views about improvements that could be made to the service, including having a Patient Participation Group (PPG).
• Information about services and how to complain was available and easy to understand. The practice proactively sought feedback from staff and patients, which it acted upon.

• There was a clear leadership structure with delegated duties distributed amongst the team and staff felt supported by management. The staff worked well together as a team.

• Quality and performance were monitored.

We saw areas of outstanding practice including:

• The practice staff organised a number of community initiatives. Previously they had held a fundraising day for MacMillan cancer research and invited their patients and staff to help with the fundraiser. They had organised a coffee day in December 2015 for their patients and invited various groups to come and meet their patients during the event. Organisations such as the falls risk team and the memory clinic staff were due to attend to help raise awareness amongst their patients and the community in regard to the support and services they could offer.

• One GP had collected data over the last 20 years and carried out a yearly audit on patient deaths. They encouraged the practice to reflect each year on all deaths to look at any factors that could be preventable or reflect on the care given. Whilst no areas of concern were identified within the audits the staff had put a lot of work into reflecting and mitigating any risks. The data collated looked at any preventable factors for their death e.g. smoking, alcohol and helped increase awareness amongst GPs with health promotion and looking into the background of patients problems. The GP was due to present the data and research for publication this year.

• In 2014-2015 the practice won an award called a ‘GOLD Quality Placement Award.’ This was for mentoring and teaching undergraduate medical students from a local university and was based on undergraduate feedback regarding the quality of their placement and teaching.

• The practice introduced a tailor made recall system in 2007 which won an award in 2011 for its innovation. It offered a high quality system offering more checks than usual recall systems which ensured the clinical management of patients to be safe and robust. Almost every aspect of patient management with the exception of medication reviews was dealt with using the clinical systems diary facility. Patients were pro-actively managed to avoid deterioration in their health outcomes, for example: cholesterol, weight management and asthma management. Patients were seen holistically for their co morbidities in one appointment and birthday reviews offered a ‘One stop shop’ approach optimising appointments. The system helped the practices management of avoiding unplanned admissions and the proactive case management of vulnerable patients. The system facilitates the identification of patients who found it difficult to attend reviews and smear tests and as a result the practice had put in strategies to accommodate the needs of these patents with late and early morning appointments and home visits.

However there were areas of practice where the provider should make improvements:

• Ensure all staff files evidence the necessary checks such as references to show safe recruitment of staff.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions, treatment and screening programmes. The practice had a very effective system in place to make sure no patient missed their regular reviews for long term conditions. Home visits were undertaken to housebound patients or those residing in residential care or nursing homes. The practice had an in-house phlebotomy clinic and a GP led warfarin clinic which they also offered to their housebound patients.

Updated 7 January 2016

The practice is rated as good for the care of families, children and young people. Staff were knowledgeable about child protection and a GP took the lead for safeguarding. Staff put alerts onto a patient’s electronic record when safeguarding concerns were raised. The practice offered family planning advice. Immunisation rates were comparable and sometimes exceeded local CCG benchmarking for all standard childhood immunisations. Urgent access appointments were available for under-fives. The practice had baby feeding and changing facilities available to patients. Patients were signposted to a health trainer working at the practice. The trainer would develop care and support needed for each individual patient to support them in good health.

Updated 7 January 2016

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. They kept up to date registers of patients’ health conditions. Home visits were made to housebound patients to carry out reviews of their health. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice had identified older patients who were at risk of unplanned hospital admissions and developed care plans to support them.

Updated 7 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this group 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 the practice offered extended hours, evening telephone appointments and early morning blood tests for working patients. 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. H ealth checks were offered to patients who were over 40 years of age to promote patient well-being and prevent any health concerns.

Updated 7 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice referred patients to the appropriate services. The practice maintained a register of patients with mental health problems in order to regularly review their needs. The practice staff liaised with other healthcare professionals to help engage these patients to ensure they attended reviews and various specialists. The practice had onsite access to assessments with the Improving Access To Psychological Therapies (IAPT) team. They also promoted ‘Positive Mental training’ with access to audio downloads and CDs to offer self-help programmes for stress, depression and anxiety and for building confidence, coping and wellbeing. The practice also referred patients to the St Helens Chrysalis Centre (Local charity supporting adult women with mental health problems and domestic violence.)

Updated 7 January 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, a register was maintained of patients with a learning disability and annual health care reviews were provided to these patients. All staff were trained and knowledgeable about safeguarding vulnerable patients and had access to the practice’s policy and procedures and had received guidance in this. The practice offered referrals to local food banks for patients and referrals to local carer’s centres. They also supported patients with letters to their local housing offices.