Halliwell Surgery 2 Also known as Drs McLardy, Jeyam & Jesudas

Updated 28 June 2016

Halliwell Surgery 2 is a GP practice situated in the Halliwell area of Bolton. At the time of this inspection we were informed 3400 patients were registered with the practice.

The practice population experiences much higher levels of income deprivation than the practice average across England. There is a higher proportion of patients above 65 years of age (18%) to the practice average across England (16%). The practice has a similar proportion of patients under 18 years of age (23%) than the practice average across England (23%). 63 per cent of the practice’s patients have a longstanding medical condition compared to the practice average across England of 57%.

At the time of our inspection two GP partners (female), a salaried GP (female), a registrar GP (male) and another qualified doctor training to be a GP (female) were providing primary medical services to patients registered at the practice. The GPs were supported in providing clinical services by two practice nurses. Clinical staff were supported by the practice business manager and the seven members of the practice administration/receptionist team.

The opening times of the practice are Monday to Friday 8am to 6.30pm. Appointment times vary between the clinicians and are fully detailed on the practice website. The practice also provides extended surgery hours on Monday and Tuesday evenings that are available outside of routine opening times. Patients are also able to access booked appointments at weekends and bank holidays at one of the 2 local GP hubs (one of which is situated in the same building as the practice). The practice has opted out of providing out-of-hours services to their patients. In case of a medical emergency outside normal surgery hours advice was provided by the 111 service and Bury and Rochdale Doctors (BARDOC). The practice website and patient information leaflet available at the practice details how to access medical advice when the practice is closed. Patients are also provided with these details via a recorded message when they telephone the practice outside the usual opening times.

The practice contracts with NHS England to provide General Medical Services (GMS) to the patients.

Updated 28 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Halliwell Surgery 2 on 3 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 to provide them 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. 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.

We saw one area of outstanding practice:

• There is a proactive approach to understanding the needs of different groups of people and to deliver care in a way that meets these needs and promotes equality. This includes people who are in vulnerable circumstances or speak another language. People who are homeless were never turned away and we were provided with a number of examples of how practice staff had gone the extra mile to support these patients. The practice had ensured their IT and other systems maximised support to patients speaking a language other than English.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 June 2016

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• 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 28 June 2016

• 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.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

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

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 28 June 2016

• 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.

• The Practice nurses attend older patient’s homes to do health checks and vaccinations if the patient is housebound.

• The surgery works closely with the integrated neighbourhood team; staying well project and the nursing home teams to organise care and continuity for both clinical and social care for this cohort of patients.

Updated 28 June 2016

• 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.

Updated 28 June 2016

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  94% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months.

• 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.

• 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 28 June 2016

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and 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.