Bolton Medical Centre

Updated 2 October 2017

The Bolton Medical Centre provides primary medical services in Bolton from Monday to Saturday. The surgery is open Monday to Saturday:

Monday from 8am to 7pm, Tuesday 8am to 8pm, Wednesday and Friday 8am to 6.30pm,

Thursday 7.30am to 6.30pm, and Saturday 9am to 11am.

Appointments with a GP are available Monday to Friday 9am to 1pm and 2pm to 6:30pm. Extended hours include appointments until 6:50pm on Tuesdays and 9am to 11am Saturdays.

Additionally patients can access GP services in the evening and on Saturdays and Sundays through a local extended hours hub.

Bolton Medical Centre is situated within the geographical area of Bolton Clinical Commissioning Group (CCG).

The practice has an Alternative Provider Medical Services (APMS) contract. The APMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. It offers direct enhanced services for meningitis provision, the childhood vaccination and immunisation scheme, extended hours access, facilitating timely diagnosis and support for people with dementia, influenza and pneumococcal immunisations, learning disabilities, rotavirus and shingles immunisation and unplanned admissions.

Bolton Medical Centre is responsible for providing care to 3895 patients. The population experiences higher levels of income deprivation affecting children and older people than the

practice average across England. There are a higher proportion of patients aged 5 to 44 (70%) compared to a nation average of 52% and a lower average of patients over 65, 3% compared with 17% nationally. There are a high number of patients registered who are from Black and minority ethnic groups, this being 68% compared to 16% national average, with approximate 30% from eastern European communities and 30% from Asian communities.

The practice consists of four GPs, one full time lead GP (male) and three part time GPs (one male and two female). The practice also has an advanced nurse practitioner for one session week, two part time practice nurses and an assistant practitioner. The practice is supported by a practice manager, receptionists and administrators.

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

When the practice is closed patients are directed to the out of hours service.

Updated 2 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bolton Medical Centre on 9 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 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.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

Patients from Bolton Medical Centre have free access to an on-site gymnasium set up and run by the provider SSP Health Primary Care Limited. The gym is open Monday to Saturday with one evening session. We saw evidence that for patients utilising the facility there health and well-being had improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 October 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.
• The practice offered appointments up to 45 minutes for those with multiple long term conditions, offering a holistic review.
• 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 social care professionals to deliver a multidisciplinary package of care.

Updated 2 October 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• Congratulation letters were sent to parents of new babies and new parents were provided with an early year’s fact sheet, developed by SSP, providing information around vaccination schedules, breast feeding, cervical cytology screening and other health related information.
• Breast feeding facilities were available.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 2 October 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.
• 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 and signposted to relevant social care and voluntary organisations for additional support.
• The practice had a dedicated Carers’ Champion whose role included maintaining the register of carers and signposting. In addition the practice also had champions for palliative care and cancer patients.
• 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 2 October 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, extended hours included appointments until 6:50pm on Tuesdays and 9am to 11am Saturdays. The practice also 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.
• Telephone consultations were available daily.
• The practice accommodated ultrasound and audiology clinics on site from other health providers. This enabled patients to access services closer to home preventing them having to travel to access care and treatment.
• The practice attended a local University Fresher’s fairs to encourage students to register with a GP, providing students with health promotion advice and where appropriate encouraging those eligible to have vaccinations such a meningococcal and MMR.

Updated 2 October 2017

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 16% above the national average.None of these patients had been exception reported 7% below the national average. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• 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.
• 93% of patients with poor mental health had a comprehensive care plan documented in the record agreed between individuals, their family and/or carers as appropriate, which was 4% above the national average. We noted 7% of patients had been exception reported 6% below the national average.
• 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 2 October 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. This ensured the needs of the most vulnerable patients were being met and their care and welfare was monitored.
• 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 used telephone translation services and offered extended appointment to those requiring and translator. The practice also had for example a Welcome pack which explained in various languages about the practice, antibiotics, cytology, childhood immunisations, COPD and Heart Failure.
• 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.