Archived: Dr Bernard Newgrosh Also known as Great Lever One

Updated 31 March 2015

Great Lever One delivers primary care under a General Medical Services contract between themselves and NHS England. As part of the Bolton Clinical Commissioning Group (CCG) they are responsible for a population of 2020 within the surrounding area.

The practice offers access to one male GP and the services of a female practice nurse who is part time. Patients of the practice have access to community services within the health centre such as district nurses, health visitors, a physiotherapist, chiropodist and dietary clinics.

The practice opens at 08.30hrs and open access is available from 09.00hrs until 10.30hrs and from 16.30hrs until 18.30hrs every weekday. Patients are given an appointment number up until the end of the booking in time and the GP will see all patients who attend. Appointments are available three days a week from 19.00hrs until 19.30hrs for those people who are working or unable to attend the drop-in. The surgery is also open on a Saturday morning from 10.00hrs until 10.30hrs. No patients are turned away and the GP will continue to see patients if they turn up at the surgery or request an urgent appointment whilst he is still at the surgery. Patients spoken with confirmed this.

The GP has worked single handed for 31 years and knows his patients very well. A practice manager was employed two years ago for two days a week and has been further embedding training, appraisal, defined line management and policies and procedures.

The CQC intelligent monitoring placed the practice in band 4. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

The practice has opted out of providing out-of-hours services to their own patients

Updated 31 March 2015

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Great Lever One.

We undertook a planned, comprehensive inspection on 15 December 2014 and spoke with Dr Newgrosh, patients, four members of staff and the practice manager.

The practice required some improvements and is rated as requiring improvement overall.

Our key findings were as follows :-

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them
• Communication with patients, their families and carers, and access to the service and to the GP was excellent.
• The GP offered total open access on a first come first served basis.
• The practice created extra appointments to accommodate young families where possible and the GP spent a lot of time getting to know families in totality. He was aware of any issues within the family structure that might affect any of its members.
• The GP had been working single handed in the practice for the past twenty eight years without any management support. He had now employed a practice manager who was embedding policy and procedure and he was currently looking for a partner.

Importantly, the provider must:

• The provider must take action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008, and necessary employment checks are in place for all staff.

There were areas of practice where the provider needed to make improvements. The provider should:

• Fully embed policies and procedures such as infection control and ensure checks and risk assessments such as those for carrying medicines and prescriptions or relating to emergency equipment are rigorous enough to minimise error and ensure safety at all times.
• Ensure all staff receive training appropriate to their roles and identify and plan further training needs.
• Ensure there are systems in place to monitor quality and improvement and identify risk. Although patients were able to offer their opinion on the service whenever they wanted there were no formal surveys or questionnaires provided. The practice was not pro-active in asking patients for feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2015

The practice is rated as requires improvement for people with long term conditions. Some checks and risk assessments such as those for recruitment, carrying medicines and prescriptions or relating to emergency equipment were not rigorous enough to minimise error and ensure safety at all times. However, patients with chronic obstructive pulmonary disease (COPD), diabetes, mental health or other long term conditions were on appropriate registers. Alerts on patients with long term conditions were reviewed on a monthly basis and lists of patients with tasks or targets were appropriately followed up by the GP. The GP used quiet months to audit failed attenders on the chronic disease registers and there was a system in place to monitor recalls. Receptionists were given lists of patients to telephone and arrange follow up appointments when required. There were no specific clinics such as asthma, diabetes or cytology and patients were fitted into the appointment system when checks were required. Longer appointments and home visits were given if needed. For those people with the most complex needs the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 31 March 2015

The practice is rated as requires improvement for families, children and young people. Some checks and risk assessments such as those for recruitment, carrying medicines and prescriptions or relating to emergency equipment were not rigorous enough to minimise error and ensure safety at all times. However, systems were in place for identifying and following-up children living in disadvantaged circumstances and those who were at risk. Immunisation rates were relatively high for all standard childhood immunisations and the GP carried out all immunisations personally. Appointments were available outside of school hours and the premises were suitable for children and babies. We were provided with good examples of joint working with midwives, health visitors and school nurses when required. Emergency processes were in place and referrals made for children and pregnant women who had a sudden deterioration in health. Appointments could be made for families to be seen together or individually as requested. The GP created extra appointments to accommodate young families where possible. The GP also spent a lot of time getting to know families in totality and was aware of any issues within the family structure that might affect its members.

Updated 31 March 2015

The practice is rated as requires improvement for the care of older people. Some checks and risk assessments such as those for recruitment, carrying medicines and prescriptions or relating to emergency equipment were not rigorous enough to minimise error and ensure safety at all times. However, nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services. Care plans had been introduced and implemented for 2% of the patients in the older age group to avoid unplanned admissions to hospital. Care was co-ordinated with other providers such as social services, Age UK, occupational therapists and other multi agency teams. We saw examples of how patients’ wishes were respected at the end of their lives and how families were involved whilst still maintaining privacy and confidentiality for the patient.

Updated 31 March 2015

The practice is rated as requires improvement for people of working age (including those recently retired and students). Some checks and risk assessments such as those for recruitment, carrying medicines and prescriptions or relating to emergency equipment were not rigorous enough to minimise error and ensure safety at all times. However, patient needs 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 offered telephone consultations and blood test results by phone. The GP spent a lot of time getting to know the patients and their family dynamics. The GP was completely accessible to all patients offering one hundred percent open access. Patients sometimes had to wait more than an hour to be seen but everyone was seen when they needed to be on a daily basis if necessary. The GP made himself accessible up until 20.00hrs each evening if required.

Updated 31 March 2015

The practice is rated as requires improvement for the population group of people experiencing poor mental health (including people with dementia). Some checks and risk assessments such as those for recruitment, carrying medicines and prescriptions or relating to emergency equipment were not rigorous enough to minimise error and ensure safety at all times. However there were high numbers of people experiencing poor mental health and the doctor worked closely with outside agencies such as social services. Multi-disciplinary teams and housing agencies. Staff were patient and tolerant of behaviours presenting a calm approach. We saw an example where the doctor had responded to concerns of a carer which had led to a psychiatric admission and a positive outcome for the patient concerned. The doctor had also attended and stayed with a patient at hospital and followed up care with their family after the patient passed away.

Updated 31 March 2015

The practice is rated as requires improvement for people whose circumstances may make them vulnerable. Some checks and risk assessments such as those for recruitment, carrying medicines and prescriptions or relating to emergency equipment were not rigorous enough to minimise error and ensure safety at all times. However, there was a register of patients with learning difficulties or who were homeless. The GP provided appointments which were appropriate to the consultations and specifically for people who were disadvantaged or vulnerable. Consultations included families and carers whilst maintaining privacy and confidentiality for the patient when necessary. The doctor regularly worked with multi-disciplinary teams in the case management of vulnerable people and patients were signposted when necessary to other organisations such as social services. The practice also provide assistance with appointments to secondary services. Staff said they would escalate any areas of concern and were knowledgeable about abuse and how it could and should be identified.