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Dr Qamar Siddiqi Good Also known as Cambridge House Surgery

Inspection Summary


Overall summary & rating

Good

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Qamar Siddiqi on 18 September 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

  • Staff knew how to and understood the need to raise concerns and report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and acted upon.
  • Risks to patients were assessed and well managed.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
  • Best practice guidance was used to assess patients’ needs and plan and deliver their care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patient information, including how to complain was available and easy to understand.
  • Patients told us they could get an appointment when they needed one, often on the same day.
  • Although the building was owned by a landlord, the GP had invested in modernising patient areas and fitted appropriate aids and adaptations to support patients with reduced mobility and /or patients with pushchairs.
  • There was a clear leadership structure and staff felt supported by management.

We saw several areas of outstanding practice including:

  • The GP had systems in place to access test results and correspondence remotely when on leave. They did this to provide continuity of care when locum cover was being used. We saw a letter from the Royal College of General Practitioners about a patient who had written to them praising the GP as they had chased up results whilst on leave to avoid any delay in treatment.

  • The GP organised and participated in a monthly walking club with patients. Any patient plus family members were welcome to attend for a brisk 30 minute walk around a local park. Numbers had steadily increased to around 20 people (some of whom are not registered at the practice). The practice used social media to advertise the date of the walk, and receive feedback from patients.

  • A pre-Christmas lunch was organised for all patients but especially for those who were vulnerable or would be alone at Christmas. The practice told us numbers had increased year on year and approximately 20 patients attended last year.

  • The GP had been involved in developing a pilot project called ‘Active Families Programme’. This was a 10 week programme to educate the family as a whole about good eating habits and exercise. The project was due to be introduced in all practices within Stoke on Trent.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Carry out routine checks on the water system to reduce the risk of legionella.
  • Ensure that records demonstrate that the defibrillator and oxygen have been checked.
  • Ensure the full employment histories are obtained when recruiting staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 December 2015

The practice is rated as good for providing safe services. There was a system in place for reporting, recording, monitoring and reviewing significant events, Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed although the practice did not carry out any routine checks relating to legionella. There were enough staff to keep patients safe.

Effective

Good

Updated 10 December 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were average for the locality. Staff referred to guidance from National Institute for Health and Care Excellence and used it routinely. The GP oversaw any changes to guidelines. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles. The practice worked closely with the Integrated Local Care Team (with representatives from both health and social care services) to ensure care plans were in place and regularly reviewed for patients with complex needs and / or at risk of unplanned admissions.

The GP had systems to place to access test results and correspondence remotely when on leave, to ensure continuity of care when locum cover was being used.

Caring

Good

Updated 10 December 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for several aspects of care. Patients told us they were treated with compassion, dignity and respect. Patients told us the GP treated them as an individual, listened to what they had to say and explained everything clearly. They described staff as being helpful and caring. Good systems were in place to support carers and patients to cope emotionally with their health and condition. Information to help patients understand the services available was easy to understand. Views of external stakeholders such as other health care professionals were positive and aligned with our findings.

Responsive

Good

Updated 10 December 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the local Clinical Commissioning Group (CCG) to plan services and to improve outcomes for patients. One CCG priority was tackling the high percentage of overweight children within the area. The practice had taken part in a pilot project called ‘Active Families Programme’. This was a 10 week programme to educate the family as a whole about good eating habits and exercise. Patients told us they could get an appointment when they needed one, often on the same day. The practice had arrangements in place with a neighbouring practice to provide a female GP if requested. The practice had good facilities and was equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

Well-led

Good

Updated 10 December 2015

The practice is rated as good for being well-led. The practice had a clear vision to deliver leading evidence-based, person-centred care. The practice described the short, medium and long term objectives to develop and improve the service. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active. Staff had received inductions, regular performance reviews and attended staff meetings and events. The practice was a research accredited practice with Keele University and had been involved in three research projects.

Checks on specific services

People with long term conditions

Good

Updated 10 December 2015

The practice is rated as good for the care of people with long-term conditions. We found that the locum practice nurse had the knowledge, skills and competency to respond to the needs of patients with a long term condition such as diabetes and asthma. Longer appointments and home visits were available when needed. The practice maintained registers of patients with long term conditions and all of these patients were offered a review to check that their health and medication needs were being met. The practice reviewed the most vulnerable four percent of the practice population who were at risk of admission. Written management plans had been developed for these patients as well as those with long term conditions. For those people with the most complex needs, the GPs worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Outstanding

Updated 10 December 2015

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 who were at risk, for example, children with complex needs, families under stress and families with children in need or on children protection plans. Appointments were available outside of school hours and the premises were suitable for children and babies. Same day emergency appointments were available for children. There were screening and vaccination programmes in place although a number of the immunisation rates were below the local Clinical Commissioning Group average. New mothers and babies were offered post natal checks.

The GP was aware of the high percentage of overweight children within Stoke-on-Trent when compared against the national average. As a consequence the GP had taken part in a pilot project called ‘Active Families Programme’. This was a 10 week programme to educate the family as a whole about good eating habits and exercise. The results from the first cohort of families demonstrated improvements, for example decrease in body mass index and waist size. The practice was part of the Developing Adolescent Sexual Health (DASH) project. DASH GPs are young person-friendly practices which offer condoms, lubricant, pregnancy testing and B-Clear Chlamydia testing for all aged 15-24. Young patients present a card with different colours on each side which alerts reception staff to the service the young person required.

Older people

Good

Updated 10 December 2015

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 population and had a range of enhanced services, for example, in dementia and shingles vaccines. Routine home visits were carried out to access any physical, mental or social needs that they may have and referrals were made to other services as required. It was responsive to the needs of older people, who were offered open access to appointments in order to facilitate early treatment and reduce admissions. The practice identified if patients were also carers and offered support and advice, and information about carer support groups was available in the waiting room.

The practice had been involved in a recent trial where a geriatrician visited the practice and reviewed a number of patients with more complex needs. Their condition was assessed and medication altered as required. This saved patients having to attend clinic at the hospital.

Working age people (including those recently retired and students)

Good

Updated 10 December 2015

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 range of on-line services were available, including medication requests, booking appointments and access to health medical records. The practice offered extended hours with the practice nurse between 7.30am and 9am (when available). Same day telephone consultations were available. The practice offered all patients aged 40 to 75 years old a health check with the nursing team. The practice offered a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice held registers of patients experiencing poor mental health or living with dementia. Ninety six percent of people experiencing poor mental health had received an annual physical health check and medication review, whilst 90% of patients living with dementia had been reviewed. The practice carried out advance care planning for patients living with dementia.

The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice referred patients for talking therapies and encouraged self-referral to the local branch of MIND.

People whose circumstances may make them vulnerable

Good

Updated 10 December 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice provided a pre-Christmas lunch for all patients but especially for those who were vulnerable or would be alone at Christmas.

The practice held a register of patients with a learning disability and had developed individual care plans for each patient. The practice carried out annual health checks and offered longer appointments for patients with a learning disability. There were 14 patients on the register and currently five had received their annual physical health check and medication review for 2015 / 2016.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. 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.