Imperial College Health Centre

Updated 25 April 2016

Imperial College Health Centre provides primary medical services through a General Medical Services (GMS) within the London Borough of Westminster. The practice is part of NHS Central London (Westminster) CCG. The services are provided from a single location to around 15,500 patients within premises owned by Imperial College. The practice has close links with Imperial College and the Royal College of Music. The majority of these colleges’ students (around 12,000) are registered with the practice, as well as many of the staff (around 1,500). There was a high turnover each year as students completed their studies and were replaced by the new intake. The services are specifically tailored for this group but the practice also provides services to around 2,000 local residents. In this group, there are significantly below average numbers of patients in the 0-4 years, 5-14 years, over age 65, 75 and 85 age groups.

The practice is registered to carry on the following regulated activities: Diagnostic and screening procedures; Family planning; Maternity and midwifery services; Surgical procedures; and Treatment of disease, disorder or injury.

At the time of our inspection, there were 5.23 whole time equivalent (WTE) GPs comprising the four partner GPs (two female and two male), three salaried GPs (all female); a trainee Registrar GP (female); a business manager (1 WTE) and a practice manager (1 WTE). The practice also employed two practice nurses (both female, 2 WTE); a healthcare assistant (0.71 WTE); two psychotherapists (0.9 WTE); and a reception manager, three receptionists, two apprentice receptionists; an administrator; and a medical secretary (a total of 7.4 WTE).

The practice is a teaching practice for GPs. Each year the practice has registrar doctors working at the practice, studying for a postgraduate qualification to become a general practitioner.

During term time the practice is open between 8:00am and 6:30pm on Monday and Wednesday to Friday and 8:00am to 1:00pm on Tuesday. Out of term time the practice closes at 5:00pm on Monday and Wednesday to Friday. Routine appointments can be booked in advance. Patients are advised that if they feel their issue can be dealt with by telephone to book a telephone appointment and the doctor would phone them at the allotted time. For urgent treatment the practice runs a daily morning triage clinic between 8:30am and 10.00am and an afternoon emergency clinic Monday, Wednesday, Thursday and Friday. The practice offers a late clinic between 6:00pm and 8:00pm on Thursday and daily appointments between 5:00pm and 6:00pm during the university term-time.

There are also arrangements to ensure patients receive urgent medical assistance when the practice is closed. Out of hours services are provided by a local provider. Patients are provided with details of the number to call.

Updated 25 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Imperial College Health Centre on 25 February 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• 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 preferred GP and daily walk in clinics and a triage system enabled the availability of urgent appointments on 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

• Ensure the arrangements in hand for GPs to receive safeguarding update training are concluded.
• Continue to seek improvements in the uptake of childhood immunisations.

We saw one area of outstanding practice:

During the first month of the academic year the practice actively promoted registration of new undergraduates to the colleges it served, running additional clinics for immunisations against meningitis and MMR. During the first weekend of term, practice staff were are on site in the student halls of residence to facilitate the registration process. GP staff presented lectures to educate students about the practice’s services and the NHS system. This was of particular benefit to the 50% or so students who came from abroad who were not familiar with the health service and how to access it.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 April 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 practice performance for the majority of 2014/15 QOF indicators for long-term conditions was similar to or above average including diabetes related indicators.
• Longer appointments and home visits were available when needed.
• Given the practice population group the majority of long-term conditions were those seen in younger people. This included asthma, epilepsy, type 1 diabetes, inflammatory bowel disease and mental health conditions including eating disorders.
• Patients with long-term conditions were invited for regular reviews with a GP or nurse as appropriate. This could be in a dedicated clinic (for example for COPD) or during routine consultations. Following Patient Group feedback the practice offered these reviews flexibly rather than in fixed time clinics.
• The practice had an in-house ‘Health Trainer’ who sees patients with long-term conditions for lifestyle, diet and exercise advice.
• There were close links with local pharmacies, with which the practice liaised to review patients who were taking multiple medicines particularly when they had been discharged recently from hospital.

