Archived: Dr Shamim Sameja

Updated 11 August 2017

Dr Shamim Sameja is located in Pelsall, Walsall an area of the West Midlands. The practice opened in Pelsall Village in 1991 and moved to the current premises in 2012.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract is a nationally agreed contract to provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some enhanced services such as childhood vaccination and immunisation schemes.

The practice provides primary medical services to approximately 2,600 patients in the local community. The practice is run by a lead male GP (provider). The nursing team consists of a practice nurse and a health care assistant. The non-clinical team consists of administrative and reception staff, a practice manager and assistant practice manager. Based on data available from Public Health England, the levels of deprivation in the area served by Dr Shamim Sameja are below the national average ranked at six out of ten, with ten being the least deprived.

The practice is open to patients between 8am and 6.30pm Monday, Tuesday, Wednesday and Friday and 8am to 1pm on Thursday. The surgery contracts an out of hours provider to cover Thursday afternoon. Extended hours appointments are available 6.30pm to 7.30pm on Wednesday. Telephone consultations are also available and home visits for patients who are unable to attend the surgery. When the practice is closed, primary medical services are provided by Primecare, an out of hours service provider and NHS 111 service.

The practice is part of NHS Walsall Clinical Commissioning Group (CCG) which has 59 member practices. The CCG serve communities across the borough, covering a population of approximately 274,000 people. A CCG is an NHS Organisation that brings together local GPs and experienced health care professionals to take on commissioning responsibilities for local health services.

Updated 11 August 2017

Letter from the Chief Inspector of General Practice

We first inspected, Dr Shamim Sameja’s surgery on 13 October 2016 as part of our comprehensive inspection programme. The overall rating for the practice was inadequate. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Shamim Sameja’s surgery on our website at www.cqc.org.uk. During the inspection, we found the practice was in breach of legal requirements and placed into special measures. This was because appropriate processes were not in place to mitigate risks in relation to the safety and quality of the services offered. Following the inspection, the practice wrote to us to say what they would do to meet the regulations.

This inspection, was an announced comprehensive inspection, carried out on 17 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found effective clinical and managerial leadership had been implemented and significant improvements had been made to the concerns raised at the previous inspection and as a result of our inspection findings the practice is now rated as Good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Since the previous inspection, an effective system had been implemented to ensure all incidents were acted on and learning shared with all staff members. The practice carried out an analysis of each event with a documented action plan.
• At this inspection, we found that all staff had received an appraisal and development plans were in place. A training matrix had been introduced following our previous inspection to monitor staff training and ensure all staff had received the appropriate training relevant to their role.
• At this inspection, we found staff had undertaken clinical coding training and systems were now in place to ensure all urgent referrals were coded appropriately and followed up to ensure patients referrals had been acted on.
• At this inspection, we saw evidence to confirm that staff had received chaperone training and appropriate checks with the disclosure and barring service (DBS).
• A comprehensive business continuity plan had been implemented since the previous inspection so all staff were aware of the procedures to follow if a major incident occurred.
• The practice had implemented a system to record staff immunisation status and vaccinations since our October 2016 inspection.
• The management team had started holding team meetings and clinical staff meetings on a monthly basis which were minuted to ensure all staff were kept up to date with changes within the practice.
• At our previous inspection, we were told that patient feedback was not sought and there was no patient participation group. At this inspection, we found a patient participation group had been set up and meetings were being held monthly.
• Following our previous inspection, the practice recruited two new managers. Staff we spoke with told us they felt supported by management and were positive about the changes that had been implemented since our previous inspection.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 August 2017

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. The latest published QOF results (2015/16) showed performance for diabetes related indicators was 100% which was higher than the CCG and national average of 96%. Exception reporting rate was 12% which was comparable to the CCG and national average of 13%.
• Patients with long-term conditions received annual reviews of their health and medication. 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. We saw evidence that meetings were held every month.
• The practice ran anti-coagulant clinics (clinics to monitor patients taking blood thining medicines) on a weekly basis for the practice patients.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• A diabetic specialist nurse held clinics every two weeks at the practice to support patients with complex diabetic needs.

Updated 11 August 2017

• 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 accident and emergency (A&E) attendances.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors to support this population group. For example, the midwife held ante-natal clinics once every two weeks.
• Childhood immunisation rates were high for all standard childhood immunisations. There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice’s uptake for the cervical screening programme was 80% which was comparable to the national average of 81%. Exception reporting rate was 3% which was lower than the CCG average of 7% and the national average of 6%.

Updated 11 August 2017

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• The clinical team and practice managers had completed end of life care training to support patients and their families.
• Documentation provided by the practice showed patients on the palliative care register were discussed at monthly meetings and their care needs were co-ordinated with community teams.

Updated 11 August 2017

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours were available every Wednesday evening.
• 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. In January 2017 the practice uptake for online services was at 0.2%. Following a proactive approach to encourage the benefits of using the online facilities the practice had seen an increase to 13% of patients using this service.
• The practice offers NHS health checks for patients aged 40-70 years. Data provided by the practice showed 118 patients had received a health check in the past 12 months.
• The practice nurse ran an in-house stop smoking service for patients and a health trainer was also available to support patients in achieving a healthier lifestyle.
• The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 11 August 2017

• Patients at risk of dementia were identified and offered an assessment. The latest QOF data (2015/16) showed 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%. Exception reporting rate was 0%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The latest published QOF data (2015/16) showed 100% of patients on the mental health register had their care plans reviewed in the last 12 months, which was higher than the national average of 89%. Exception reporting rate was 0%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia and had completed dementia awareness training.

Updated 11 August 2017

• The practice held a register of patients living with a learning disability, frail patients and those with caring responsibilities and regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice offered longer appointments and annual health checks for people with a learning disability. At our previous inspection, we found that patients on the learning disability register had not received an annual review. At this inspection, unverified data provided by the practice showed six patients on the learning disability register and 100% had received an annual health and medication review.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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’s computer system alerted GPs if a patient was also a carer. The practice had engaged with local support groups and all staff had completed carers awareness training to increase the number of carers registered at the practice. At this inspection, data provided by the practice showed patients on the practices register for carers had increased to 1% of the practice list. The practice had trained a member of staff to be a carers’ champion.