Archived: Whittle Surgery

Updated 9 January 2017

Whittle Surgery provides primary medical services in Whittle-Le-Woods, Chorley from Monday to Friday and every 1st and 3rd Saturday.

The practice is open between 8am and 6.30pm Monday to Friday and between 8.30am and 2.30pm every 1st and 3rd Saturday.The first appointment of the day with a GP is 8.20am and the last appointment with a GP is 6pm. Same day urgent appointments and home visits are available each day.

The practice is situated within the geographical area of NHS Chorley and South Ribble Clinical Commissioning Group (CCG).

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

Whittle Surgery is responsible for providing care to 9475 patients.

The practice consists of a four GP partners, two male and two female, two salaried GPs, both female and two long term locums, one male and one female, one prescribing pharmacist, three practice nurses, one trainee assistant practitioner and one health care assistant.The clinical team is supported by a practice manager, assistant practice manager, admistration manager and a team of admistration and reception staff. It is a training practice for year 5 medical students from Manchester University.

When the practice is closed patients are directed to the out of hour’s service run by GTD Healthcare Ltd.

One of the partners is an examiner with the medical school at Manchester University.

The practice work with a local research company by inviting patients with diabetes to take part.

Updated 9 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Whittle Surgery on 9 December 2016. 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.
• 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.
• Patients said they found it easy to make an appointment with a named 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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 9 January 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.
• All patients in this population group had a named GP.
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 54% which was lower than the CCG average of 87% and the national average of 88%. The practice told us that the service was offered by the local Trust who allocated eight appointments to the practice every four weeks. The practice had recently negotiated with the local Trust who had increased the number of appointments to eight appointments every two weeks. They were also in the process of training the Health Care Assistant to carry out these examinations.
• 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.
• Patients with asthma and diabetes were offered a personalised care plan.
• The practice was were piloting a diabetic service where it initiated GLP1 which is a drug used by diabetics. The practice planned to offer this service to other practices.
• The practice offered an in house anti coagulation service and was able to initiate warfarin. It offered a 24hour emergency response line and home visits. 80% of patients taking warfarin used this service. The other 20% used the service offered by the hospital. The practice planned to offer this service to other practices.
• Appointments with the practice nurse were available on the first and third Saturday each month for patients that were unable to attend the surgery during the normal working week.
• In addition to letters, text messages and emails were sent to patients inviting them in to the surgery for their review. The practice have seen a significant increase in patients attending their review appointments due to the new method of communication.

Updated 9 January 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 percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 80% which was comparable to the national average of 82%.
• 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.
• Six to eight week baby checks were offered at the same time as the baby’s first immunisations so that parents did not have to attend the surgery for multiple appointments.

Updated 9 January 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.
• All patients over the age of 75 were offered an annual health check. On the day of the inspection 539 (82%) health checks had been carried out.
• All patients over the age of 75 who were at risk of being admitted to hospital had a personalised care plan in place and were invited for review.
• The practice were promoting the NHS health check to patients aged between 70 and 74 years before they became 75 years and therefore ineligible.
• All eligible patients were offered pneumococcal and shingles vaccinations.
• Dementia screening was offered to all elderly patients.
• The practice embraced the Gold Standards Framework for end of life care. This included

supporting patients’ choice to receive end of life care at home.

• Monthly multi-disciplinary team meetings were held where vulnerable older patients were discussed and were referred to the community matron, as appropriate, who offered extra support.

Updated 9 January 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 practice used a communications system to text or email patients to remind them of their appointments and to invite them in for health checks and reviews.
• Appointments were available every first and third Saturday each month for patients that were unable to attend during normal working hours.
• Telephone appointments were available for patients that wanted them.
• The practice offered an automated telephone system where patients could leave a telephone message to request repeat prescriptions.
• The practice offered electronic prescribing which meant that a patient could nominate a pharmacy where the GP sends prescriptions to, making the whole process more efficient and convenient for the patient.

Updated 9 January 2017

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

• The practice had 77 patients registered from two facilities for patients with severe physical and learning difficulties.
• 89% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 84%.
• 95% 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 which is higher than the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• Patients were signposted to Minds Matter where appropriate.
• The practice referred to specialist services such as memory assessment and mental health services as appropriate.

Updated 9 January 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.
• 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.
• The practice worked closely with Lancashire Wellbeing Service who were able to visit patients in their own homes and offer them support and assistance with arranging carers and finance.
• The practice worked with Encompass which offered support to carers, held coffee mornings and offered a buddy service where meetings were set up for patients that required peer support.
• All vulnerable patients, who were at risk of being admitted to hospital, had a personalised care plan in place and were reviewed on a regular basis.
• Patients were referred to the substance misuse services when necessary.