Parrock Street Surgery

Updated 20 April 2017

Dr Siraj Shah is situated in Gravesend, Kent and has a registered patient population of approximately 2750. The practice is housed in an adapted building which has been extensively renovated providing improved access to patients and an improved working environment for staff. The premises has consulting and treatment rooms based on the ground floor and administration rooms and a meeting/training room on the first floor. The building is accessible for patients with mobility issues and those with babies/young children. There are parking facilities available in a public car park next to the practice.

The practice patient population mostly compares to the England average in terms of age distribution, however, there are more patients from the age of 0 and 4, more male patients from the age of 25 and 34 and more female patients from the age of 25 and 29.

It is in an area where the population is considered to be more deprived. On the Indices of Multiple Deprivation (IMD) decile the practice is rated at 4 across England, with 1 being most deprived and 10 being least deprived. The practice is the 5th most deprived borough within the county of Kent. The practice serves a large Asian and Afro-Caribbean community.

The practice provider registration consists of one GP partner (male) and one practice manager partner. There is one practice nurse and administration and reception staff. Three partners from a separate practice have recently joined Dr Shah, each working one day a week. One of these partners is female and she provides patients with access to a female practitioner. The two practices work together to share resources and personnel and to provide patients with a wider range of services. There is also a male salaried GP who works one day each week.

The practice is not a teaching or training practice (teaching practices have medical students and training practices have GP trainees and FY2 doctors).

The practice has a Primary Medical Services contract with NHS England for delivering primary care services to the local community.

The practice is open from Monday to Friday from 8.30am until 1pm and from 2pm until 6.30pm. The telephone lines are open from 8am and during the lunch break period. Extended hours appointments are available every Monday evening from 6.30pm until 8pm with a GP or a practice nurse. In addition to routine appointments that can be booked in advance, urgent on the day appointments are available for people that need them. Appointments can be booked over the telephone, online or in person at the practice. There are arrangements with other providers (Integrated Care 24) to deliver services to patients outside of the practice’s working hours.

The practice runs a number of services for its patients including; family planning; minor surgery; chronic disease management; NHS health checks; immunisations and travel vaccines and advice.

Services are provided from: Parrock Street Surgery, 186 -187 Parrock Street, Gravesend, Kent DA12 1EN.

Updated 20 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Siraj Shah on 21 February 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.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff understood their responsibilities to raise concerns and report incidents and were fully supported to do so.
• Safeguarding vulnerable adults, children and young people was given priority. Staff took a proactive approach to safeguarding, responded appropriately to signs or allegations of abuse and engaged effectively with relevant organisations to implement protection plans.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Patients had comprehensive assessments of their needs, which included consideration of clinical needs, mental health, physical health and wellbeing. Care and treatment was regularly reviewed and updated.
• Data from the Quality and Outcomes Framework showed patient outcomes were below or comparable to the national average. However, The practice did not consistently use the Quality and Outcomes Framework and the data was therefore not reliable.
• The practice used a system of searches, flags and pop up alerts to identify the care and treatment needs of patients with long-term conditions.
• Clinical audits were carried out and these were completed audits which demonstrated quality improvement.
• The practice’s uptake for the cervical screening programme was 65%, which was highlighted as a significant negative variation from the clinical commissioning group (CCG) average of 87% and the national average of 81%. However, the practice had a consistent high level of non-attenders, and provided clear evidence of regular follow ups to engage these patients.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 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.
• The practice had a higher than average level of patients with diabetes.
• The practice had committed to a CCG driven diabetes pilot, where a Specialist Nurse Practitioner held two clinics per month and supported patients with diabetes.
• 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 20 April 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 variable 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 provided support for premature babies and their families following discharge from hospital.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications and were able to demonstrate this.

Updated 20 April 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. For example, 100% of patients who were unable to get to the practice had received their flu vaccine.
• 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.

Updated 20 April 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, for example, extended opening hours on a Monday evening until 8pm.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Ultra-sound scanning (unfunded) was available at the practice and was offered to patients in place of pregnancy tests.

Updated 20 April 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.
• 67% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG and national average of 84%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 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 acted to support patients in mental health crises.
• 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 20 April 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, asylum seekers in sheltered housing, and those with a learning disability.
• 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 and ensured that where vulnerable patients did not attend they were telephoned and an alternative appointment arranged.
• 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.