Lever Chambers 1

Updated 17 March 2017

Lever Chambers 1, also known as Dr Lyon and Partners, is located in Bolton town centre. The practice is located on the first floor of a building housing other NHS and community services. There is a public car park and public transport links close by.

At the time of our inspection 6273 patients were on the practice list. The practice is a member of Bolton Clinical Commissioning Group (CCG). It delivers commissioned services under a General Medical Service (GMS) contract.

The practice age and gender profile is similar to the national averages, with a slightly below average of patients in the 10 to 19 and under five age groups. The proportion of patients registered who have a long standing health condition is above the CCG and national average (69% compared to the CCG average of 57% and the national average of 54%). The practice also has an above average number of patients who are unemployed. The practice is in the second most deprived decile and life expectancy rates are below average for males and females.

There are five GP partners, two male and three female. There is also an advanced nurse practitioner, a practice nurse. Members of the clinical team are supported by a practice manager and administrative and reception staff.

The practice is open from 8am until 6.30pm Monday to Friday. Appointment times are 8.45am until 11.30am and 2pm until 5.30pm each day, although there is the facility for earlier or later appointments if these are required. Patients can also book an appointment at a nearby practice from 9am until 1pm on Saturdays and bank holidays and from 10am until 1pm on Sundays. There is an out of hours service available when the practice is closed, provided by BARDOC, the out of hours provider.

The practice is a training practice.

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lever Chambers 1 on 18 January 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 an effective system in place for reporting and recording significant events. However there was no annual review of all significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients said they found it easy to make an appointment with a 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 and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• One staff member had the role of patient liaison officer. They provided additional support to a range of patients. They attempted to contact all patients who had not attended a cancer screening appointment to offer advice and additional support if required. They also contact patients with a new cancer diagnosis and contacted patients on the palliative care register on a monthly basis to offer non-clinical support.

The areas where the provider should make improvements are:

• The provider should carry out an annual review of significant events so trends can be identified and learning needs assessed.

• The provider should consider the need for meetings involving the whole practice team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2017

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.

• Performance for diabetes related indicators was 83%. This was below the CCG average of 88% and the national average of 90%. The practice had held a diabetic event to encourage engagement by patients with diabetes.

• 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 17 March 2017

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.

• The practice’s uptake for the cervical screening programme was 88%, which was above the CCG average of 82% and the national average of 81%.

• Appointments were available outside of school hours, including during weekends at a nearby practice, and the premises were suitable for children and babies.

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

Updated 17 March 2017

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.

• There was a named GP for the over 75s and care plans were in place.

• The patient liaison officer telephoned all patients on the palliative care register each month to ask if any additional non-clinical support was required.

Updated 17 March 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.

• 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 patient liaison officer supported patients who had not attended routine cancer screening appointments. They telephoned patients to find out why they had not attended, explained procedures if required and gave support to make new appointments where possible.

Updated 17 March 2017

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

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

• 4% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG average of 5% and the national average of 7%.

• 78% of patients with schizophrenia or other psychoses had their alcohol consumption recorded in the preceding 12 months compared to the CCG and national average of 89%.

Updated 17 March 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 and those with a learning disability.

• Additional support was available for homeless patients to be able to register with the practice and access local services.

• 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 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.