Dr Mahmud & Partners Also known as Church View Surgery and Jones Fam1-ily Practice

Updated 27 September 2017

Dr Mahmud & Partners situated at Burley House 15 High Street, Rayleigh, Essex is a GP practice which provides primary medical care for approximately 14,800 patients living in Rayleigh and the surrounding areas. There is a branch, the Jones Family Practice, situated in Southend Road, SS5 4PZ at the nearby village of Hockley. The practice maintains one patient list and patients can consult at any of the above locations. We did not inspect the Hockley branch at this time.

Dr Mahmud & Partners provide primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. The practice population is predominantly white British along with a small ethnic population of Asian and Eastern European origin.

The practice currently has five GPs partners (two female and three male). There are two other male salaried GPs. The registered manager told us that the practice was in the process of changing their partnership. There are two practice nurses who are supported by two health care assistants and a phlebotomist. There is a practice manager who is supported by a team of administrative and reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

The practice operates out of a two storey building. Patient care is provided on the ground floor. There is a pay and display car park nearby with disabled parking available on the main street near the practice.

The practice is open Monday to Friday from 8am to 6.30pm. There are a variety of access routes including telephone and web consultations, on the day appointments and advance pre bookable appointments.

When the practice is closed services are provided by Integrated Care 24 Limited via the 111.

Updated 27 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mahmud & Partners 10 August 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. Lessons learnt were shared to make sure action was taken to improve safety in the practice.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect. However some aspects of GP interactions with patients and access to care and treatment were rated below the local and national averages. Despite the improvements implemented since the last national GP patient survey these improvements had not filtered through in positive patient responses in the latest 2017 national GP patient survey.
• 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.

• Six out of eight patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

A dedicated GP provided pre diabetic care and proactively managed medicine compliance and diabetes reviews regularly through reminder letters, phone calls or text messages. This work had resulted in targeted management of patients with diabetes, for example good control in blood glucose readings of patients with diabetes. This GP also provided training for GPs and nurses to raise the standards of diabetes care and to provide individualised care for patients. The training is called the EDEN project (Effective Diabetes Education Now). The GP had published a paper in a health journal about management of blood glucose in type 2 diabetes and had contributed to a section about when to intensify glucose lowering therapy in the prescribing reference guide (MIMS) for general practice. Their contribution to diabetic care was recognised by the Castle Point and Rochford Clinical Commissioning Group (CCG) as a model for use within the wider local health community.

The areas where the provider should make improvement are:

• Undertake an annual infection control audit.

• Continue to identify and support carers.

• Continue to monitor and ensure improvement in patient satisfaction as highlighted in the areas identified by the national GP patient survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 September 2017

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

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

• Performance for diabetes related indicators was comparable to the local and national averages. The practice achieved 85% of available points compared to the CCG average of 82%.

• A dedicated GP provided pre diabetic care and proactively managed medicine compliance and diabetes reviews regularly through reminder letters, phone calls or text messages.

• A dedicated GP provided in house pain control for the oncology and palliative care patient helping them to manage pain control without the need to attend an acute care facility.

• There was a system to identify patients at risk of hospital admission that had attended A&E or the out of hours service and these patients were regularly reviewed to help them manage their condition at home.

• The practice offered monitoring of condition and medicine which required blood tests for example patients on warfarin, chemotherapy or immunotherapy.

• Patients with osteoarthritis were offered in-house joint injections.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met.

• For patients with more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 27 September 2017

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

• There were systems 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.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice’s uptake for the cervical screening programme was 83%, compared to the CCG average of 86% and the national average of 81%.

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

• The practice opportunistically provided joint family clinical assessment.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice offered family planning including the management of intrauterine system and related screening such as chlamydia screening .

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 27 September 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• Patients over 75 had a named accountable GP and were offered the over 75 health check.

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

• For the housebound patient the practice monitored essential wellbeing, medicine compliance and current health needs through telephone consultations.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example eligible older people were offered flu and shingles vaccines.

• The practice supported one care/nursing home. A dedicated GP visited weekly to provide a ward round and provide healthcare including preventative care such as against osteoporosis, deep vein thrombosis (DVT) and skin care.

Updated 27 September 2017

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.

• 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.

• Telephone and web GP consultations were available which supported patients who were unable to attend the practice during normal hours.

• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

• 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.

• A text message reminder system was used so patients could be reminded of forthcoming appointments or sent a short message for example about a normal test result.

• University students were offered confidential or general clinical advice routinely.

Updated 27 September 2017

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

• The practice carried out advance care planning for patients living with dementia.

• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months was 87% where the CCG average was 75% and the national average was 84%.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The percentage of patients with diagnosed psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 94% where the CCG average was 79% and the national average was 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access a number of support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended A&E where they may have been experiencing poor mental health.

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

Updated 27 September 2017

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

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access support groups and voluntary organisations.

• Staff interviewed 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 identified patients who were also carers and signposted them to appropriate support. The practice had identified 51 patients as carers (less than 0.5% of the practice list). of the practice list). The GPs provided information and directed carers to the various avenues of support available to them. The practice offered carers health checks and flu vaccinations.