Premier Health Team

Updated 6 January 2017

Premier Health Team is based within Bridgewater Medical Centre in Henry Street, Leigh, Lancashire, WN7 2PE. The patient list size is 2,786 and the service is available to patients within Leigh Central and Leigh East boundaries. It is close to public transport and there is car parking available with disabled spaces.

The team consists of a male GP and a female Nurse Practitioner who are the practice partners. In addition there is a male salaried GP and a female practice nurse. These clinicians are supported by a practice manager, office manager and a team of reception and administration staff. The nurse partner is advanced nurse practitioner who is able to prescribe medicines and the practice nurse is currently training to be a prescriber.

The practice offers a number of services including the management of long term conditions, family planning, well health clinics, minor surgery and travel vaccinations. These services are commissioned to the practice by Wigan Borough Clinical Commissioning Group under a Personal Medical Services Contract. There are district nurses, community matrons and health visitors associated with the practice who undertake dressings, ear syringing and child development assessments.

As part of the Prime Ministers challenge fund, Premier Health Team support the new extended hours hub service. This means that patients can access a GP and Nurse for routine appointments 6.30pm-8pm Monday to Friday and also Saturday’s 10am-4pm in the practice premises. These hours are in addition to standard opening hours.

The practice standard opening hours are :

Monday 8am to 6.30pm

Tuesday 8am to 6.30pm

Wednesday 8am to 5pm

Thursday 8am to 1pm and 4pm to 8pm

Friday 8am to 6.30pm

Premier Health Team is a training practice for pre-registration student nurses.

Updated 6 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Premier Health Team, Bridgewater Medical Centre on 19 October 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were assessed and well managed.

• The practice used some innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice had engaged in annual school visits to encourage health promotion since 2011 and the office manager led the “Think Ahead” pilot to facilitate increased care and wellbeing for stroke patients.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. They were the link practice for the Live Well Complex Team, holding two clinics per week for homeless patients across the Leigh Locality.

• The Patient Participation Group (PPG) had been in existence since 2009 and in addition to the PPG role, the practice was also part of the Atherleigh and Patient Focus Group (ALPF).

• The practice is part of the Prime Minister’s challenge fund awarded to Wigan Borough ensuring patients can access a GP at the practice Monday to Friday 8am to 8pm and Saturdays 10am to 4pm.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Feedback from patients about their care was consistently positive and the practice did a lot of charity work and fund raising annually for Children in Need, The Sturge-Weber Foundation and Macmillan support.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• There were strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• The practice manager submitted a business plan to the Single Commissioning Engagement and Outcome Scheme (SCEOS) and as a result of that the practice received money to fund a project creating displays and presentations on health topics for children of local schools.As a result vulnerable children had been identified and helped.

• The practice maximised opportunities to support learning and development for all staff. For example funding was provided for a diploma in management studies and placements were offered for pre-registration nurses so that students could experience this branch of nursing.

• As a result of links that had been forged with Wigan Council social services, the nurse partner became aware of and obtained cold-emergency boxes for elderly or vulnerable patients during the winter months.The boxes contained a blanket, gloves, hat, thermos, mask, socks and a hot water bottle. The practice shared this knowledge with other practices through the CCG-wide nurse forum so that they could also obtain supplies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 January 2017

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

• The practice was responsive to the needs of the population.Due to the historical coalmining and cotton mill working area, the nurse partner set up one of the first in-house chronic obstructive pulmonary disorder (COPD)/respiratory care clinics in the Borough.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice had a total of 19 long term condition registers including hypertension, epilepsy, COPD and diabetes.

• Outcomes for all clinical domain indicators except diabetes were 100 per cent. Outcomes for diabetes were 98%.

• Longer appointments were available for patients on several disease registers so that all their needs could be assessed and monitored at one visit and home visits were available when needed.

• All these patients had a named GP and a structured annual review, at the least, to check their health and medicines needs were being met.

