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Inspection Summary


Overall summary & rating

Good

Updated 14 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashton Medical centre on 26 September 2017. Overall the practice is rated as good.

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

  • There was a clear leadership structure and staff felt supported by management. The practice had systems in place to obtain feedback from staff and patients.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and all further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.
  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed and there was a system in place for reporting and recording significant events.
  • Information about services and how to complain was available and easy to understand.
  • The practice was part of the SSP Health group of practices and provided flexible staff working across different SSP locations.

We saw two areas of outstanding practice :

  • The practice identified a high number of patients in residential and nursing homes requiring home visits. To reduce the impact on clinical time an acute visiting service was introduced. Following consultation with 12 neighbouring practices it was ascertained that they would also benefit from this service and a business case was submitted to the Clinical Commissioning Group (CCG) to introduce a community acute visiting services. This was approved and commenced in March 2017 and a re-audit in September 2017 confirmed that home visit demand had reduced because of this service.
  • The practice implemented and developed a Childhood Initiative Scheme for parents, expectant parents, guardians and grandparents. The sessions included professional advice and support on how best to deal with common minor illnesses such as coughs and colds, fever and febrile convulsions. In addition Basic Life Support training was delivered. The practice was able to evidence that this service reduced attendance at accident and emergency, hospital admissions and inappropriate requests for GP appointments. Feedback from the first year’s appraisal identified where improvements could be made and the sessions now included meningitis awareness, help and advice about routine emergency conditions and one-to-ones at the end of each session. Collaboration has taken place with the CCG who plan to link the practice with Sure Start in order to share the learning more widely across the Wigan Borough.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 February 2018

The practice is rated as Good for providing safe services.

  • There was a system in place for reporting and recording significant events.We saw that information about safety was recorded, monitored and reviewed.
  • We reviewed a number of recorded incidents and saw that lessons were shared to make sure that safety was improved when required.
  • Staff told us that they understood their responsibilities to raise concerns, and to report incidents and near misses.
  • When things went wrong, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
  • There was evidence that risks to patients were assessed and well managed.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

Effective

Good

Updated 14 February 2018

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were above average for the locality.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 14 February 2018

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for some aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 14 February 2018

The practice is rated as good for providing responsive services.

  • The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.Two schemes had been initiated and introduced by the practice and then shared with the wider community to benefit patients with Wigan.They were able to produce evidence that suggested a reduction in attendance at accident and emergency by parents with young children and older people because of the services they had initiated.
  • Patients said they found it easy to make an appointment with the GP and that there was continuity of care, with urgent appointments available the same day. This was seen on the day and with the patients we spoke to.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed that the practice usually responded quickly to issues raised.

Well-led

Good

Updated 14 February 2018

The practice is rated as good for being well-led.

  • There was a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff understood the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt well supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 14 February 2018

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.Nursing staff also worked with other nurses in the area to raise increase knowledge throughout the community.
  • The advanced nurse practitioner implemented and developed patient group consultations which were personal medical consultations delivered by a clinician in a supportive peer group setting with other patients in the group listening in and learning from one another.The process was in its infancy but there had been two sessions, with a third planned. The first cohort (three sessions in total) was for patients with diabetes.The aim of the sessions was to empower patients to know their numbers (ie: blood results, cholesterol level, blood pressure etc) and look at target setting.The group gave the patients the chance to talk with each other, discuss coping mechanisms and share good practice as well as receiving input from a clinician on how to manage their condition.
  • The practice offered appointments of up to 60 minutes duration for patients with long term conditions
  • Patients had a six monthly or annual review with either the GP and/or the nurse to check that their health and medication. Longer appointments and home visits were available when needed.
  • The practice had registers in place for several long term conditions including diabetes and asthma.
  • Rescue packs were prepared in advance for patients with chronic obstructive pulmonary disorder to reduce the risk of hospital admission.
  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 14 February 2018

