Woodbank Surgery

Updated 3 August 2017

Woodbank Surgery is located in Brandlesholme, Bury, Lancashire which is within the Bury Clinical Commissioning Group area. The surgery has a car park for 15 cars including two dedicated disabled parking bays; there is also off street parking. There surgery is located on a bus route which gives easy access to Bury town centre. There are five GPs working at the practice, three are male and two are female. One GP is the medical director, three are long term locums and one is a salaried GP. The GPs work between two and seven sessions per week. There is one senior practice nurse, one advanced nurse practitioner, a health care assistant (all female) and a locum pharmacist (male). There is a full time practice manager and a team of administration staff.

The practice is open from 8am to 8pm Monday to Friday. The core hours are from 8am to 6.30pm Monday to Friday.

GP appointment times are as follows:

Monday, Tuesday and Thursday: 8am to 7.45pm

Wednesday and Friday: 8am to 5.30pm

Extended hours are provided Monday to Friday between 6.30pm and 8pm.

The practice is closed every fourth Wednesday of the month between 1pm and 3.30pm for staff training and team meetings.

The practice is part of the Bury extended working hours scheme which means patients can access a designated GP service in the Bury area from 6.30pm to 8.00pm Monday to Friday and from 8am to 6pm on Saturdays, Sundays and bank holidays. Patients requiring a GP outside of normal working hours are advised to call Bury and Rochdale Doctors On Call (BARDOC) using the surgery number and the call will be re-directed to the out-of-hours service.

The practice has a Primary Medical Services (PMS) contract. The PMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

4,739 patients are registered at the practice.

Updated 3 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the practice of Woodbank Surgery on 9 June 2017. Overall the practice is rated as good.

The practice had been previously inspected on 19 July 2016. Following that inspection the practice was rated as overall requires improvement with the following domain ratings:

Safe: Requires Improvement

Effective: Requires Improvement

Caring: Requires Improvement

Responsive: Good

Well led: Requires Improvement

At that time:

• The provider did not demonstrate good governance and had not implemented effective governance arrangements to improve communication among the staff team, keep staff informed about identified risks and the ongoing monitoring and reviewing of the safety of the service including information about significant events, medical alerts, for the purpose of learning and improving outcomes for patients.

The practice provided us with an action plan detailing how they were going to make the required improvements.

The full comprehensive report on the 19 July 2016 inspection can be found by selecting the ‘all reports’ link for Woodbank Surgery on our website at www.cqc.org.uk.

This full comprehensive inspection on 9 June 2017 was to confirm if the required actions had been completed and award a new rating if appropriate. Following this re-inspection, our key findings across all the areas we inspected were as follows:

Since the last inspection the practice had made the following improvements:

• The practice kept minutes of all meetings.These minutes were shared with the whole staff team including staff that were unable to attend the meeting.

• Alerts were included as a standard agenda item at all meetings.Discussions were recorded and actions noted.

• Significant events were discussed at staff meetings.

• The medical alerts / critical alerts policy had been reviewed and implemented.

• A nominated person was appointed to keep an electronic record / log book of all staff members being in receipt of any alerts.

• An audit of searches for alerts that require any action would be completed.

Other key findings were as follows:

• Significant events were recorded and discussed for the purpose of learning.However, they were not always identified and thoroughly investigated.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Clinical audits had been carried out and we saw evidence that audits were driving improvements to patient outcomes.
• The national GP patient survey results were published in July 2016. The results showed the practice was performing in line with and below local and national averages.
• Information about how to complain was available. Complaints received were not always logged and managed through the practice’s complaint procedure.
• The practice was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff told us they felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

• Significant events should be analysed thoroughly.

• There should be a record of checks made on doctors’ bags.

• GP safeguarding training records should be easily accessible.

• Locum GPs personnel files should be easily accessible.

• The provider should implement systems to improve the patient satisfaction rates with service they receive.

• Detailed records should be kept of discussions held about patients who require end of life care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 August 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 percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 80% compared to the CCG of 89% and the national average of 80%.

• 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 follow up 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.

• Clinicians maintained regular contact with other health care professionals such as Macmillan nurses and third sector services such as AgeUK.

Updated 3 August 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.

• The IT system highlighted patients who were at risk.

• When parents visited the practice, clinical staff took the opportunity to enquire about the wellbeing of their child if they were highlighted as being at risk of harm.

• 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.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• A full range of family planning services were available.

• Younger patients were given advice on sexual health and family planning.

• Most staff were up to date with safeguarding training and one of the GPs took responsibility for managing safeguarding alerts and referrals. We were unable to establish clearly the level of training completed by the GPs.

Updated 3 August 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.

• Patients over the age of 75 years had a named accountable GP but could see any clinician of their choice within the practice.

• 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 so they could maintain their health and independence for as long as possible.

• GPs and nursing staff carried out a weekly ward round at a local nursing home for patients registered at the practice.

Updated 3 August 2017

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

• The needs of these patients 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 opening hours and Saturday appointments were available for patients who were unable to attend during normal working hours.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Appointments were available from 8 am with the practice nurse and health care assistant.

• Routine GP appointments were available to pre-book in advance from 8.30 am.

• Clinical staff actively promoted NHS Health checks.

• The practice was open from 8 am to 8 pm Monday to Friday.

• Patients were able to book appointments with the extended hour’s service through the practice.

• Extended opening hours meant patients could book appointments outside of work.

• Appointments could be booked on line.

• The practice offered a two week turn around for medical reports and work-related medical examinations.

Updated 3 August 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. Annual reviews were carried out with patients with dementia and longer appointments were provided as required including same day access to healthcare services.

• 97%

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months. This was compared to 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.

• 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.

• Patients had access to drug and alcohol services and more recently to the “Big White Wall” online service that supported patients with mental health problems.

• There was a register of patients with mental health problems.

• GPs supported patients in their appeals as appropriate in relation to benefit claims.

Updated 3 August 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 those 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.

• The IT system alerted staff to patients who failed to collect prescriptions.

• GPs worked with and referred patients to local services such as Bury drug and alcohol services.

• Asylum seekers and patients new to the UK and had increased health care needs were supported by the nursing team who liaised with relevant healthcare professionals. A dedicated GP was responsible for co coordinating their care with extended appointments available.