Archived: Bolton Community Practice CIC Also known as Market Surgery Branch

Updated 25 April 2016

Bolton Community Practice, Community Interest Company (CIC) is a Social Enterprise Organisation. There are four GP practices located across Bolton, managed by the organisation. The organisation also runs Bolton violent patient scheme (GP safe haven). A range of medical services and treatments are provided for people of all ages. This report relates to the location known locally as the Market Surgery practice situated on Chorley New Road in the Horwich area of Bolton. Patients registered with Bolton Community Practice CIC are able to access appointments, care and treatment at any of the five GP practices managed by the organisation. We were informed the patient population at the Chorley New Road Practice was 2224. The five locations of the organisation had a total of 11600 registered patients.

At the time of our inspection four salaried GPs (two male and two female) were providing primary medical services to patients registered at the practice. The GPs were supported in providing clinical services by one clinical pharmacist, one advanced nurse practitioner, one practice nurse, one health care assistant, one deputy manager and three administrative staff. The practice also hosted a phlebotomy service provided by the local NHS Trust. Practice staff were also supported by the provider’s central management team.

The opening times of the practice were 8am to 6pm Monday to Friday. GP appointments could be made on line or by telephoning the organisation’s central call centre. Appointments could be made at the patient’s local surgery or at one of the other four locations if more convenient. This enabled patients to access a wide range of early and late appointments (and Saturday morning appointments). The practice has opted out of providing out-of-hours services to their patients. In case of a medical emergency outside normal surgery hours advice was provided by the 111 service and Bury and Rochdale Doctors (BARDOC). The practice website and patient information leaflet available at the practice details how to access medical advice when the practice is closed. Patients are also provided with these details via a recorded message when they telephone the practice outside the usual opening times.

The practice contracts with NHS England to provide General Medical Services (GMS) to the patients registered with the practice.

Updated 25 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bolton Community Practice (Market Surgery Chorley New Road Horwich) on 3 March 2016. Overall the practice is rated as Good.

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.

• The importance given to safeguarding at the practice demonstrates that the practice team were regularly reviewing their safeguarding systems and were taking innovative action to make sustained improvements to those systems to maximise the protection of children and vulnerable adults.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• Feedback from patients about their care was consistently and strongly positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• 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 patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• The practice had an effective overarching governance framework that supported the delivery of the strategy and good quality care.
• The management team had strived for continuous improvement and staff are accountable for delivering change.
• 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.

We saw one area of outstanding practice:

It was evident the practice clinical and managerial team had investigated and critically analysed the issues, identified lessons to be learnt and had discussed how improvements could be implemented with staff at the monthly clinical meetings. Importantly the practice had co-operated and shared information with local social and health agencies to ensure the individual patient’s safety issues were addressed and to disseminate the lessons learnt with practices in the wider Bolton area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 April 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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 25 April 2016

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

• 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. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The importance given to safeguarding at the practice demonstrates that the practice team were regularly reviewing their safeguarding systems and were taking innovative action to make sustained improvements to those systems to maximise the protection of children and vulnerable adults.

Updated 25 April 2016

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

• 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.

• Information about safety was highly valued and was used to promote learning and improvement.

• The practice team had accessed training and advice in respect of becoming ‘dementia friends’ to improve how they respond to patients living with dementia and improve their access the services provided. We saw that action had been taken to improve signage and the environment at the practice to help these patients navigate their way through the practice.

Updated 25 April 2016

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.

• 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.

• The practice had made changes to the patient electronic records system to ensure data relating to recent laboratory results was simultaneously presented to clinicians alongside the medicines currently prescribed. This enabled and prompted clinicians to swiftly review the effectiveness of current treatment and make timely changes where required.  

Updated 25 April 2016

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

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  96.6% of patients with schizophrenia or a bi-polar disorder and other psychoses had a comprehensive, agreed care plan documented in their records in the last 12 months, which is higher than the national average.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

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

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice team had accessed training and advice in respect of becoming ‘dementia friends’ to improve how they respond to patients living with dementia and improve their access the services provided. We saw that action had been taken to improve signage and the environment at the practice to help these patients navigate their way through the practice.

Updated 25 April 2016

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

• The practice held a register of patients living in vulnerable circumstances.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice informed vulnerable patients about how to access various 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.

• Action had been taken to remove barriers to register and access the services of the practice especially for vulnerable people. The practice team had taken into account the differing needs of people by planning and providing care and treatment services that were individualised and responsive to individual needs and circumstances.