Archived: Dr Shiba Hameed

Updated 11 August 2017

Dr Shiba Hameed/Heathfield Surgery provides primary medical services in South Croydon to approximately 2800 patients and is one of 58 practices in Croydon Clinical Commissioning Group (CCG). The practice population is in the fourth most deprived decile in England.

The practice population has a higher than CCG and national average representation of income deprived children and older people. The practice population of children is lower than the CCG and in line with the national average and the practice population of working age people is higher than the CCG and national averages; the practice population of older people is lower than the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded 25% are White British, 10% are other White and 3% are mixed.

The practice operates in converted premises. All patient facilities are wheelchair accessible. The practice has access to two doctors’ consultation rooms and one nurse consultation room on the ground floor.

The clinical team at the surgery is made up of one part-time female lead GP and one part-time female long-term locum GP, one part-time male long-term locum nurse practitioner and one part-time female practice nurse. The non-clinical practice team consists of practice manager and five administrative and reception staff members. The practice provides a total of seven GP sessions per week and the nurse practitioner provides three sessions per week.

The practice has experienced a number of management changes over the last few years and is currently supported by the local medical committee and NHS England.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice reception and telephone lines are open from 8am to 6:30pm Monday to Friday. Appointments are available from 8:30am to 1pm and from 4pm to 6:30pm Monday to Friday.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8:00am and directs patients to the out-of-hours provider for Croydon CCG.

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury.

The lead GP of the practice has recently changed and the provider had informed NHS England and they were in the process of changing the partnership to an individual provider. The provider informed us that they will also be changing their registration with CQC. The practice is providing maternity and midwifery services and family planning services; the practice is planning to register for these regulated activities as part of the change in registration application.

Updated 11 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Shiba Hameed / Heathfield Surgery on 25 October 2016. The overall rating for the practice was requires improvement with requires improvement for safe, effective, caring and well-led. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Shiba Hameed on our website at www.cqc.org.uk.

This announced comprehensive inspection was undertaken on 15 June 2017. The provider had made improvements in most of the areas where issues were identified in the inspection in October 2016, in particular in safe. However there were still improvements to be made and the practice remains rated as requires improvement for effective, caring and well-led.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. We reviewed a sample of patient records and found that the care was delivered in line with current evidence based guidance. However the data
• 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.
• The practice offered a daily GP led telephone triage. The patients were put on a telephone triage list when they called for an appointment and the duty GP called and spoke to patients and they were provided same day or urgent appointments as required. The practice had recently started offering longer GP sessions which they said had reduced their appointment waiting times.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• T he lead GP was new and settling into their role which meant they were developing the leadership within the practice.
• The practice proactively sought feedback from staff and patients, which it acted on. The practice had recently re-established its Patient Participation Group and sought feedback from patients through this.
• The provider was aware of and complied with the requirements of the Duty of Candour.

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

Importantly, the provider must:

• Ensure that all patients’ needs are identified and care and treatment is provided to meet their needs.

In addition the provider should:

• Review practice procedures to ensure the uptake of cervical screening, childhood immunisations and breast and bowel cancer screening are improved.
• Consider undertaking internal clinical meetings on a regular basis.
• Consider increasing the provision of GP sessions.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 11 August 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The national Quality and Outcomes Framework (QOF) data showed that 57% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 70% and the national average of 78%. We saw 63% of patients with diabetes had received a foot examination in the preceding 12 months which was below the CCG average of 87% and national average of 89%. Unpublished data for 2016/17 provided by the practice indicated an improvement in the diabetes indicators.
• The national QOF data showed that 76% of patients with asthma in the register had an annual review, compared to the CCG average of 74% and the national average of 76%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• While there was a system to recall patients for a structured annual review, records did not demonstrate these patients care and needs were always being met. 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.

Updated 11 August 2017

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

• From the sample of documented examples we reviewed we found 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• 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 patients had access to GP led 6 week mother and baby checks.

Updated 11 August 2017

The practice is rated as requires improvement 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.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• All practice patients had a named GP.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• The practice lead GP undertook weekly visits for three local nursing and residential homes supporting the needs of the residents.

Updated 11 August 2017

The practice is rated as requires improvement for the care of working age people (including those recently retired and students).

• The needs of these patients had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.
• 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.
• The practice offered catch up programme for students aged 17 and above for MMR and Men C vaccination.

Updated 11 August 2017

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

• Records indicated that 93% of 65 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average of 86% and national average of 89%.
• The practice carried out advance care planning for patients living with dementia.
• All the patients with dementia had received an annual review which was above the Clinical Commissioning Group (CCG) average of 83% and national average of 84%.
• 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 various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency 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 11 August 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers, carers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability. Only 30% (7 patients) out of 23 patients with a learning disability had received a health check in the last year.
• 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 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 various 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.