Archived: Dr Nabil Shather Also known as Bilston Street Surgery

Updated 9 November 2016

Dr Nabil Shather’s practice is based in Bilston Street Surgery within the Sedgley area of Dudley. There are approximately 2,875 patients of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The clinical team includes a male single handed GP and a female practice nurse. The GP and the practice manager form the management team and they are supported by a non-clinical team of four staff members who cover reception, secretarial and administration duties.

The practice is open between 8am and 6:30pm on Monday to Friday. The practice offers extended hours on Mondays between 6:30pm and 8pm. There are also arrangements to ensure patients received urgent medical assistance when the practice is closed during the out-of-hours period.

Updated 9 November 2016

Letter from the Chief Inspector of General Practice

We undertook an announced comprehensive inspection of Dr Nabil Shather’s practice, at Bilston Street Surgery, on 10 August and 6 September 2016.

This inspection was also carried out to check that the provider had made improvements in line with the recommendations made as a result of our focussed inspection on 9 December 2015. This was because during our inspection on 9 December 2015, the practices rating remained as requires improvement for providing safe services as the provider had not made sufficient improvement in order to comply with legal requirements.

During our visit on 10 August 2016 we found that although some improvements had been made we identified further areas of concern pertaining to the practices systems for managing and monitoring high risk medicines. We also found that at this stage, we did not have sufficient evidence in order to make a fair and proportionate judgement of the service.

Therefore, we visited the practice further on 6 September 2016 to obtain further evidence and to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This report covers our findings in relation our findings on 10 August and 6 September 2016. You can read the report from the practices previous comprehensive inspection, by selecting the 'all reports' link for Dr Nabil Shather on our website at www.cqc.org.uk

Overall the practice is rated as requires improvement. Our key findings across all the areas we inspected were as follows:

• During our comprehensive inspection we found that the practice had made some improvements with regards to specific areas of medicines management. However, we noted a reactive approach to improvement and that sometimes the practice did not proactively improve and had not identified areas to improve on independently.

• Furthermore, we found that the practice had made some improvements regarding systems and processes associated with medicines management. However, we identified that 78 patients on specific medication to reduce cholesterol levels in the blood were overdue for specific liver function tests.

• The practice had improved their programme of continuous clinical and internal audit by using this to monitor quality and to make improvements. Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

• There were adequate arrangements in place to respond to emergencies and major incidents. There were some effective arrangements in place to the support processes for identifying, recording and managing risks.

• During our inspection visits we saw that that members of staff were friendly, respectful and helpful to patients. Practice staff spoke positively about working at the practice.

• Patients we spoke with and the completed comment cards we received described staff as helpful, caring and respectful.

The areas where the provider must make improvements are:

• Ensure that effective systems and processes are established in order to proactively improve and to sustain improvement work across all areas of medicines management.

The areas where the provider should make improvements are:

• Ensure that all aspects of medication needs are continually managed through well embedded systems to support that where required, necessary monitoring and reviews take place.

• Ensure that records are well maintained to reflect emergency protocols such as fire drills.

• Continue to identify carers and ensure that all carers are captured on the computer system, in order to provide further support where needed.

• Consider contingency arrangements to provide continuity of medical and nursing care during annual leave.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 November 2016

The practice is rated as requires improvement for the care of people with long-term conditions.

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

• Performance for overall diabetes related indicators was 57%, compared to the CCG average of 89% and national average of 90%. More recent (unverified) data provided by the practice highlighted that they had slightly improved in this area.

• Clinical 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 hypertension having regular blood pressure tests was 100%, with an exception rate of 2%. 

Updated 9 November 2016

The practice is rated as requires improvement for the care of families, children and young people.

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

• 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.

• Childhood immunisation rates for under two year olds ranged from 84% to 96% compared to the CCG averages which ranged from 83% to 98%. Immunisation rates for five year olds ranged from 91% to 100% compared to the CCG average of 93% to 98%.

• The practice offered urgent access appointments for children. 

Updated 9 November 2016

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

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Immunisations such as flu vaccines were also offered to patients at home, who could not attend the surgery.

• The practice worked with the local Dudley Council for Voluntary Service (CVS) team to help to provide social support to their patients who were living in vulnerable or isolated circumstances. This included members of the practices older population.

• The GP saw patients on the ground floor and the nurses’ room was situated on the first floor. We noticed that there was no lift in place and only stairs to access the first floor. The practice advised that staff would move between consulting rooms to suit patient needs including, elderly patients and patients with mobility difficulties.

Updated 9 November 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students).

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

• Appointments could be booked over the telephone, face to face and online. The practice also offered telephone consultations with a GP at times to suit patients.

• The practice offered text messaging reminders for appointments to remind patients of their appointments in advance.

• The practice offered extended hours on Mondays until 8pm for those who could not attend the practice during core hours.

Updated 9 November 2016

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

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

• Data showed that appropriate diagnosis rates for patients identified with dementia were 100%, with an exception rate of 4%. The data provided by the practice highlighted that 72% of their eligible patients had care plans in place and 72% had received a medication review in a 12 month period with ongoing reviews planned.

• Performance for mental health related indicators was 92%, compared to the CCG average of 93% and the national average of 92%.

• The practice also supported patients who were experiencing poor mental health by referring them to a gateway worker who provided counselling services on a weekly basis in the practice.

Updated 9 November 2016

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

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

• The practice offered longer appointments for patients with a learning disability. There were 30 patients on the practices learning disability register, 78% of these patients had care plans in place and 78% of the eligible patients had received a review in a 12 month period.

• There was a register which contained 37 patients from vulnerable groups, including patients with drug or alcohol dependency these patients were frequently reviewed in the practice and 56% had received a review in a 12 month period.

• Vulnerable patients were regularly reviewed and discussed as part of the practices multidisciplinary team meetings to support the needs of patients and their families.