Archived: Dr Surraiya Zia

Updated 23 November 2016

Dr Surraiya provides primary medical services in Enfield to approximately 2800 patients and is one of 49 member practices in the NHS Enfield Clinical Commissioning Group (CCG).

The practice population is in the fifth least deprived decile in England. It had a greater than CCG and national average percentage of patients with long standing health conditions (61% compared to a CCG average of 52% and a national average of 54%). The practice population has a lower than average percentage of people aged under 18. The practice had surveyed the ethnicity of the practice population and had determined that 33% of patients identified as having white ethnicity, 39% Asian, 15% black and 13% as having mixed or other ethnicity.

The practice operates from a converted shop with all patient facilities on the ground floor that are wheelchair accessible. The offices for administrative and management staff are also on the ground floor.

The practice operates under a General Medical Services (GMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract). The enhanced services it provides are: childhood vaccination and immunisation scheme; extended hours access; facilitating timely diagnosis and support for people with dementia; influenza and pneumococcal immunisations; minor surgery; rotavirus and shingles immunisation; and unplanned admissions.

The practice team at the surgery is made up of one part-time female GP principal along with one part-time male locum GP. At the time of our visit the principal GPs clinical sessions were being covered by a number of different locum GPs. There is one part-time practice nurse and a full-time health care assistant (HCA). The doctors provide 11 clinical sessions per week.

There are seven administrative, reception and clerical staff including a full-time practice manager, and a full-time deputy practice manager. There is also a full-time cleaner.

The practice is open between:

8.00am and 8.00pm Monday and Tuesday;

8.00am and 7.00pm Wednesday to Friday;

9.00am and 4.00pm Saturday.

GP appointments are from:

Monday to Friday 9.00am to 12.00pm and 3.00pm to 6.30pm

Nurse appointments are from:

Thursday 2.00pm to 5.50pm, Friday 2.00pm to 6.50pm, Saturday 9.30am to 12.30pm

Extended surgery hours are offered from 6.30pm until 8.00pm On Tuesdays. The practice has opted out of providing out of hours (OOH) services to their own patients and directs patients to the OOH provider for NHS Enfield CCG.

Dr Zurraiya Zia is registered as a sole principal GP with the Care Quality Commission to provide the regulated activities of: diagnostic and screening procedures; maternity and midwifery services; family planning; treatment of disease, disorder or injury; and surgical procedures.

Dr Surraiya Zia has not previously been inspected by CQC.

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Surraiya Zia on 25 May 2016. Overall the practice is rated as requires improvement.

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

• The practice was not carrying out pre-employment checked for all new employees, this included not obtaining Disclosure and Barring Service (DBS) checks to ensure that employment was not offered to candidates who may be unsuitable for certain work.
• The practice had a legionella risk assessment which found that there was no legionella present, but had not acted on other recommendations in the report.
• The practice had not disposed of some out of date vaccines that remained in the vaccines fridge. Nor was it recording the temperature of the vaccines fridge.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary pre-employment checks for all staff as set out in schedule three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Ensure that all staff receive a DBS check or suitable risk assessment of the need.

• Ensure that vaccines are stored and disposed of in line with Department of Health guidelines, and implement a system to monitor the temperature of the vaccines fridge.

• Ensure that it actions work identified in its Legionella risk assessment report.

• Ensure that it improves governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

In addition the provider should:

• Consider providing bookable advance appointments.

• Review and take action to address lower scoring areas of the GP patient survey results to increase patient satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 November 2016

The practice is rated as requires improvement for the care of people with long term conditions. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Patients were not able to book advance appointments.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 95% of patients with diabetes, on the register, had a last blood pressure reading (measured in the preceding 12 months) of 140/80 mmHg or less (CCG average 76%, national average 78%).

• 99% of patients with diabetes, on the register, had had influenza immunisation in the preceding 1 August to 31 March (CCG average 92%, national average 94%).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP.

Updated 23 November 2016

The practice is rated as requires improvement for the care of older people families, children and young people. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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. Immunisation rates were comparable to local averages 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, and we saw evidence to confirm this.

• 86% of women aged 25-64 had had a cervical screening test performed in the preceding five years (CCG average 81%, national average 82%).

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 23 November 2016

The practice is rated as requires improvement for the care of older people. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice held monthly meetings with a pharmacist, social worker, district nurse and community matron to discuss at risk patients.

Updated 23 November 2016

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 offering a range of health promotion and screening that reflects the needs for this age group.

• The practice offered nurse appointments on Saturday mornings as well as extended hours appointments on Tuesday evenings for patients who could not attend during working hours, however, patients could not book appointments in advance.

Updated 23 November 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had had their alcohol consumption recorded in the preceding 12 months (CCG average 90%, national average 90%).

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 November 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.