Astley General Practice

Updated 26 June 2017

Astley General Practice provides primary care services to its registered list of about 2850 patients.

The surgery has suitable facilities with disabled access.

The surgery is open Monday to Friday:

Monday 8am to 7:30pm

Tuesday 8am to 6:30pm

Wednesday 8am to 1pm

Thursday 8am to 6:30pm

Friday 8am to 6:30pm

Patients requiring a GP outside of normal working hours are advised to contact the surgery and they will be directed to the local out of hours service which is provided by Bridgewater NHS Foundation Trust –through NHS 111. Additionally patients can access GP services in the evening and on Saturdays and Sundays through the Wigan GP access alliance at locations across Wigan Borough.

There are three GPs (two female and one male), supported by a practice nurse who provide clinical care to the patient population. There is also a practice manager and reception team. There is regular support for the practice from senior leadership team, including clinicians and managers, at SSP Health.

The practice delivers commissioned services under the General Medical Services (GMS) contract and is a member of NHS Wigan Borough CCG. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. It offers direct enhanced services that include minor surgery, accountable GP, learning disabilities, pertussis for pregnant women, hepatitis B for new born babies, the childhood vaccination and immunisation scheme, meningitis provision, and influenza and pneumococcal immunisations

The practice is part of SSP Health GPMS Ltd, a federated organisation and benefits from support from the leadership and governance teams. The practice has access to support and leadership from a nursing lead and pharmacist as well as access to human resources, auditing and finance teams.

Updated 26 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Astley General Practice on 23 May 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients were truly respected and valued as individuals and were empowered as partners in their care. Feedback from patients about their care was consistently positive.
• The practice had a proactive patient participation group (PPG) who supported the community and patients. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the PPG. For example the recent renovation and redecoration of the surgery was implemented by the practice in cooperation with the PPG.
• Patients we spoke with 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements, and the leadership, governance and culture were used to drive and improve the delivery of high-quality person-centered care.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw several areas of outstanding practice:

• The practice had recognised that loneliness can impact on the health and wellbeing of its patient population and had addressed this through community integration. This had been driven by the practice and the PPG. It had included the production of a comprehensive newsletter which had been distributed across the population, offering patient transport to those who had difficulty in attending the practice and facilitating social events both in the practice and the local community hall. We saw evidence that this had reduced social isolation and increased well-being for several patients, especially those who were housebound. Staff in co-operation with other patients had collected and returned patients from their homes. Any monies raised from these events were given to local and national charities.
• The practice had a very active PPG which showed a person centred culture for the patients and care they received. There was evidence of a strong engagement within the local community to help local patients and the local community. The group had strong leadership from both the chair and vice chair, worked collaboratively with the local community to help support local events, offered dementia sessions to families to help care for loved ones and invited all housebound patients to participate in PPG meetings, and offered to provide transport for them. They also produced a comprehensive newsletter that was sent to all patients registered with the practice. The recent renovation and redecoration of the surgery was implemented by the practice in cooperation with the PPG.
• The practice identified that the need to promote lesbian, gay, bisexual, and transgender (LGBT) information and services for those patients. The practice staff had received training and there was a LGBT notice board in the waiting area that promoted LGBT patient inclusion in the practice, had information on LGBT matters and signposted them to appropriate available services. LGBT patients commented on how they considered the new patient process for them to be welcoming and inclusive. This work had been accredited by the LGBT foundation, a charity based in Manchester, and the practice received their “pride in practice” silver award for this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 June 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• All the diabetes indicators we reviewed from Quality and Outcomes Framework (QOF) data were above the CCG and national averages.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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.
• The organisation SSP also had an in house pharmacist who was the pharmaceutical advisor available to support all practice staff.

Updated 26 June 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice had an early year fact sheet for all new parents in the practice, providing information around vaccination schedules, breast feeding, cervical cytology screening and other health related information. This was also sent with a congratulations letter to all new parents.
• The practice provided support for premature babies and their families following discharge from hospital.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 26 June 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care. GPs had attended training sessions in end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible

Updated 26 June 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, , for example, appointments were available one evening a week until 7.30pm and the practice participated in a local extended hours hub in where patients could access GP services in the evening and on Saturdays and Sundays.
• 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 26 June 2017

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

• The practice held an “Important patient” register which included vulnerable patients, carers, drug monitoring, learning disabilities, military veterans, deprivation of liberty safeguards (DOLs), cancer, gold standard framework (GSF), childhood asthma and those patients who were housebound. End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice offered an in house counselling service available to all patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.

People experiencing poor mental health (including people with dementia)

Good

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

• The practice carried out advance care planning for patients living with dementia.
• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is above the clinical commissioning group (CCG) and national averages.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 26 June 2017

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

• The practice held an “Important patient” register which included vulnerable patients, carers, drug monitoring, learning disabilities, military veterans, deprivation of liberty safeguards (DOLs), cancer, gold standard framework (GSF), childhood asthma and those patients who were housebound. End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice offered an in house counselling service available to all patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.