Pembroke House Surgery

Updated 12 February 2018

Pembroke House Surgery is a GP practice which provides its services under a Personal Medical Service (PMS) contract for approximately 17,400 patients. The practice is situated in the seaside town of Paignton.

The practice has been in the local area since the 1920’s. The practice moved to the current purpose adapted premises in 2010 following taking on additional patients from a GP practice which closed In 2015. The GPs began supporting a local large medical partnership and in 2017 agreed to a merger with this partnership. The building was then extended to incorporate the increase in patient and staff population.

Pembroke House Surgery is open between Monday and Friday: 8am until 6pm. Phone calls between 6pm and 8am are answered by the out of hours message handling service by patients dialling the NHS 111 service. The practice offers extended hour pre bookable appointments once a week on a Saturday morning from 8am until 12.30pm. Nurse and health care assistant (HCA) appointments can be booked up to four weeks in advance. Appointments for these are available from 8am. There is also a duty nurse and HCA who also have urgent appointments on the day.

The practice uses the Dr First appointment system. Patients speak directly to the GP before any appointment is booked to allow for patients to be seen by a GP, nurse or nurse practitioner, at a time which is most convenient for them. This allows for a flexible length of appointment if appropriate, further investigations, including use of the health pod and eliminates the need for a face to face appointment if needed.

The practice population area is in the fifth decile for deprivation. In a score of one to ten, the lower the decile the more deprived an area is. The practice distribution and life expectancy of male and female patients is equivalent to national average figures. However, the practice had a higher than average number of patients aged over 75, (13.36% of the practice list compared to the national average of 7.7%). Average life expectancy for the area is similar to national figures with males living to an average age of 79 years and females living to an average of 83 years.

There is a team of thirteen GPs. Of the 13 GPs (nine females and four males), five are GP partners, four are fixed salary GP partners, and four are salaried GPs. There were two GP registrars (Doctors training to become a GP). The whole time equivalent of GPs was 8.13 (without the two GP registrars, foundation doctor or nurse practitioners)

The team of GPs are supported by a practice manager partner, three advanced nurse practitioners, 11 practice nurses, one assistant practitioner (higher level HCA), three health care assistants, a phlebotomist, 15 administration staff, 10 reception staff, two apprentices and a carer support worker.

Patients using the practice have access to community staff including community nurses, health visitors, counsellors, other health care professionals and midwives held clinics at the practice. There is an independent pharmacy on the same site as the practice.

The practice is a teaching practice for medical students, student nurses and has been a training Practice since 1981 for GP Registrars, foundation doctors (doctors who have qualified in the last two years).

Together with other neighbouring practices, the GPs provide medical support to sixteen residential care homes and nursing homes.

The practice is registered to provide regulated activities which include:

Treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services and Diagnostic and screening procedures and operate from the location of:

266-268 Torquay Road

Paignton

Devon

TQ3 2EZ

Updated 12 February 2018

Letter from the Chief Inspector of General Practice

This practice is rated as good overall and outstanding in well led. The previous inspection was in October 2015 where the practice was rated as– Good with outstanding in the responsive domain.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia)-- Good

We carried out an announced comprehensive inspection at Pembroke House Surgery on 9 January 2018. The reason for the inspection was as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, there was a genuinely open culture in which all safety concerns raised by staff and people who use services were highly valued as opportunities for learning and improvement.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• The practice understood the needs of its population and tailored services in response to those needs. For example, the nursing team had introduced a ‘drop in’ flu clinic for patients who could not attend the routine flu clinics.

• The practice made reasonable adjustments when patients found it hard to access services. For example, the practice worked with other GPs in the area and provided treatment to patients in 16 local residential and nursing homes and offered a winter pressures GP home visiting service to nine care homes with the most vulnerable patients in Paignton & Brixham.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.The leaders used feedback from staff and patients to achieve growth and positive change.

• The practice was organised, efficient and supported effective governance processes. Leadership was clear, supportive and encouraged creativity.

• Evidence based techniques and technologies were used to support the delivery of high-quality care and staff were consistent and proactive in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health. For example, the use of a telephone system which tracked calls, patients who used online services, a detailed self-service health pod, GPs use of clinical templates and the use of electronic correspondence with acute hospitals and out of hour’s providers.

• The leadership and culture of the practice are used to drive and improve the delivery of high-quality person-centred care.

