23 December 2016
The Dr Ajaz Nabi surgery (also known locally as Cippenham surgery) is situated in Slough. The practice is located in a converted building with limited car parking for patients and staff. The premises are accessible for patients and visitors who have difficulty managing steps. All patient services are offered on the ground and first floors. The practice comprises of three consulting rooms, one treatment room, a patient waiting area, reception office and management office (located in annexe in the garden area).
This premises was designed for 2,250 patients in 2001 and the patient list size has been significantly increased in last few years. The practice has recognised this challenge and is making efforts to find a new premises in order to meet the increasing demand. At the time of inspection, the practice had a patient population of approximately 5,380 registered patients. The practice population of patients aged between 0 and 39 years is higher than national average and there are a lower number of patients over 45 years old compared to national average.
There is one principal GP and six long term locum GPs at the practice. Five GPs are male and two female. The practice employs three locum practice nurses. The practice manager and a business advisor are supported by a team of administrative and reception staff. Services are provided via a General Medical Services (GMS) contract (GMS contracts are negotiated nationally between GP representatives and the NHS).
The practice is facing difficulties in recruiting a new practice nurse and relying on locum nurses to deliver the services. The practice has recognised they are required to recruit a new permanent practice nurse and actively trying since previous nurse left in October 2015, and another practice
nurse left soon after due to ill health. Since our previous inspection, the practice has recruited a Health Care Assistant (HCA).
The practice has opted out of providing out of hours services to their patients. There are arrangements in place for services to be provided when the surgery is closed and these are displayed at the practice, in the practice information leaflet and on the patient website. Out of hours services are provided during protected learning time and 30 minutes before opening time (between 8am and 8:30am) and after closing time (between 6pm and 6:30pm) by East Berkshire Primary Care service or after 6:30pm, weekends and bank holidays by calling NHS 111.
Services are provided from following location: Dr Ajaz Nabi, 261 Bath Road, Slough, SL1 5PP
23 December 2016
Letter from the Chief Inspector of General Practice
In February 2016, during our previous comprehensive inspection of Dr Ajaz Nabi (also known locally as Cippenham surgery), we found issues relating to the effective delivery of healthcare services at this practice. As a result of this inspection, we asked the practice to make further improvements, in order to encourage the uptake of health promotion services offered at this practice. Health promotion is a process which a practice can use to help patients improve their health and wellbeing. Health promotion can involve a range of activities, from encouraging and advertising flu vaccines, to promoting the importance of cancer screening.
During our previous inspection, we also found that the practice did not have a system or a rolling programme for carrying out clinical audits. Furthermore, the practice did not have a clear action plan for patients experiencing poor mental health. The practice’s complaints response did not refer patients to other organisations for example the Ombudsman, if a patient wished to escalate their complaint. Finally at our previous inspection, we also found that the practice needed to review the feedback offered by patients, to help improve services.
As a result of these issues, the practice was previously rated as requiring improvement in effective services, and good for safe, caring, responsive and well led services. This meant that the practice had an overall rating of good.
We carried out a desk based inspection in October 2016 to ensure the practice had made improvements since our last inspection. The practice sent us evidence in the form of letters to patients, patient information leaflets in a number of different languages, and health posters to demonstrate the wide range of improvements they had made since our last visit. The practice also further supplied an audit schedule; this outlined the different audits which were carried out in the practice and how often each audit should take place. Finally the practice was able to provide further supporting evidence, in the form of statistical figures, to demonstrate the impact that changes made to their patient population. We found the practice had made significant improvements since our last inspection in February 2016.
At this inspection we found that:
The practice had reviewed and updated its bowel cancer screening policy.
The practice had reviewed and updated its breast cancer screening policy.
The practice had reviewed and updated its cervical screening policy.
The practice developed a patient information leaflet explaining the importance of cervical screening.
Systems were now in place to promote the benefits of cervical, breast and bowel screening.
The practice had advised us that they had employed an additional member of staff to help monitor the uptake of flu vaccines within the practice.
The practice had made changes to their website; this included a link to the NHS choices flu webpage for more information.
The practice developed an audit schedule, outlining the different audits and when each would take place.
Systems were now in place to monitor and improve services through the use of a clear programme of audits.
The practice was able to demonstrate the impact of improvements to patient uptake of health promotion services.
The practice was able to demonstrate evidence of action taken to improve the outcomes for patients experiencing poor mental health.
The practice had reviewed and updated their complaints policy and procedures. This ensured that within response to complaints, patients were given the necessary information of the complainant’s right to escalate the complaint to the Ombudsman if dissatisfied with the response.
The practice was able to demonstrate evidence that patient feedback was taken into account regarding practice issues.
Following this desk based inspection we rated the practice as good for providing effective services. The overall rating for the practice remains good. This report should be read in conjunction with the full inspection report of 3 February 2016. A copy of the full inspection report can be found at www.cqc.org.uk.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
10 March 2016
The practice is rated as good for the care of patients with long-term conditions.
- There were clinical leads for 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 patients with long term conditions had a named GP and a structured annual review to check that their health and medicines needs were being met.
- The practice was proactively screening for diabetes and identified 60% new diabetic patients in the last two years which had significantly increased the workload.
- 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.
10 March 2016
The practice is rated as good for the care of families, children and young patients.
- 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 patients who had a high number of A&E attendances.
- Immunisation rates were comparable for all standard childhood immunisations.
- Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.
- The practice’s uptake for the cervical screening programme was 57%, which was lower than the national average of 82%.
- 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.
10 March 2016
The practice is rated as good for the care of older patients.
- The practice offered proactive, personalised care to meet the needs of the older patients in its population.
- It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
- The percentage of patients aged 65 or over who received a seasonal flu vaccination was lower (66%) than the national average (73%).
- The premises were accessible to those with limited mobility. However, the front door was not automated and the practice did not provide a low level desk at the front reception.
- There was a register to manage end of life care.
- There were good working relationships with external services such as district nurses.
10 March 2016
The practice is rated as good for the care of working-age patients (including those recently retired and students).
- The needs of the working age population, those recently retired and students had been identified. For example, the practice offered extended hours appointments (Monday to Friday from 6:30pm to 8pm, and every Saturday and Sunday from 9am to 1pm) at Crosby House Surgery (funded by Prime Minister’s Access Fund) as part of cluster arrangements with other local practices.
- The practice was proactive in offering online services.
- Health promotion was not monitored effectively and there was a low uptake for health screening which did not reflect the needs for this age group.
10 March 2016
The practice is rated as good for the care of patients experiencing poor mental health (including patients with dementia).
- 85% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
- 41% of patients experiencing poor mental health were involved in developing their care plan in last 12 months. We saw care plans were not always agreed and signed by the patients.
- The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
- The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations.
- Systems were in place to follow up patients who had attended accident and emergency, when experiencing mental health difficulties.
- Staff had a good understanding of how to support patients with mental health needs and dementia.
10 March 2016
The practice is rated as good for the care of patients whose circumstances may make them vulnerable.
- The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice did not have any homeless patients or travellers.
- It offered annual health checks for patients with learning disabilities. Health checks were completed for 13 patients out of 18 patients on the learning disability register.
- Longer appointments were offered to patients with a learning disability.
- The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
- 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.