Updated 25 April 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. The practice held a child health surveillance clinic fortnightly with the local health visitor, practice nurse and GP. The GP and health visitor discussed any children/families about which there was a health or safeguarding concern.
• 2014/15 rates for the standard childhood immunisations were mixed. For example , childhood immunisation rates for the vaccinations given to under two year olds ranged from 47% to 57% and five year olds from 33% to 87%, compared to CCG rates of 61% to 77% and 50% to 72% respectively. The practice had comparatively low numbers of children under the age of 5 which could skew their data. However, in the current year at 1 January 2016 the practice had achieved 90% of its CCG target for these immunisations.
• The practice’s uptake for the cervical screening programme was 72%, which was below the CCG and national average of 82%. The relatively lower rate was mainly due to the predominantly student population.
• 78% of patients with asthma, on the register, had had an asthma review in the last 12 months that included an assessment of asthma control. This was comparable with the national average of 75%.
• The practice provided ante and post-natal care which was provided by all of the doctors. Longer appointments were provided for both ante and post-natal checks.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 25 April 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, albeit relatively small proportion of the patient population within this group.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• All patients over 75 years old had a named GP of which they had been informed in writing. This named GP was primarily responsible for overseeing their care which included routine consultations, home visits, post-hospital discharge and medication reviews.
• The practice worked closely with a multidisciplinary team (MDT) to review and co-ordinate the care and treatment of older people. including other GPs in acute settings, practice nurses, community nursing services and the locality care coordinator, an in-house health trainer (lifestyle/diet/exercise) and complementary practitioners (for example, osteopathy and acupuncture).
• They actively promoted the uptake of appropriate immunisations for this age group, such as flu (84% uptake of over 65s), pneumococcal and shingles, and followed up non-responders.

Updated 25 April 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.
• A large proportion of the practice’s population were students and the services were specifically tailored for this group. During the first month of the academic year the practice actively promoted registration of new undergraduates, running additional clinics for immunisations against meningitis and MMR. During the first weekend of term, practice staff were on site in the student halls of residence to facilitate the registration process. With explicit patient consent the practice liaised with the students’ colleges about student health issues that may be impacting on their studies.
• A full contraception service was offered, including contraceptive implants and coil fitting. The practice promoted sexual health during consultations and encouraged attendance at local sexual health clinics if appropriate.
• The practice had a GP with an interest in sports and musculoskeletal medicine who offered joint injections, if clinically indicated.
• Patients could see a ‘Life Coach’ who worked with them to build their confidence and introduce clarity and focus.
• There was on-site access to a broad range of complementary therapies including osteopathy, chiropractic and acupuncture.
• 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.
• The practice had responded to patient comments regarding access, by introducing telephone consultations, appointments throughout the day, online appointment booking. And electronic prescribing.

Updated 25 April 2016

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

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is above the national average. QOF performance for the majority mental health related indicators was above national averages.
• Patients screened for dementia were referred to the local memory service, if indicated, for assessment. Their care would then be coordinated by the named GP along with community nursing services.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• Staff had a good understanding of how to support patients with mental health needs and dementia. All GPs had particular mental health expertise and worked closely with a visiting psychiatrist, psychodynamic psychotherapists, cognitive behaviour therapists and with the local Improving Access to Psychological Therapies(IAPT) service, who saw patients on-site.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• There were close links with Imperial College’s disability service and the practice liaised regularly with the service regarding patients with a wide range of difficulties including Attention deficit hyperactivity disorder (ADHD ) and those on the autistic spectrum. The practice also had access to student counselling services and the educational psychologist assessment service at Imperial College.

Updated 25 April 2016

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

• Patients living in vulnerable circumstances including children and families at risk, patients with mental health problems and those with a learning disability were flagged on the practice’s computer system.
• The practice offered longer appointments for patients with a learning disability and provided an annual health check, including a medicines review.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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. Cases were discussed in a regular Clinical Governance meeting.