• There had been many organisational changes and an increase in patient population in the last two years. Despite this, the provider had maintained positive patient outcomes, positive feedback from patients and provided a popular place for staff to work.

We saw two areas of outstanding practice:

The involvement of other organisations in the local community and innovative approaches to providing integrated person-centred care meant that patients received flexible, responsive care. For example, the practice had set up and continued to fundraise and support a patient support group called Karing. The practice had helped to relaunch the charity when it moved offices to be closer to the practice. The group had invited a celebrity, who is nationally known for charity work with the vulnerable elderly and used this to raise the profile of the service. The practice and volunteers had recognised the change in patient need and as a result there had been a changed of focus of the group to concentrate more on social activities and befriending to reduce social isolation. The staff and their families had joined with patients to put on a concert at the Palace Theatre Paignton, to help raise awareness of Karing. The feedback received from patients was that it brought back a real sense of community and reduced social isolation. The practice staff and some patients had organised a ‘sell out’ show which raised £3000 towards the charity.

There were consistently high levels of constructive staff engagement and innovative approaches to gather feedback from people who use services and the public. For example:

• Action had been taken as a result of staff and patient feedback and detailed extensive public engagement, which had been recognised as good practice by NHS England.

• Many changes had occurred to benefit patients following engagement with staff. For example, streamlining the prescription, scanning and medical report processes which ensured patients received a more efficient service, changes to the length of some appointments patients did not feel rushed and improving the way samples were received from patients to reception staff to reduce the spread of infection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Of the 598 patients with diabetes, 93% had received an annual review and health check. Of 199 patients with Chronic Obstructive Pulmonary Disease (COPD) 93% had received an annual review and health check within the last 12 months.

Updated 18 February 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 routine health screening appointments for children living in disadvantaged circumstances or those at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates for children 12 months old and for 24 months old were between 98-100% which was higher than CCG average of 93-95%.

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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. The health visitor team was based at the practice.

The practice had implemented a condom card scheme to protect and improve patient health. This was called the “C Card Scheme”; a confidential service which enabled patients aged 13-24 years old to get free condoms as well as sexual health information and advice. Young people could produce their “C Card” at reception and receive condoms discreetly without the need for potentially embarrassing explanations which could be overheard. This was particularly relevant as Torbay has one of the highest rates of unplanned teenage pregnancy in the country.

This scheme had achieved a positive impact. The C card scheme lead at the sexual health outreach team advised us that there was evidence from the latest data taken in 2013-14 of decreasing sexually transmitted infections and unwanted pregnancy rates within Torbay following the efforts of Pembroke House Medical Practice and other practices in Torbay which offered the C Card scheme. Between January - August 2015 the practice processed 25 chlamydia test kits (freely available in practice toilets) with only four returning positive supporting the evidence mentioned above.

Updated 18 February 2016

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

The practice had initiated positive service improvements for its patients that were over and above its contractual obligations, such as running a health and social interaction organisation called “Karing”. It acted on suggestions for improvements and changed the way it delivered services in response to feedback from the patient participation group (PPG). Older patients we spoke with told us this service had a positive impact on their outlook and improvements in their feelings of health and wellbeing. The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure service improvements where these had been identified.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 18 February 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. The practice was successfully achieving smoking cessation targets. Of 33 patients who smoked and wished to stop, 17 had been supported to stop smoking within four weeks. This matched local CCG targets.

The practice offered NHS health checks to patients aged between 40 – 65 years. The practice also offered these opportunistically when patients attended for other reasons. The practice computer system had a marker which appeared on eligible patients’ records in order to remind staff to carry out these health checks. As a result the practice carried out a higher than CCG average number of these checks, achieving an average of 80 a month, which was higher than the CCG average.

Updated 18 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Of the 100 patients experiencing poor mental health, 98% had received an annual physical health check. The remaining 2% had received follow up invitations. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 18 February 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 had carried out annual health checks for 80 patients registered with a learning disability and 100% of these patients had received a check or a follow-up. The practice offered longer appointments for people with a learning disability. Staff showed us alternative communication formats such as easy to read letters, pictures, diagrams and nationally recognised symbols which were used to patients with learning disabilities or communication difficulties. For example, diagrams explained simply what retinal screening involved. There was clear picture signage around the practice, such as a picture of a toilet on the outside of toilet doors.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.