Pennygate Medical Centre

Updated 8 September 2016

Pennygate Medical Centre is located in Hindley, Wigan, Lancashire. The practice is located in a large modern building which also houses a pharmacy and includes a gym. There is easy access to the building and disabled facilities are provided. There is a large car park serving the practice. Primary medical services are provided under a Personal Medical Services (PMS) contract with NHS England and the practice is part of the Wigan Borough Clinical Commissioning Group.

There are nine GPs working at the practice. Eight GPs are partners, four male and five female and one male, salaried GP. There is one advanced nurse practitioner (full time), five practice nursesl(all part time) and one part time health care assistant (all female). There is a full time practice manager, an assistant practice manager and a team of administrative and reception staff.

The practice opening times are Monday 7am to 8pm, Tuesday 8am to 8pm, Wednesday 7am to 1pm, Thursday 8am to 8pm and Friday 8am to 6.30pm. The practice appointment times are Monday to Friday 8am to 12pm and 3pm to 6pm except Wednesday which is 8am to 12pm.

Patients requiring a GP outside of normal working hours are advised to call NHS 111 who may refer Bridgewater Community Healthcare.

The practice offers teaching and placements to medical students and trains GP’s.

There are 16,882 patients on the practice list. The majority of patients are white British with a high number of elderly patients and patients with chronic disease prevalence. There is a small number of Polish and Russian /Eastern European patients.

Updated 8 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pennygate Medical Centre on 28 April 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. However during our inspection we identified a controlled drug stored in an unlocked bag.This incident was reported and closed with 24 hours.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.

• Thorough recruitment procedures were carried out before staff were employed.

• Most patients said they found it easy to make an appointment with a named GP and that 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.

The areas where the provider should make improvements :

• Ensure that all medicines are stored securely

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 September 2016

The practice was rated as good for the care of people with long-term conditions.

• Practice nurses held chronic disease management clinics and made referrals to specialist nurses such as for patients with diabetes.

• Longer appointments were offered for patients with multiple conditions.

• The practice complied with QoF guidance for patients with long term conditions with a robust call/recall system for regular health checks.

• Home visits were undertaken for housebound patients requiring annual reviews.

• The practice was part of Wigan Federated Healthcare which had recently started to provide remote INR testing ( a test which monitors Warfarin levels are safe within the patients blood).

• Patients were able to self-check their blood pressure on an easily accessible machine in the waiting area.

• Online access to records was available which had been evidenced to show it improved care and communication for patients with long term conditions.

Updated 8 September 2016

The practice was rated as good for the care of families, children and young people.

• The practice had high achievement with their childhood immunisation programme achieving up to 100% uptake in 2014/15.

• There was a dedicated child & adult safeguarding lead. Safeguarding training had been provided to practice staff.

• The practice offered same day access for children with urgent problems, particularly the under 5’s.

• Teenage drop in clinics offered advice and support for young people including sexual health and contraception.

• The practice was piloting a paediatric INT (Integrated Neighbourhood Team) clinic run by a GP and a paediatric nurse identifying children that frequently attended hospital and worked with the family to support them.The service offered 12 week courses for new mothers which educated them on various topics and helped to build their confidence.

• Monthly meetings were held with the Health Visitor to discuss children in need, those on the child protection register and families with concerns. The clinical system flagged these records for clinicians who saw them in surgery.

Updated 8 September 2016

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

• The surgery offered patients over 75 years a health check and dementia screening.

• There was a register of patients on the Gold Standard Framework (for people at the end of life). Meetings were held monthly with the wider practice team involved in their care to ensure the needs of the patient were being met.

• The practice provided continuity of care allocating each nursing home two nominated GPs to ensure that complex cases were well understood by the visiting clinician.

• Home visits were offered for housebound patients.

• High numbers of telephone consultations were offered to allow patients with mobility problems to access care including chronic disease management.

• A Hearing Loop was available in the reception area and there was good access for people with mobility problems.

• There were district nurses on site which ensured an excellent working relationship allowing easy communication regardingconcerns with patient care.

• The practice referrred patients to the fire safety scheme which offered advice to ensure they were safe in their home.

• There were community link workers and health trainers in the practice who offered both social and lifestyle support.

• The Active Living Team ran two exercise sessions per week at the practice enabling patients to get fit and socialise.

Updated 8 September 2016

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

• 79% of patients with asthma, on the practice register, had an asthma review in the preceding 12 months that included an assessment of asthma control using the 3 RCP (Royal College of Practioners) questions. This compared to a national average of 75%.
• 82% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compared to a national average of 82%. The practice promoted online services and text messaging to make it easier for patients who worked to access services outside of practice hours.
• Extended access appointments were available between 7am and 8am and 6.30pm and 8pm. The practice had also recently opened an extended access hub (in partnership with other practices in the neighbourhood) with appointments which run alongside clinics 6.30-8pm Monday- Friday and 10am-4pm on Saturdays.

• The practice offered telephone appointments.

• NHS health checks were available for patients over 40 years.

• Meningitis vaccinations were available for students.

.

Updated 8 September 2016

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

• Practice nurses held a dementia clinic which identified patients with memory problems, provided a healthcheck and referred them to occupational therapists or back to the GP where required.

• The practice had a dedicated area in the waiting room with information regarding dementia and carer information.

• 100% 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 a national average of 88%.

• 78% of patients diagnosed with dementia had their care reviewed in a face-to-face review in the preceding 12 months. This compared to a national average of 84%.

  The practice offered mental health and learning disability reviews in line with QoF guidance.

• When appropriate consent was gained to contact a carer or nominated individual on behalf of the patient.

• Patients had a named nurse.

• All staff had dementia awareness training to help in their understanding the condition and meeting the needs of the patients.

• All records for this group of patients had an alert on the clinical system in order to make staff aware of the patient’s vulnerability/condition

Updated 8 September 2016

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

• Patients with a learning disability(LD) or other significant disability had an alert on their medical record, this allowed all staff to quickly identify when dealing with a patient that they may require additional assistance. The practice had a good working relationship with the LD team and regularly did joint patient reviews with them.Clinical staff were trained in the Mental Capacity Act. There were procedures in place for identifying patients with a DoLS (Deprivation of Liberty Safeguard) in place.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• A register for military veterans and patients active in the armed forces was held which flagged their records.

• The practice worked closely with the adult and children’s safeguarding team and one of the GP’s was the named children’s safeguarding doctor for the CCG.

• Staff had received training to improve their awareness of the LGBT(Lesbian, Gay, Bisexual and Transgender) community. With the patient’s permissiondata regarding their sexual identity was recorded in order to improve their healthcare.One of the GP’s had recently appeared in the media to discuss the lack of services for transgender patients in the area.