Archived: Garden City Medical Centre

Updated 16 May 2017

Garden City Medical Centre is located in Holcomb Brook, Bury, Lancashire within the Bury Clinical Commissioning Group area. The surgery has car parking for nine cars including one dedicated disabled parking bay which are all free of charge. There is also off street parking. The surgery is located on a bus route which gives access to Bury town centre.

There are two male GPs working at the practice, both are partners of the practice and work between eight and ten sessions per week. There are three long term locum GPs, two female and one male. One of these GPs works eight sessions per week and three work between two and four sessions per month. There are two female practice nurses, one works full time and the other works part time. There is also a part time phlebotomist. There is a team of administrative staff made up of a full time practice manager and a team of eight receptionists.

A pharmacist works at the practice for 1.5 days per week and is part of the Bury GP Federation 3 year Pharmacy Project.

The practice is a training practice which supports GP trainee and FY2 doctor placements.   There is currently one FY2 doctor working at the practice.

The practice was open from 8 am to 6.30 pm Monday to Friday. GP appointment times were between 8am and 6pm Monday to Friday. In addition to pre-bookable appointments, urgent appointments were also available for patients that needed them. The practice was part of the Bury extended working hours scheme. This meant patients could access a designated GP service in the Bury area from 6.30 pm to 8 pm Monday to Friday and from 8 am to 6 pm on Saturdays, Sundays and bank holidays.

Updated 16 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Garden City Medical Practice on 7 June 2016. The overall rating for the practice was requires improvement with the effective domain rated as inadequate and the safe, responsive and well led domains rated as requires improvement. The caring domain was rated as good. The practice was issued with a Warning Notice to ensure the compliance actions issued at that inspection were met. The full comprehensive report 7 June 2016 inspection can be found by selecting the ‘all reports’ link for Garden City Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 15 March 2017. Overall the practice is now 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 told us through the CQC comment cards that 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.
• A new practice manager had been employed since the last inspection on 7 June 2016. In partnership with the GPs they have worked hard to address the shortfalls raised at the previous inspection. They gave us an assurance that they were committed to improving the service through making the necessary changes to the leadership, management and governance of the practice.
• The recently established Patient Participation Group was organising an event to support patients with dementia and their carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 May 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.
• 76% of patients with diabetes, on the register, had a blood pressure reading (measured in the preceding 12 months) of 140/80 mmHg or less which was lower than the CCG average of 82% and the national average of 78%.

• 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. The practice had created a tracker document to ensure any patients who attended accident and emergency more than two or three times a week or month were monitored closely by their GP and contacted by phone or letter to ensure they received the support and care they needed.

• 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.

Updated 16 May 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 attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• 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.

• Family planning services were available on site.
• All staff were trained to the appropriate level in adult and child safeguarding. Administration staff were due to complete refresher training via the newly set up e-learning training package.

Updated 16 May 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.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, there was a wide range of information available in the patient waiting area and on the practice website about local services and national charities who offer support and advice to older patients.

• All patients over 75 had a named GP.
• Hand rails and a sloped access were in place outside the surgery to support patients with their mobility.
• Influenza, pneumococcal and shingles vaccination clinics were available. The clinical team provided more clinics at the weekends and in the evenings to meet the needs of these patients.

Updated 16 May 2017

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

• The needs of this population group 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 from 8.30 am to 6.30 pm Monday to Friday.
• 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.
• Phlebotomy appointments were available at the practice.
• The surgery promoted NHS health checks and patients were contacted via email, text, telephone or letter to ensure they were invited for the regular health checks.
• The clinical and management team worked with the Bury Public Health Team to ensure they were up to date with health care issues relating to this group of patients.
• Online appointments, access to the extended hours service and telephone consultations were available to patients who were unable to attend the surgery during normal working hours.

Updated 16 May 2017

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

• The practice carried out advanced care planning for patients living with dementia.
• 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 88% and the national average of 84%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, one of the GPs was in the process of reviewing the full health care needs of all patients with a learning disability.
• 96% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months. This was above the CCG average of 92% and the national average of 89%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 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 with longer appointments available as necessary.
• 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 attended accident and emergency where they may have been experiencing poor mental health. Referrals were made to the appropriate agencies and support teams as necessary.

• The practice was registered with Dementia UK as a Dementia Friend and with Marie Curie to ensure patients were kept informed about new information and to ensure staff had the right skills to support these patients.
• A representative from Dementia UK was due to attend a staff team meeting to train staff on dementia awareness and how they could support patients with newly diagnosed or early on-set dementia.

Updated 16 May 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 with a learning disability.
• 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 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.

• All staff were up to date with current safeguarding guidelines (Adult and Child).
• One of the GPs was the safeguarding lead and kept staff informed of developments in this area.
• The IT system alerted staff to patients who had not collected their prescriptions. There was a system to check the dates of prescriptions and to ring patients if they were concerned.
• GP’s and clinical staff worked with local external services to ensure patients received holistic care and support. For example, the Bury drug and alcohol team, Bury Hospice, Dementia UK, the Palliative Care team and the Child and Adolescent Mental Health Services.