Archived: Irnham Lodge Surgery

Updated 13 August 2015

Irnham Lodge Surgery, Townsend Road Minehead, Somerset TA24 5RG is situated in the town centre of Minehead. The practice had approximately 6,584 registered patients from Minehead and the surrounding areas.

The practice is located in purpose built premises attached to a Complementary Health Centre and Pharmacy. There is a central patient waiting room with a reception desk with consulting and treatment rooms leading off these areas. Administration, management and meeting rooms are located on the ground floor and first floor of the building. Somerset Clinical Group commissions Enhanced Services from the practice. A general medical service contract is held with the Bristol, North Somerset, Somerset, South Gloucestershire NHS Area Team. Irnham Lodge Surgery is part of a federation of GP practices in West Somerset.

The practice supported patients from all of the population groups such as older people, people with long-term conditions, mothers, babies, children and young people, working-age population and those recently retired; people in vulnerable circumstances who may have poor access to primary care and people experiencing poor mental health.

Over 30% of patients registered with the practice were working aged from 15 to 44 years, 28.9% were aged from 45 to 64 years old. Just above 10% of the practice patients were 75-84 years old and 57% of patients were over 85 years old. Just above 12% of patients were less than 14 years of age. Information from NHS England showed that just below 59% of the patients had long standing health conditions, which was above the national average of 54%. The percentage of patients who had caring responsibilities was 21.6% which is above the national average of 18.5%. Of the practice patients 54% were from the working population or full time students. Disability allowance claimants were 54% which was above the national average of 50%. Patients living in a nursing or care home were 1.9% of the patients the practice supported, which was above the national average of 0.5%.

The practice consisted of five GP partners (3.78 WTE) and one salaried GP. Of these six GPs there were three male and three female GPs. There was one male trainee GP at the practice. There was a nurse practitioner three practice nurses and one health care assistant all of whom provided health screening and treatment five days a week. There were additional clinics implemented when required to meet patient’s needs such as the undertaking of influenza vaccinations. There was a team of administration, reception and secretarial staff. The practice had a full time practice manager who was in charge of the day to day management of the service.

Irnham Lodge Surgery had core hours of opening from 8.30am to 6.30pm every weekday. Saturday morning GP appointments were available by advance booking. The practice telephone line was open from 8.00am Monday to Friday. GPs were available from 9.00am to 12.00 noon and again between 2.00pm and 6.00pm. Home visits were usually conducted at lunch time. The practice operated a ‘sit and wait’ same day appointment system twice a day. The practice referred patients to another provider NHS 111, then Somerset Doctors Urgent Care (from 1 July 2015) for an out of hour’s service to deal with any urgent patient needs when the practice was closed.

Updated 13 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Irnham Lodge Surgery on 20 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well led services. It was also good for providing services for older people, people with long-term conditions, mothers, babies, children and young people, working-age population and those recently retired, people in vulnerable circumstances who may have poor access to primary care and people experiencing poor mental health.

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

• 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.
• Risks to patients were assessed and well managed, including those relating to recruitment checks, infection control and medicines management.
• 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.

• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Ensure the policy and procedure for safety of GPs bags is carried out including the checks on the calibration of equipment and the processes for checking in and the checking out of prescriptions pads and medicines.

• Ensure that patient’s written consent is obtained before specific treatments and clinical interventions are carried out.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 13 August 2015

The practice is rated as good for the care of people with long-term conditions. Information from NHS England showed that just below 59% of the patients had long standing health conditions, which was above the national average of 54%. 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 medication 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.

Updated 13 August 2015

The practice is rated as good for the care of families, children and young people. Just above 12% of patients were less than 14 years of age. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. 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. 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. Childhood immunisation rates for the vaccinations given to children under the age of two ranged from 85.5% to 100% and five year olds from 77% to 100%. These were above or comparable to Clinical Commissioning Group/National averages.

Updated 13 August 2015

The practice is rated as good for the care of older people. Above 10% of the practice patients were 75-84 years old and 57% of patients were over 85 years old. 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. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice had implemented named GPs to lead care and support to patients living in care or nursing homes.

Updated 13 August 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). Of the practice patients 54% were from the working population or full time students. Disability allowance claimants were 54% which was above the national average of 50%. 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 reflected the needs for this age group.

Updated 13 August 2015

The practice is rated as good for the care of people experiencing poor mental health (including people living with dementia). There were 73 patients on the practice register with a mental health condition of whom 53 had a care plan agreed. People experiencing poor mental health had received an annual physical health check. The percentage of patients diagnosed with dementia whose care had been reviewed with a face to face consultation during the previous12 months (89%) was above the national average of 83%.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those living with dementia. It carried out advance care planning for patients living with dementia.

The practice had signposted patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had received training on how to care for people with mental health needs and was planning to improve staff knowledge in supporting patients living with dementia.

Updated 13 August 2015

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 those with a learning disability. It had carried out annual health checks and offered longer appointments for people with a learning disability.

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