Archived: Dr Shada Parveen Also known as Maybury Surgery

Updated 14 March 2018

Dr Shada Parveen is also known as Maybury Surgery and offers general medical services to people living and working in Woking. The practice population (2,300 patients) has a significantly higher than average proportion of working patients and also patients that are unemployed. There is a higher proportion of children under the age of 18 and a below average proportion of older patients. There is higher deprivation affecting older people and children. The practice population has a high proportion of Asian and Eastern European patients. The practice is placed in the sixth least deprived decile.

The practice holds a General Medical Service contract and is led by one female GP. At the time of this inspection the GP providing the service is different from the GP registered with CQC as the provider. We were told that the practice was going through a change of management. The GP is supported by a locum GP (male), a locum practice nurse, a healthcare assistant, a business manager and a team of reception and administrative staff. A range of services are offered by the practice including asthma reviews, child immunisations, diabetes reviews, new patient checks, and smoking cessation.

The practice was open between 8.30am and 6.30pm Monday to Friday. Between 8am and 8.30am access to the practice was through an out of hour’s provider (Care UK). The practice does not offer extended hours appointments but does run a drop in service two mornings a week on a Tuesday and Thursday. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments were also available for people that needed them. The practice has opted out of providing Out of Hours services to their patients. When the practice is closed patients are advised to call NHS 111 where they will be given advice or directed to the most appropriate service for their medical needs.

The service is provided from the following location:

The Maybury Surgery

Alpha Road

Woking

Surrey

GU22 8HF

Updated 14 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Shada Parveen (also known as The Maybury Surgery) on 15 November 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. We carried out a focused inspection on 26 April 2017 to ensure that the practice had complied with legal requirements. We reviewed the safe, effective and well led domains and found these still to be inadequate. Therefore the practice remained in special measures. The full comprehensive report on the 15 November 2016 and the focused report on the 26 April 2017 inspection can be found by selecting the ‘all reports’ link for Dr Shada Parveen on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection undertaken on 26 September 2017, following the period of special measures. The practice has failed to adequately improve and overall the practice remains rated as inadequate.

Our key findings at this inspection in September 2017 were as follows:

• We received positive feedback from patients who said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• There was an effective system for identifying, risks and issues. However it was not always clearly recorded when mitigating actions had been completed.
• The practice had a number of policies and procedures to govern activity, although a few contained out of date or missing information.
• The practice proactively sought feedback from staff and patients, which it acted on.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events, and learning from significant events and complaints was shared to support improvement.
• The practice had identified the needs of its population and was working closely with a community link worker to support the population.
• Staff felt supported by management; however the leadership structure was not clear.
• The practice proactively sought feedback from staff and patients, which it acted on.

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

The provider must:

• Ensure that recruitment checks, including indemnity insurance and Disclosure and Barring, are completed for all staff including locums prior to starting work in the practice.
• Ensure that training records are maintained for all staff, including locums, to ensure that they have the skills, knowledge and experience to deliver effective care and treatment.
• Ensure that a clear leadership structure is in place with roles and responsibilities clearly defined.
• Ensure that computer printable prescription paper is stored securely.
• Ensure that systems for safety checking within the practice are completed and monitored, including medicine and consumable expiry dates and infection control.

The provider should:

• Review the emergency medicines held on site.
• Continue to review and update practice policies.
• Review and improve uptake of health screening by patients within the practice.

Although I recognise improvement made to the quality of care provided by the service, the practice had failed to make sufficient improvement in some areas. I am therefore extending the period of special measures for a further six months.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 March 2018

Our inspection in November 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of people with long-term conditions.

At this inspection in September 2017 we saw improvements, however in some areas these were not sufficient and the practice remains rated as inadequate overall. Concerns found affected all patients including this population group.

• The practice was performing in line with the local and national averages for Quality and Outcomes Framework clinical indicators.
• Longer appointments and home visits were available when needed.

Updated 14 March 2018

Our inspection in November 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of families, children and young people.

At this inspection in September 2017 we saw improvements, however in some areas these were not sufficient and the practice remains rated as inadequate overall. Concerns found affected all patients including this population group.

• 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 accident and emergency attendances. Data available to CQC indicated that immunisation rates were below the 90% target level for two year old standard childhood immunisations. The practice has provided unverified data for 2016-17 that showed they had met the 90% target level for all childhood vaccinations.
• 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.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable with the clinical commissioning group average of 80% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors.

Updated 14 March 2018

Our inspection in November 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of older people.

At this inspection in September 2017 we saw improvements, however in some areas these were not sufficient and the practice remains rated as inadequate overall. Concerns found affected all patients including this population group.

• The practice offered personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offered integrated care with a locality health hub to reduce hospital admissions.

Updated 14 March 2018

Our inspection in November 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of working age people.

At this inspection in September 2017 we saw improvements, however in some areas these were not sufficient and the practice remains rated as inadequate overall. Concerns found affected all patients including this population group.

• 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 did not offer formal extended hours appointments but did offer some flexible appointments for patients who were unable to attend during normal surgery hours.
• The practice also offered walk in clinics two mornings a week, which was in response to patient feedback.
• 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. However patients told us they had difficulty finding appointments that they could book online.

Updated 14 March 2018

Our inspection in November 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of people experiencing poor mental health.

At this inspection in September 2017 we saw improvements, however in some areas these were not sufficient and the practice remains rated as inadequate overall. Concerns found affected all patients including this population group.

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the local average of 85% and the national average of 84%.
• 100% of patients with severe and enduring mental health problems had a comprehensive care plan documented in their records within the last 12 months which was comparable to the local average of 92% and the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice facilitated self-help and contact with counselling services for patients.
• 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 14 March 2018

Our inspection in November 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of people whose circumstances may make them vulnerable.

At this inspection in September 2017 we saw improvements, however in some areas these were not sufficient and the practice remains rated as inadequate overall. Concerns found affected all patients including this population group.

• 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.
• The GP partners offered flexible appointment times for patients who had difficulty with transport to the surgery.