Bradshaw Medical Partnership

Updated 22 November 2017

Bradshaw Medical Partnership moved to the current purpose built premises in 2002 and offers a service to 8854 patients. It is based in Bradshaw Street, Orrell. Its population is spread over a large and diverse area of Wigan. It is a training practice for Foundation Year 2 GPs who are with the practice for four months. One of the GPs is currently training to be a trainer for Foundation Year 3 GPs who are GP registrars.

There are five GPs, four male and one female, and an all-female nurse team of two practice nurses (one who can prescribe medicines), an assistant practitioner and a trainee assistant practitioner. The clinical teams are supported by a practice manager, an assistant practice manager, two medical secretaries and nine reception and administration staff. They are also supported by district nurses, community midwives, a health trainer, a community matron, a link worker, a cognitive behavioural therapist and a physiotherapist who are attached to the practice. They are not employed by the practice but they provide services on the premises so that access is better for patients.

The practice opening times are as follows :

Opening Hours Details of opening hours for reception

Monday 8am – 8pm

Tuesday 8am – 8pm

Wednesday 8am – 8pm

Thursday 8am – 8pm

Friday 8am – 8pm

Routine appointments can be made with any doctor or nurse by telephoning the practice or whilst at surgery. Same day urgent appointments are available. Telephone consultations are available after 11.30am or after 5.30pm. Ongoing problems and medicine reviews can be dealt with over the telephone. Regular home visits are made to residential and nursing homes by named GPs to ensure continuity of care. Other home visits are available but are only done when the medical condition prevents the patient from attending surgery but is not serious enough to require hospital. These are assessed by the GP on call at the practice each day. When the practice is closed patients can access Wigan borough-wide hub by appointment or can be transferred to the out of hour’s service via NHS111.

Since our previous inspection the premises had been decorated throughout.

Updated 22 November 2017

Letter from the Chief Inspector of General Practice

We carried out our first announced comprehensive inspection at Bradshaw Medical Partnership on 10 October 2016 and the practice was rated as requires improvement overall. The areas where the provider was required to make improvements related to the safe and well led domains. The full comprehensive report following that inspection can be found by selecting the ‘all reports’ link for Bradshaw Medical Partnership on our website at www.cqc.org.uk.

We carried out a further announced comprehensive inspection at Bradshaw Medical Partnership on 04 April 2017 to check that the practice had made improvements. Improvements were demonstrated in some areas but further improvements were required to evidence that systems were embedded in the responsive and well led domains. Overall the practice remained rated as requires improvement and they submitted an action plan after the inspection demonstrating how they would address the issues.

On 27 October 2017 we went back to check that the continuing issues relating to the responsive and well led domains had been addressed. At that inspection on 27 October we found that the practice had reviewed their complaints procedure and embedded policies and procedures to ensure they were being followed. The practice is now rated as good.

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

• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from patients, which it acted on. There was now a formal mechanism to obtain feedback from staff.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. A mechanism to record and monitor all staff training, including clinical staff, was in place.
• Information about services and how to complain was available. Improvements had been made to the quality of care as a result of historic complaints and concerns. There was now a system to formally record and monitor verbal comments and concerns. This had been recently introduced and was now effective.
• The practice was able to demonstrate that staff complied with the requirements relating to complaints and we saw formal documented evidence to support complaints received. Staff, including medical staff, were aware of the term Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 November 2017

The practice is now rated as good for the care of people with long term conditions and the issues identified at the previous inspection have been addressed. The findings below are from the Inspection on 4 April 2017 and the full comprehensive report following that inspection can be found by selecting the ‘all reports’ link for Bradshaw Medical Practice on our website at www.cqc.org.uk.

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

• The overall quality outcome framework (QOF) results for diabetes was 100% compared to the CCG average of 92% and the national average of 90%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a review to check their health and medicines needs were being met.

• The GP worked with the relevant health and care professionals to deliver a multidisciplinary package of care for patients with the most complex needs.

Updated 22 November 2017

The practice is now rated as good for the care of families, children and young people and the issues identified at the previous inspection have been addressed. The findings below are from the Inspection on 4 April 2017 and the full comprehensive report following that inspection can be found by selecting the ‘all reports’ link for Bradshaw Medical Practice on our website at www.cqc.org.uk.

• 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 high for all standard childhood immunisations.

• Staff we spoke to told us that children and young people were treated in an age-appropriate way and were recognised as able to make their own decisions.

• 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 where possible.

• Child immunisation rates were 7% above the required standard of 90% for all four immunisation data indicators.

Updated 22 November 2017

The practice is now rated as good for the care of older people and the issues identified at the previous inspection have been addressed. The findings below are from the Inspection on 4 April 2017 and the full comprehensive report following that inspection can be found by selecting the ‘all reports’ link for Bradshaw Medical Practice on our website at www.cqc.org.uk.

• 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.

• In particular staff were able to recognise signs of abuse in older people and knew how to escalate or refer these concerns.

• There was a register of older people who needed extra support and a system whereby they could directly contact a clinician who was familiar with their requirements.

Updated 22 November 2017

The practice is now rated as good for the care of working age people (including those recently retired and students) and the issues identified at the previous inspection have been addressed. The findings below are from the Inspection on 4 April 2017 and the full comprehensive report following that inspection can be found by selecting the ‘all reports’ link for Bradshaw Medical Practice on our website at www.cqc.org.uk.

• 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 reflected the needs for this age group. There was an informative web site with access to appointments and electronic prescription services.

• Patients could access the borough-wide HUB outside of normal working hours. Patients were able to book appointments at a nearby practice between 6.30pm and 9pm on weekdays and from 10am until 4pm at the weekend.

Updated 22 November 2017

The practice is now rated as good for the care of people experiencing poor mental health (including people with dementia) and the issues identified at the previous inspection have been addressed. The findings below are from the Inspection on 4 April 2017 and the full comprehensive report following that inspection can be found by selecting the ‘all reports’ link for Bradshaw Medical Practice on our website at www.cqc.org.uk.

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

• There was a named GP for patients in residential and nursing homes to improve continuity of care.

• 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.

• People with mental health needs and dementia were well supported by the assistant (and trainee assistant) practitioners.

Updated 22 November 2017

The practice is now rated as good for the care of people whose circumstances may make them vulnerable and the issues identified at the previous inspection have been addressed. The findings below are from the Inspection on 4 April 2017 and the full comprehensive report following that inspection can be found by selecting the ‘all reports’ link for Bradshaw Medical Practice on our website at www.cqc.org.uk.

• The practice had identified patients who were in need and had ensured that these patients received extra support. They included military veterans, carers, patients with learning disabilities, patients with mental health conditions and those with dementia. Two members of staff had lead roles in supporting these patients and were able to demonstrate the positive impact it provided.

• For those patients with a learning disability the assistant practitioners (APs) had met with and knew each person on the register and what support they needed. They were able to evidence the positive impact provided specifically for this group of patients by offering them instant access with a person who was familiar to them, continuity of care and an enhanced support service.

• The practice offered longer appointments for patients with a learning disability and others who would benefit from them as well as a “knock and wait” clinic for an hour each day with one of the APs.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. They informed vulnerable patients about how to access various support groups and voluntary organisations and encouraged and accompanied them to attend.