The Dicconson Group Practice

Updated 7 October 2016

The Dicconson Group Practice, Boston House, Frog Lane, Wigan WN6 7LB is located in the NHS Wigan Borough CCG. The practice is located in a large purpose built health centre. Other health care services are located in the building. These include; a pharmacy, health visitors, podiatry and an eye clinic. There is a large car park and a local bus service to Wigan town centre.

There are two male GPs and four female GPs (all partners) working at the practice. They work between four and eight sessions per week. There are two female practice nurses; one is a nurse prescriber, a practice manager, a practice supervisor and a team of 11 administrative staff.

The practice is a training and teaching practice (Teaching practices take medical students and training practices have GP trainees and F2 doctors).

The practice is open between 7am and 12 noon and 1.30pm and 6.30pm Monday, Tuesday, Thursday and Friday. The practice is open on Wednesday between 8am and 1pm.

The practice appointment times are as follows:

Monday and Tuesday 7.10am to 11.30am and 1.30 to 5.50pm

Wednesday 8.30am to 11.30am

Thursday and Friday: 8.30am to 11.30am and 1.30 pm to 5.50pm

Extended hours appointments are offered between 7am and 8am Monday and Tuesday.

The practice has a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Updated 7 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Dicconson Group Practice on 30 August 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. Medicines were well managed and thorough recruitment procedures were in place to ensure suitably qualified staff were employed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• There was evidence of quality improvement including ongoing clinical audits to monitor the effectiveness of the treatments provided to patients.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They commented they were involved in making decisions about their health care and GPs and nursing staff responded well to their health care needs and kept them informed about test results and information relating to their care such as follow up appointments and flu clinics.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns. There was evidence that staff learned from complaints to prevent them from reoccurring.

• 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 were disabled facilities, a hearing loop and translation services for patients whose first language was not English.

• There was a lead GP for adult and child safeguarding. Most staff had achieved appropriate safeguarding training.

• Staff worked with other agencies to promote patients’ health and well-being. The practice had been involved in three major projects relating to the promotion of good health in the community, fuel poverty and promoting the needs and care of homeless people.

• 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. Staff told us there was an open culture within the practice and they have the opportunity to raise any issues at team meetings and feel confident and supported in doing so.

• There was a focus on continuous learning and improvement at all levels within the practice. All staff regularly took time out to work together to resolve problems and to review performance to improve the service provision.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 October 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.
• 93% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months. This compared to the CCG average of 87% and the national average of 88%.
• Longer appointments and home visits were available when needed.
• 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 social care professionals to deliver a multidisciplinary package of care.
• Clinical protocols were regularly reviewed against current best practice evidence (including NICE guidance and local guidelines). GPs took a clinical lead in each area to ensure protocol development in the practice and to support staff in their roles.
• Health care assistants were involved in some aspects of chronic disease monitoring (i.e. blood pressure checks and some aspects of COPD review). The Healthcare apprentice role had recently been developed to become more involved in the clinical review process.
• All cancer patients received a cancer care review by a GP.
• Patients approaching the last 12 months of their life would be discussed in the practice Gold Standards Framework meetings, and the use of advanced care planning was considered.

• Newly registered patients received a new patient registration check. If a long term condition was identified, the patient was signposted to the appropriate clinical team member.

Updated 7 October 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.
• 91% of women aged 25-64 had a record of a cervical screening test being performed in the preceding 5 years. This compared to the CCG average of 84% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Staff worked with midwives, health visitors and school nurses.
• GPs provided contraceptive and pre-conceptual advice where clinically appropriate, and referred high risk patients to appropriate services (i.e. pre conception diabetic clinic).
• Ante natal care was delivered by community midwives and a “maternity pack” was given to all expectant mothers.
• All pregnant women were offered appropriate vaccinations. Recent data indicated the practice had a higher than average uptake of influenza vaccination.
• The practice nurse team attended annual immunisation update training.
• Post-natal reviews were initially undertaken by telephone consultation. If health care needs were identified, then appropriate advice would be given.
• A face to face review by the GP took place at the 6-8 week Child Health Surveillance check. This appointment was combined with the first immunisations appointment for the convenience of the mother.
• There was a lead GP for child and adult safeguarding. Staff were trained in safeguarding procedures. Some GPs were awaiting further training; an in-house training session was planned in the interim.
• Children and young people were signposted to appropriate support agencies where appropriate. For example, the Fit for Fun activity group and young people’s drug and alcohol service.
• Regular safeguarding meetings were held, and the practice received reports from other agencies. The IT system alerted clinicians and other practice team members when seeing a patient where safeguarding concerns existed.

