Archived: Dr Ashraf Zaman Also known as Dr Zaman's Surgery

Updated 24 July 2017

Dr Ashraf Zaman at the Malzeard Road Surgery provides a range of primary medical services from a partly purpose built premises at Malzeard Road, Luton, LU3 1BD. The overall boundary area of the practice is greater Luton. The core area covers the Biscot and Bury Park districts. The practice serves a population of approximately 2,965 patients.

The area served has an above average deprivation rate compared to England as a whole. Approximately 98% of the practice population are from a South Asian and Bangladeshi background. Recently there has been an increase in patients from Eastern Europe. The practice serves a considerably higher than average population between the ages of 0 and 39 years and a considerably lower than average population over the age of 45 years.

The clinical staff team includes a male GP, a nurse practitioner (female) and a part-time practice nurse. The team is supported by a practice manager and a team of administration staff.

The practice is open from 9am to 6.30pm Monday to Friday except Wednesdays when the practice closes at 1pm. The practice does not offer extended hours appointments however telephone consultations are available.

When the practice is closed, out of hours services for patients requiring a GP are provided by either the NHS 111 service or Care UK.

Updated 24 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Zaman on 13 June 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 an effective system in place for reporting and recording significant and ‘near miss ‘events. However there was no analysis of trends.
• Risks to patients were assessed and well managed.
• The practice undertook appropriate recruitment checks including references and professional registration checks.
• The practice had a comprehensive business continuity plan in place for major incidents.

• 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 felt listened to and cared for 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.
• Patients said they found it easy to make an appointment with a named 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 clear 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 evidence of a strong patient centric culture and staff informed us that they were committed to provide high quality, personalised care for patients.
• Staff we spoke to were knowledgeable with regard to their role and the changing needs of the patient population. They demonstrated a kind and caring attitude and were an asset to the clinical team.

The areas where the provider should make improvement are:

• Implement a process to monitor trends from incidents, complaints and significant events.
• Continue to identify and support carers.
• Continue to encourage patients to attend national cancer screening programmes.
• Establish a patient participation group (PPG) to ensure communication and feedback is sought from patients registered at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 24 July 2017

The practice is rated as good 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.
• Performance for diabetes related indicators was comparable with the CCG and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading was 140/80 mmHg or less was 82% above the local CCG average of 73% and the national average of 78%.
• The nurse practitioner held a clinic with the community diabetes nurse to support patients with diabetes and to initiate treatment.
• 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.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were 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 24 July 2017

The practice is rated as good 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. This group of patients were always offered an appointment when required.
• The practice had a designated baby change and breast feeding area on the first floor; a lift had been installed for easy access to this floor.

• 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. These community staff attended practice clinical meetings.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 24 July 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.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They 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.
• Where older patients had complex needs, the practice shared summary care records with local care services. Including referrals to the Home First Team.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 24 July 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Although the practice did not offer extended hours appointments telephone consultations were available.
• 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 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.
• There were a number of access routes to the practice for those patients who were unable to get to the practice during normal hours, for example, the use of the online booking system for appointments. Patients were also able to book a telephone appointment.
• The practice offered the Men ACWY vaccine to young teenagers and first year students going to university to protect them against meningitis (an inflammation of the lining of the brain) and septicaemia (blood poisoning).
• 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’s uptake for the cervical screening programme was 83%, which was above the CCG average of 80% and the national average of 81%.

Updated 24 July 2017

The practice is rated as good for the care of people experiencing poor mental health (including people 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 83% comparable to the local CCG average of 86% and the national average of 84%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. This included care planning and memory assessments.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Performance for mental health related indicators was comparable to the local CCG and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 64% below the local CCG average of 90% and the national average of 89%. The practice recognised this low figure and worked closely with the local mental health professionals and held a weekly clinic to encourage patients to engage with the practice.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• 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 we spoke to demonstrated a good understanding of how to support patients with mental health needs and dementia.

Updated 24 July 2017

The practice is rated as good 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 and those with a learning disability. There were 29 patients on the register of which 17 had received a health check and the remaining number were being actively contacted to attend however it was noted that due to the ethnicity of the population this was often difficult due to long term travel out of the country.
• 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 held a register of patients with learning disabilities and was proactive in remaining them of the importance of health reviews.
• 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 demonstrated awareness of challenges faced with the cultural makeup of the local population and had a holistic approach offering support and guidance for issues outside of general health matters for example, benefits and social care advice.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 17 patients as carers (0.5% of the practice list).