Archived: Lower Ince Surgery Also known as SSP Health Ltd

Updated 21 January 2016

Lower Ince Surgery has about 3817 patients registered. It is part of and managed by the SSP Health group of practices and is overseen Wigan Borough Clinical Commissioning Group (CCG). At the time of our inspection the majority of patients were of white British background.

In 2002 the practice was one of the highest prescribers of Benzodiazepine medicines in the UK. The practice implemented a reduction programme and currently are now the second lowest prescribers of this medicine in the CCG and below national average.

The practice is situated in Claire House. Services inside the building include two GP practices (of which Lower Ince Surgery is one) and community services including out of hours emergency, older persons mental health, children’s nursing team community and a pharmacy.

The practice is based on the ground floor, which is fully accessible to those with mobility difficulties. There is ample car parking available with disabled parking spaces.

There are three GPs (three male), supported by one practice nurse, and healthcare assistant. There is also a newly appointed practice manager and supporting administration and reception team. There is regular support for the clinician and non-clinical team from the wider SSP Health including clinicians and managers.

The practice is open 8am to 6.30 pm Monday, Tuesday, Thursday and Friday; with extended opening on Wednesdays until 8.30pm. Patients requiring a GP outside of normal working hours are advised to call NHS 111 to access out-of-hours service. There also is a walk in centre for patients to attend without an appointment at Leigh walk in centre.

The practice has a Primary Medical Services (PMS) contract and is a teaching practice for new doctors. They also offer a range of enhanced services for example: minor surgery and rotavirus and shingles immunisation.

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lower Ince Surgery on 15 December 2015. Overall the practice is rated as good.

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

• Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.

• 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.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice is a teaching practice for GP Registrars and medical students.
• The provider was aware of and complied with the requirements of the Duty of Candour.

• 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.

We saw an area of outstanding practice:

The practice was one of the highest prescribers of Benzodiazepine medicines in the UK. Benzodiazepines are a group of medicines that are sometimes used to treat anxiety, sleeping problems and other disorders.

The practice had approximately 10% of their patients receiving this medicine; they developed a “Hypnotic Reduction Programme”. The programme has taken many years of supporting patients by various methods such as counselling, regular reviews and direct patients support.

We saw evidence of the practices prescribing rates reducing over the years from the highest in the UK to being the second lowest prescribers in the CCG and below national UK averages.

The hypnotic reduction programme is now part of the practice’s new patient health check programme and ongoing support programme for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 January 2016

The practice is rated as good for the care of people with long-term conditions.

• There was a methodical system to ensure patients received annual reviews.

• The practice offered appointments of up to 60 minutes for patients with multiple conditions.

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

• Longer appointments and home visits were available when needed.

• Patients had a six monthly or annual review with either the GP and/or the nurse to check that their health and medication.

• The practice had registers in place for several long term conditions including diabetes and asthma.

• Patients were allocated specific practice nurses for the patient’s management of the condition.

• All these patients had a named GP and a structured annual review to check that 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 21 January 2016

The practice is rated as good for the care of families, children and young people.

• The practice had an early year fact sheet for all new parents in the practice and a childhood initiative scheme to support new parents in areas of emergency first aid.

• 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.

• The practice sent a congratulation letter to all new parents.

• The practice regularly liaised with health visitors who attended on a weekly basis. Appointments were available outside of school hours and the premises were suitable for children and babies.

• Immunisation rates were high for all standard childhood immunisations.

• We saw good examples of joint working with midwives, health visitors and school nurses to support families.

Updated 21 January 2016

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

• Nursing staff had lead role in chronic disease management. This extended to the nurse offering housebound patients chronic disease management and vaccines.

• The practice offered all over 75 year olds, a health check to support health and wellbeing.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice offered a virtual ward round for all their patients in a residential/ nursing home

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• There was a named GP for the over 75s with longer appointments when required

Updated 21 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered extended access to appointment for example on Wednesday evenings until 8.30pm.

• The practice had a number of online services, one example being a text to cancel an appointment and online appointment booking.

• 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.

Updated 21 January 2016

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

• Staff had a good understanding of how to support patients with mental health needs and dementia; this was monitored and maintained by all staff using the important patient register.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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.

• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 21 January 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice had tools in place to review and keep up to date with the practices most vulnerable. One example being the important patient register they had developed to support patients.

• Staff knew how to recognise signs of abuse in vulnerable adults and children, with the practice having dedicated clinical staff leading. For example, the practice had a children’s at risk step down register.

• Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and had a safeguarding lead and deputy.

• The practice held a register of patients living in vulnerable circumstances including homeless patients and also the carers of these patients.

• The practice nurse worked close to educate and improve access to the most vulnerable patients.

• The practice worked with multi-disciplinary teams in the case management of vulnerable patients.