Imperial Surgery Also known as Imperial Medical Practice

Updated 25 October 2016

Imperial Surgery was inspected on Tuesday 20 September 2016. This was a comprehensive inspection.

The practice is situated in the coastal town of Exmouth, Devon. The deprivation decile rating for this area is seven (with one being the most deprived and 10 being the least deprived). The 2011 census data showed that 98% of the local population identified themselves as being white British.

The practice provides a primary medical service to 4,600 patients of a diverse age group. The practice is a teaching practice for medical students and a training practice for trainee GPs. The practice had one GP registrar working at the practice at the time of the inspection.

There is a team of five GPs partners and one GP registrar. Two GPs are female and four are male. Some worked part time and some full time. The whole time equivalent provided 24 GP sessions a week. Partners hold managerial and financial responsibility for running the business. The team were supported by a business manager, practice manager, three practice nurses, one health care assistants, one phlebotomist and additional administration staff.

Patients using the practice also have access to community nurses, mental health teams, health visitors and the district nursing team who were based next door to the practice. Counsellors and other health care professionals visit the practice on a regular basis.

The practice is open between the NHS contracted opening hours 8am - 6.30pm Monday to Friday. Appointments are offered anytime within these hours. Extended hours surgeries are offered at the following times; on Wednesdays 7.30am to 7pm and on Mondays from 7.30am.

Outside of these times patients are directed to contact the Devon doctors out of hour’s service by using the NHS 111 number.

The practice offered a range ofappointment types including book on the day, telephone consultations and advance appointments.

The practice has a Personal Medical Services (PMS) contract with NHS England.

The practice provides regulated activities from a single location at 45-49 Imperial Road, Exmouth EX8 1DQ. We visited this location during our inspection.

Updated 25 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Imperial Surgery on 20 September 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. The practice also recorded learning events and opportunities for shared learning took place at meetings on a monthly basis.
• The vast majority of risks to patients were assessed and well managed. However, we found that there was no current legionella risk assessment in place. The practice responded immediately to rectify this and had a risk assessment in place within 24 hours of the inspection.
• 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.
• The practice had an active patient participation group (PPG) who provided us with examples of how the practice had responded positively to patient feedback.
• The practice had identified 3% of the practice list as carers. Written information was available to direct carers to the various avenues of support available to them. The practice had a carer’s support officer employed by an agency who visited the practice once a month, offering 30 minute support appointments to carer’s.
• 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 consistently scored highly in all areas of the national GP patient survey and had achieved the highest results of any practice in East Devon in the July 2016 national GP patient survey.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The PPG supported the practice by fund raising to provide additional equipment.
• 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.

The areas where the provider should make improvement are:

• To review the legionella risk assessment to ensure it is fully embedded in practice governance processes.

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 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.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months was 80% which was comparable with the national average of 77%.

• 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.

• The practice held virtual diabetic clinics every six months with a diabetic consultant specialist in support of the GPs and patients managing their condition more effectively.

Updated 25 October 2016

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 practice’s uptake for the cervical screening programme between April 2015 to March 2016 was 78%, which was comparable with 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.

• The practice had several patient toilets and a baby changing facility.

• The practice had responded to PPG feedback through the creation of a children’s play area in one corner of the waiting room with appropriate décor and furnishings, children’s books and colourful interactive toys.

Updated 25 October 2016

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.

• The practice worked closely with its PPG to encourage older people to stay healthy, offering the services of a variety of social groups: a walking group, knitting group, social group and reading group.

• The practice offered online services such as appointments and prescriptions aimed at patients who were not particularly mobile, to give them another option for accessing services.

• All patients aged over 75 years had a named GP and arrangements were made to facilitate older patients who have mobility issues; the practice arranged travel to and from the practice, using community services and their own patient participation group volunteer drive service.

• The practice had appropriate facilities for older patients including a hearing aid induction loop to help patients who had a hearing impairment, a variety of chairs with arm support and accessible toilet facilities.

• The practice provided a carers clinic, aimed at this population group as carers registered with the practice were predominantly older people. A carer support worker visited the practice on a monthly basis and offered 30 minute appointments.

• A multi-disciplinary team core group met at the practice every other week to review the most elderly and vulnerable patients.

Updated 25 October 2016

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.

• promotion material available through the practice.

• The practice offered an SMS text messaging service for reminders of appointments, access to online services to make appointments or order prescriptions.

• The practice offered a family planning service, including the implantation of intrauterine contraceptive devices.

• Other services relevant to this population group included a travel vaccination service, telephone consultations and both early and late appointments being pre-bookable in advance.

Updated 25 October 2016

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

• 87% of patients diagnosed with dementia had their care plan reviewed within the last 12 months which was better than the national average of 84%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 96% which was better 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.

• The practice supported a nearby dementia care home and provided a weekly GP visit and meetings with the relevant consultant psychiatrist every month in support of effective patient care and treatment.

• The practice held multi-disciplinary core group meetings every fortnight with GPs, psychiatric nurses, social workers and other health professionals to discuss patient care relevant to this population group.

• The practice maintained close relationships and regular contact with nearby supportive accommodation for those patients with mental health problems.

• GPs at the practice were also able to make referrals to a dementia support worker who worked in the local community.

Updated 25 October 2016

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, travellers 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 told us that homeless patient’s often registered at a nearby centre the ‘Open Door, Exmouth’, which was a dedicated homeless shelter for persons with no fixed abode. The practice maintained good liaison with this facility.