Archived: Lower Ince & Platt Bridge Medical Practice Also known as IntraHealth Limited

Updated 25 October 2016

The practice is part of the national Intrahealth organisation. They are based at Claire House in Lower Ince and have a branch surgery in Platt Bridge. They offer services under an alternative primary medical services (APMS) contract to 3565 patients in and around Lower Ince and Platt Bridge and patients can access whichever location is preferable to them. They are close to public transport and there are ample able and disabled car parking spaces.

The practice is situated in a high area of deprivation (two on a scale of one to 10 where 10 is the least deprived) with a transient population (eight per cent) whose first language is not English.

The team consists of a full time lead GP, a male salaried GP, male and female Locum GPs, male GP Registrar and two female advanced nurse practitioners. They work closely with community services within the building including mental health services and are a teaching and training practice.

Lower Ince surgery is open 8am to 6.30pm daily except Wednesday when the surgery is open 8am to 8pm and Saturday from 8am to 12.00 noon. Appointments are available throughout the day and clinic sessions are staggered so that the whole day is utilised with appointments available over the lunch time period.

The practice has a branch surgery in Platt Bridge where similar clinics are held. The practice is open at Platt Bridge every day from 8am until 2pm offering GP clinics on a Monday and Wednesday, Advanced Nurse Practitioner (ANP) and Practice Nurse clinics on a Tuesday and Thursday and an ANP clinic on a Friday.

The practice provides a large number of services including joint injections, minor surgery, new patient health checks and clinics for patients with long term conditions. In addition there are specialist diabetes clinics with the lead GP and a specialist Benzodiazepine Clinic (monitored reduction of addictive medicines).

They are a teaching and training practice, providing support and clinical education to medical students, trainee nurses and trainee GPs. They currently have an ST3 which is a GP in their third year of training who is able to see patients.

Updated 25 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lower Ince and Platt Bridge on 8th September 2016. Overall the practice is rated as good.

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

• There was a strong focus on safety. 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 and shared with other local providers.

• The practice used innovative and proactive methods to improve patient outcomes, working with them to share best practice. They had introduced a patient navigation system to reduce impact on appointments and offered specialised clinics for diabetes and controlled drug-reduction.The lead GP is the main speaker at an event to promote the new Type 2 Diabetes Guidelines and how they can be used to help individualise patient care.

• Feedback from patients about their care was positive with examples of life changing stories.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. Examples included The Brick (a small charity helping the homeless) and Wigan Family Welfare (a Churches Association helping disadvantaged families in Wigan).

• They had created a carer’s and cancer champion role that supported their population through palliative care and bereavement.They actively identified and supported carers.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients, from the patient participation group and from staff. They offered text message reminders and telephone consultations in direct response to requests from patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs with a branch surgery to support the larger community. They were open from 8am until 8pm on Wednesdays when most neighbouring practices were closed and 8am until 12noon on Saturdays.
• The practice encouraged and reviewed complaints, responded appropriately to patients who complained and made changes to the way they provided services if necessary. They monitored trends and undertook training if a need was identified through complaints.
• The whole practice shared a vision that 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 and was in the process of being updated to make it more reflective of current standards.
• It was evident that there was strong and visible clinical and managerial leadership and governance arrangements.

• There were high levels of staff and patient satisfaction and patient satisfaction results were higher than national and local averages.

We saw some areas of outstanding practice :

• The practice had identified a high number of Polish speaking patients and had met with them to increase their knowledge about how and when to access services.The outcome of this meeting had actively reduced inappropriate access of other services such as Out of Hours and Accident and Emergency.

• The practice were very responsive to the needs of vulnerable patients including homeless people, asylum seekers and those patients with a learning disability. They were actively involved with several other organisations and support services helping patients in cases of domestic violence and other patients facing social issues. They were the recommended practice in the area for support of patients in these categories.They had a nominated member of staff who co-ordinated work in partnership with Wigan Adult Learning Disability Services to enhance the support provided to this group of patients

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 October 2016

The practice is rated as good for the care of patients with long term conditions because :

• They offered a specialist in-house clinic for patients with diabetes which included foot checks. They had identified that this had helped to cut down secondary care referrals. They were now planning to roll out this model to other IntraHealth practices in the North West.