Updated 7 October 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.
• All patients had a named GP to coordinate their care.
• The practice participated in the health check local enhanced service in 2015. This was a nine month enhanced service that aimed to screen patients over 75 years for a number of health conditions and social needs, medication compliance and included a general health questionnaire.

Updated 7 October 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 reflected the needs for this age group.
• A wide range of appointment times and types were available i.e. telephone or face to face, and included early morning and later practice nurse appointments.
• Routine GP and practice nurse appointments were also available via the local “Primary Care Hub”. These appointments ran from 6 30pm to 8pm Monday to Friday and all day Saturday and Sunday.
• Repeat prescriptions could be requested electronically at any time of day and could be ordered via the patients’ nominated pharmacy.
• General NHS health checks were available where clinically appropriate.
• The practice had on site access to community link workers and health trainers for lifestyle and social / welfare issues.
• All patients over 65 years were offered influenza and pneumococcal vaccinations.
• The practice was proactively involved in the bowel screening programme and was currently discussing how best to target at risk patients before they received their test packs and chase up patients who failed to respond.

Updated 7 October 2016

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

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG and national average of 84%.
• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This compared to the CCG average of 92% and the national average of 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 carried out advance care planning for patients with dementia and patients were monitored under the admission avoidance register where appropriate. .
• The practice had told patients experiencing poor mental health and dementia 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 had been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia. One of the GPs was the dementia care lead and a member of the reception staff was the appointed dementia care champion offering support and advice to patients’ carers.
• Patients with severe mental illness were actively recalled for physical health checks. If necessary, appointments were booked via the carer or relative and a longer appointment was allocated.
• Alerts were added to certain patient notes where risks to staff had been identified. These alerts were removed on the advice of clinical staff should their situation change.
• The register of patients with dementia was kept updated to ensure patients received the care they needed.
• GPs and members of the patient participation group were planning a dementia awareness day to bring together services that could support patients and their families.
• Staff provided holistic care to family units. For example, support was offered to family members of patients with dementia.

Updated 7 October 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 those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• 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.
• The practice offered regular reviews for patients identified with learning disabilities and mental health problems. GPs had close links with the local Learning Disability Team regarding those patients who did not attend review appointments.
• Homeless patients were identified and staff had regular dialogue with social workers where appropriate, and other support agencies staff including drug and alcohol link workers.
• Hearing and sight impaired patients had alerts added to their notes to facilitate appropriate contact with the patient and discussion with family members or carers. For example, a note to physically call a patient in from waiting room as they were unable to see the information screen.
• The practice had access to a hearing loop system, and the building was wheelchair friendly.
• Patients’ needs were identified and met on an individual case by case basis. For example, vulnerable patients were given the practice manager’s direct line telephone number to allow rapid access to GPs for advice from a suitably qualified staff member.
• The practice had received positive feedback from the community link worker service regarding the appropriateness of referrals. Patients referred into this service presented at times of financial or social crisis (or impending crisis that had a considerable potential health impact). These patients may not always see themselves as vulnerable in the long term, but were appropriately signposted to reduce their vulnerability (and hopefully avoid deterioration in medical and social functioning).
• The practice worked with other agencies to promote health and well-being and in the last two years the practice had been involved in three major projects promoting good health in the community which included fuel poverty and promoting the needs and care of homeless people.