• For those patients with the most complex needs, the named GP undertook monthly integrated neighbourhood team meetings and worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 6 January 2017

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

• The practice has worked with local schools since 2011 offering health promotion/prevention programmes. Joint working has included school visits into the practice, healthy eating and lifestyle promotions and information leaflets which have been sent to three local schools as a result of the practice’s “summer safety” campaign. As a result of these visits the practice formed an affiliation with fitness groups and helped to set up “fitness for fun” in schools.

• The practice has visited schools to give talks and advice to children about services available at the practice. Feedback has been positive and as a result of their attendance, three vulnerable children who may not otherwise have sought help, have been identified and followed up.

• The practice identified 19% of their patient population as aged 18 or below and offered services according to their needs. Appointments were available outside of school hours and the premises were suitable for children and babies.

• All children aged 16 and below were offered same day urgent appointments and staff told us that children and young people were treated in an age-appropriate way and recognised as individuals. We saw evidence to confirm this.

• 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. We saw positive examples of joint working with midwives, health visitors and community matrons who attended monthly neighbourhood meetings to discuss case management.

• Immunisation indicator rates were 100% for all but three standard childhood immunisations. The practice offered immunisations to young people as part of the recent catch up programmes and also offered sexual health discussions and advice.

• Cervical screening indicators were higher than average for females attending cervical screening within the target period. The practice indicators were 82% compared to the CCG average of 78% and National average of 74%.

Updated 6 January 2017

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

• Care and treatment of older people reflected current evidence-based. 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.

• All patients aged 75 and over, and not just those on disease registers, were offered health checks.

• Weekly get active walks were arranged by the PPG.

Updated 6 January 2017

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

• 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.

• Premier Health Team was one of the first practices in the country to take the focus away from the “GP only” based care and took the lead on a whole team ethos approach to primary care. The practice is run and managed by a GP and Nurse partner.

• The GP partner had an interest in cardiology, minor surgery and dermatology. He was well known to his patients for participating in at least one marathon per year and encouraging patients by example. A small number of the practice patients competed against him via media applications improving their fitness levels in the process.

• 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.

• Patients could access appointments and services in a way and at a time that suited them either by attending at the practice, telephoning or directly on-line. The practice had made all appointments available on-line (except for emergency ones) and patients had the same view of appointments as the reception staff.
• The practice was open from 8am until 8pm Monday to Friday and Saturday 10am to 4pm as part of the Prime Minister’ challenge fund awarded to Wigan Borough.
• GPs from the practice provided out of hours services, including the Saturday morning clinic, to support continuity of care.

Following a recent review of requirements for patients, nurse led appointments were offered between 8am until 6.30pm Monday to Friday.

Updated 6 January 2017

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

• 83% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the local average of 84% and national average of 84%.However no patients had been excepted, compared to the local exception rate of 6% and the national rate of 8%.(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.Practices with lower exception rates have provided better outcomes for patients).

• The percentage 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 was 100% compared to the local average of 92% and the national average of 88%.The exception rate was only 5% compared to the local average of 10% and the national average of 10%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and carried out advance care planning for those patients that needed it.

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

• There was a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health and staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 6 January 2017

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

• The practice had devised their own registers of vulnerable patients to ensure that patients did not fall off the practice radar. Those registers included asylum seekers, vulnerable children and homeless people. They were the link practice for the Live Well team at Wigan Council who used the practice, free of charge, twice a week to hold open clinics for homeless people in the Leigh locality. This service was not limited to patients who registered at the practice.

• Direct links were held with the local homelessness and inclusion team and annual updates were received from the team leader who also referred new patients, including asylum seekers, to the practice for registration.

• Monthly integrated neighbourhood team meetings were held to discuss the case management of the most vulnerable patients of the practice, including those identified in all the other population groups.

• The practice offered longer appointments for patients with a learning disability and used several different referral pathways for patients requiring additional support such as access to 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. We saw evidence where staff vigilance had identified patients where there may be cause for concern.

• As a result of links that had been forged with Wigan Council social services, the nurse partner became aware of and obtained cold-emergency boxes for elderly or vulnerable patients during the winter months. The boxes contained a blanket, gloves, hat, thermos, mask, socks and a hot water bottle. The practice shared this knowledge with other practices through the CCG-wide nurse forum so that they could also obtain supplies.