• Health promotion and prevention including, NHS Health Checks, dietary advice, weight management and smoking cessation services were all provided in house in partnership with Active Living (Wigan New Deal)

• The practice worked in partnership with the University of Manchester and National Institute of Health Research (NIHR)as one of the pilot practices in Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC) project ) which was aimed at improving care in Chronic Kidney Disease.

• They regularly supported charity events.

Updated 25 October 2016

The practice is rated good for the care of families, children and young people with long term conditions

• They had identified this group as the second largest in their practice population.

• There were stringent 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 and those who were children of asylum seekers or homeless parents.

• Immunisation rates were good for all standard childhood immunisations.

• Staff 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 with regular and easily accessible in-house clinics

They had set up a “Teenager Clinic” which was an open clinic for parents and/or teenagers to seek help and advice about any matters, including mental health, with no pressure and in total confidence

Updated 25 October 2016

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

• The practice identified the number of patients in this population group and offered proactive, personalised care to meet their basic needs.  In addition they set up other in-house services such as enhanced anti-coagulation clinics (including home visits and care home visits), , in-house phlebotomy services, health trainers and hearing tests.

• The practice pro-actively identified patients who may benefit from a Winter Survival Pack and referred them to the Wigan Care Link Worker (CLW) team to receive further support.  Wigan has a scheme of Integrated Neighbourhood Working and the pilot was set up at Platt Bridge Medical Centre which is still delivering the scheme. Social isolation is one of the things being tackled by the scheme.

• A member of staff set up and introduced “Healthy Walks” for patients within the practice to help combat social isolation, increase confidence and promote health and active lifestyles. Once established the walks were handed over to the Active Living team to continue.

Updated 25 October 2016

The practice is rated good for the care of working age people :

• 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. For example they catered their appointment system so that they were staggered during the whole day and available over the lunch time period.

• They created and introduced a patient navigation system, and trained staff to support it, within the practice. There was evidence to show that this improved access for patients, ensuring they received they were directed to the most appropriate clinician at the practice and easing the demand on GP appointments.

• Appointments were available from 8am until 6.30pm every day and until 8pm on Wednesdays and the practice was also open on Saturday mornings which was in addition to any contractual obligations.

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

Updated 25 October 2016

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

• 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, in the preceding 12 months.

• 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 regularly worked with other voluntary organisations such as the Early Detection and Intervention Team (for dementia) and Belong Wigan, to enhance and improve their dementia care.

• 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 used a Toolkit – “The Mental Health Consultation with a Young Person” (developed through the Charlie Waller Memorial Trust and RCGP) to help improve consultations with patients in this group. The toolkit was used to teach trainees.

Updated 25 October 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable because :

• They held a register of patients living in vulnerable circumstances including homeless people, asylum seekers and those patients with a learning disability. The practice worked closely with other organisations such as the housing association, domestic abuse homes in the area, homeless shelters, local charities and Support for Wigan Arrivals Project (SWAP) supporting refugees and asylum seekers in Wigan. They were actively involved with organisations helping patients facing other social issues.

• There were innovative approaches to providing integrated patient-centred care for those who were vulnerable. They had analysed their population and identified a high number of Polish patients whose expectations of services were based on their experiences in Poland. To educate those patients they arranged and attended a meeting at a local venue and delivered advice about local NHS services and when and how they could and should be used. This had reduced the number of unnecessary attendances at walk in centres and accident and emergency departments.

• The practice worked with in conjunction with several other health care professionals in the case management of vulnerable patients. They had a nominated member of staff who co-ordinated work in partnership with Wigan Adult Learning Disability Services to enhance the support provided to this group of patients. They used easy read documentation for patients with learning disabilities to encourage them to share information.

• 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.

• The practice provided an in-house Benzodiazepine Clinic which had been running for many years and supported patients to reduce from addictive medicines. We heard direct positive response about this service from patients who had been helped.