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

  • The practice implemented and developed a Childhood Initiative Scheme for parents, expectant parents, guardians and grandparents. The sessions included professional advice and support on how best to deal with common minor illnesses such as coughs and colds, fever and febrile convulsions.In addition Basic Life Support training was delivered. The practice was able to evidence that this service reduced attendance at accident and emergency, hospital admissions and inappropriate requests for GP appointments. Feedback from the first year’s appraisal identified where improvements could be made and the sessions now included meningitis awareness, help and advice about routine emergency conditions and one-to-ones at the end of each session. Collaboration has taken place with the CCG who plan to link the practice with Sure Start in order to share the learning more widely across the Wigan Borough.
  • 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.
  • There were weekly and ad-hoc baby immunisation clinics and eight week baby checks to allow more flexibility for parents with young children. Immunisation rates were high for all standard childhood immunisations.
  • The practice has an early year fact sheet for all new parents in the practice and a childhood initiative scheme to support new parents in areas of emergency first aid. We saw good examples of joint working with midwives, health visitors and school nurses to support families.
  • 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 patients who had a high number of A&E attendances.
  • The practice offered travel vaccinations to students and young people travelling abroad, contraception and sexual health advice and chlamydia screening.
  • The practice supported the Text Santa charity and had annual Christmas Jumper days with the proceeds going to a local charity chosen by staff or the patient participation group (PPG).

Older people

Good

Updated 14 February 2018

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

  • The practice identified a high number of patients in residential and nursing homes requiring home visits. To reduce the impact on clinical time an acute visiting service was introduced. Following consultation with 12 neighbouring practices it was ascertained that they would also benefit from this service and a business case was submitted to the Clinical Commissioning Group (CCG) to introduce a community acute visiting services. This was approved and commenced in March 2017 and a re-audit in September 2017 confirmed that home visit demand had reduced because of this service.
  • The practice held charity coffee mornings to encourage patients to come together and to help reduce social isolation.
  • The needs of older people in the community had been assessed and services were offered to support those needs. They worked in conjunction with local pharmacies to ensure the elderly population were assisted with ordering and collection of prescriptions.
  • There was a dedicated telephone line for patients on the unplanned admissions register.
  • All patients over 75 years were offered an extensive health check and care plans by the practice nurse who discussed coping mechanism, social support and emotional frailty.
  • The Integrated Care Team, which is made up of various agencies, met with the practice on a monthly basis to discuss patients who have been referred into the service

Working age people (including those recently retired and students)

Good

Updated 14 February 2018

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

  • The practice offered extended access to appointments for example on Tuesday, Wednesday and Friday mornings  with first appointment being 7am. 
  • The practice was part of the Wigan GP alliance service and patients could book into one of the local hubs to see a clinician.
  • Appointments were available weekdays between 6.30pm and 8.00pm and weekends between the hours of 10.00am to 4.00pm. The clinicians working at the hubs were local and were fully aware of all local services. They had full access to patients’ medical records.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 February 2018

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

  • 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 told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • It 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.

People whose circumstances may make them vulnerable

Good

Updated 14 February 2018

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

  • Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and had a safeguarding lead and deputy. We saw evidence where considerable safeguarding concerns had been highlighted and actioned because of the diligence of staff.
  • The practice held a register of patients living in vulnerable circumstances including homeless people and also the carers of these patients.
  • The practice nurse worked closely with patients to educate and improve access for them.
  • The practice worked with multi-disciplinary teams in the case management of vulnerable patients.
  • All staff were trained in safeguarding and the IT system alerted staff to patient who were subject to safeguarding alerts.
  • Regular safeguarding meetings took place to ensure those patients received the support and medical treatments they needed.
  • Staff were trained to act as chaperones.
  • The practice was accredited by the Lesbian Gay Bisexual and Transgender (LGBT) Foundation and received a gold award for its services provided to LGBT patients.
  • There was wheelchair access, disabled parking areas and large font leaflets for patients who were partially sighted.
  • Patients who were deaf or partially deaf could contact the practice in a number of other ways including email and text speak.