Archived: The Shehadeh Medical Centre

Updated 3 December 2015

Dr Emil Shehadeh is a GP registered with the Care Quality Commission (CQC) as an individual provider.

The provider has two locations registered with CQC. One in Grays (The Shehadeh Medical Centre), the other in Tilbury (Dr Emil Shehadeh). The provider holds a Personal Medical Services contract with NHS England which covers both locations. Around 10,000 patients are registered between the two locations. Our inspection looked solely at the practice in Tilbury (Dr Emil Shehadeh).

Approximately 4,900 patients are currently registered at the Tilbury location, although patients can access services at either site. The practice is open from 8am to 6:30pm on Monday, Tuesday, Wednesday and Friday and from 8am to 7:30pm on a Thursday.

Published demographic data covers both locations. The practice has a higher number of younger than older patients. The number of patients under the age of 18 makes up 18% of total patients. This is higher than the national average of 14.8%. Patients over the age of 65 account for 10.4% of total patients; this is lower than the national average of 16.7%. The practice area has a higher level of deprivation when compared with the national average. For example, the rate of income deprivation affecting children is 29% higher than the national average. All of these factors can increase the demand on GP practices.

Four GPs (two male, two female) assisted by locum GPs when required provide clinical care over both sites. The nursing team comprises of two advanced nurse practitioners, a practice nurse and healthcare assistant. Administrative staff employed directly at Tilbury include a practice manager and five receptionists.

The practice does not provide out-of-hours services to registered patients. These services are provided by South Essex Emergency Doctors Service (SEEDS) and are accessed by telephoning NHS 111.

Updated 3 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Emil Shehadeh on 14 October 2015. This inspection was in follow up to our previous comprehensive inspection at the practice on 2 December 2014 where breaches of legal requirements were found. The overall rating of the practice following the 2014 inspection was inadequate and the practice was placed into special measures for a period of six months. After the December 2014 inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to safe, effective and well-led services.

At our inspection on 14 October 2015 we found that the practice had improved. The two requirement notices we issued following our previous inspection related to the safe and effective delivery of care and both had been met. The ratings for the practice have been updated to reflect our recent findings. The practice is rated as requires improvement overall, and specifically requires improvement for providing safe and well led services, and good for providing effective, caring and responsive services.

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:

• Arrangements to safeguard children and vulnerable adults by the detection of suspected non-accidental injury were robust and well managed.

• Patients told us that they felt well cared for and were treated with dignity and respect.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients told us that it was easy to contact the practice and they could get an appointment when they needed one.

• Risks relating to infection prevention and control also ensuring staff had received the necessary training required better management.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that the risks to patients, staff and visitors from healthcare associated infections are minimised by establishing, and if required taking action on, the immunity of staff to vaccine preventable illnesses.

• Ensure that accurate and required records are kept of staff members’ suitability for employment and have oversight of the training they have undertaken.

In addition the provider should:

• Consider the implementation of guidance issued by Public Health England on the storage of vaccines. In particular, consideration of a second method of checking fridge temperature that is independent of mains power. Also, to minimise the risk of mains power to the fridge being turned off unintentionally.

• Review the practice infection prevention and control policy and appoint responsibility and governance to a suitably trained and skilled person to carry out the role.

• Expand practice held emergency medicines to include treatments for a sudden drop in a patient’s responsiveness level due to hypoglycaemia (low blood sugar) or prolonged seizures (fitting).

• Evaluate the methods of gathering feedback from patients, to ensure they reflect a wider representation of patients registered at the practice.

I confirm that this practice has improved sufficiently to be rated requires improvement overall. This practice will be removed from special measures.

Further progress must be made; therefore we will re-inspect the practice in 2016 to ensure the requirements of further improvements detailed in this report have been met.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 December 2015

The provider was rated as good for effective, caring and responsive services overall and this includes for this population group. The provider was rated as requires improvement for safety and for well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

All clinical staff took lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication 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. Nationally reported data from 2013/14 showed that outcomes for patients with long-term conditions were in line with others. For example, 88.3% of patients with diabetes had received a recent blood test that indicated their longer term blood glucose control was below the highest accepted level. This was similar to the clinical commissioning group (CCG) average of 84% and national average of 87.1%.

Updated 3 December 2015

The provider was rated as good for effective, caring and responsive services overall and this includes for this population group. The provider was rated as requires improvement for safety and for well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There was a formal system in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Immunisation rates were in line or higher than the local and national averages for all standard childhood immunisations. 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. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 3 December 2015

The provider was rated as good for effective, caring and responsive services overall and this includes for this population group. The provider was rated as requires improvement for safety and for well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in 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 avoiding unplanned hospital admissions. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. All patients over the age of 75 had a named GP.

Updated 3 December 2015

The provider was rated as good for effective, caring and responsive services overall and this includes for this population group. The provider was rated as requires improvement for safety and for well-led services. The concerns which led to these ratings apply to everyone using the practice, 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 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.

Updated 3 December 2015

The provider was rated as good for effective, caring and responsive services overall and this includes for this population group. The provider was rated as requires improvement for safety and for well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Ninety per cent of patients with dementia who were on the related practice register had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia. It 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. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 3 December 2015

The provider was rated as good for effective, caring and responsive services overall and this includes for this population group. The provider was rated as requires improvement for safety and for well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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