Archived: Bolton General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bolton General Practice on 16 June 2017. Overall the practice is rated as outstanding.

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

• 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.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example employing a patient liaison officer, a weekly ‘Conversation café’ and patients could access free gym facilities at a neighbouring SSP practice.
• Feedback from patients about their care was consistently positive
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice had a diverse population and in order to meet the needs of patients from a different background and those for whom English was not their first language, the practice had multi-lingual literature, attended local community events and worked with local organisations such as the Befriending Refuges and Asylum Seekers (BRASS).

We saw several areas of outstanding practice including:

• The practice were proactive in providing safety nets for vulnerable and at risk patients. For example, the practice initiated a ‘do not allow to DNA’ register. This was created to ensure that vulnerable patients who required follow up, referrals or treatments following consultations were proactively contacted to ensure they attended their appointment. The practice also monitored vulnerable patients on high risk medication who were assessed as being at risk of not complying with their medication. The practice put in place multiple safety nets for these patients.
• The practice recognised the need for advocacy and support services for patients to be provided in house and had a number of initiatives on-going, for example, the practice employed a patient liaison officer to provide advocacy for vulnerable patients especially those for whom English was not their first language and those new to the practice. They acted as a focal point for communication between patients, GPs and other health and social care teams. The practice had also become increasing aware of the impact on patients physical and emotional wellbeing in light of changes to the benefit system and patients being refused asylum. As a result the practice supported patients with legitimate reasons to appeal against these decisions by providing detailed medical letters and reports when required.
• The practice recognised that social isolation was a key issue for some patients and the practice had established a number of services to address this, for example, patients living in social isolation or new to the practice were invited to attend a weekly conversation café. The conversation café was run by the patient liaison worker, attended by staff, voluntary organisations and community workers. Patients could drop in for advice, guidance and support or to meet new people. The practice had also introduced welfare appointments with the health care assistant. These could be accessed by filling in a confidential ‘loneliness slip’ or speaking with a member of staff.

However there was one area of practice where the provider should make improvements:

• Ensure all sharps bins are signed and dated.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice