Dr Reshma Rasheed Also known as Chapel street surgery

Updated 10 March 2016

Dr Reshma Rasheed (The Chapel Street Surgery) provides primary care services to a population of approximately 4,500 patients in the Billericay area. The surgery has three female GPs, one male GP and two practice nurses. The practice holds a Personal Medical Services (PMS) contract and is a teaching practice.

The practice population is similar to the national average for younger people and children under four years, and for those of working age and those recently retired. It is slightly higher for older people aged over 75 years. Economic deprivation levels affecting children, older people and unemployment are lower than the practice average across England. Life expectancy for men and women are similar to the national averages. The practice patient list is similar to the national average for long standing health conditions and lower disability allowance claimants. The practice covers one care home.

The Chapel Street surgery is not a dispensing practice but offers the Electronic Prescription Service, which allows patients to choose or "nominate" a pharmacy to get medicines or appliances from.

The surgery is close to the local high street and can be accessed by bus. The premises are not purpose built, and are currently undergoing refurbishments to improve the patient and clinical areas. Disability access by ramps is available but some areas of the practice may restrict access due to being narrow in places. The washroom is not designed for disabled people. The surgery has parking at the front and rear of the premises but no designated spaces for disabled people. Translation services and induction loops are available and several staff speak other languages to assist patients who do not speak English as a first language.

The practice is open between 7am and 6.30pm Monday to Friday. GP and nurse appointments are available between 7am and 12pm and 3.30pm to 6.00pm. Patients are able to book appointments with a midwife between 9am and 12pm on Mondays, and with a counsellor between 1pm and 4pm on Wednesdays. There are practice nurse appointments available between 9am and 1pm on Saturdays.

Emergency appointments are available throughout the day. The practice has opted out of providing GP out of hour’s services. Unscheduled out of hours care is provided by the NHS 111 service and patients who contact the surgery outside of opening hours are provided with information on how to contact the service. The out of hours provision is provided by IC24 and commissioned by Basildon and Brentwood CCG. This information is also available on the NHS choices website. In an emergency patients are advised to dial 999.

Dr Reshma Rasheed was previously inspected in January 2014 by the Care Quality Commission and found to be compliant with the Health and Social Care Act 2008 regulations at that time.

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Chapel Street Surgery on 19 January 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• We found that the service provision at Chapel Street Surgery was safe, effective, caring, responsive and well led. Staff we spoke with were confident to report serious incidents, whistle blow or challenge poor practice.There were arrangements in place to implement good practice and learn from any untoward incidents. There was an open culture that focused on patient safety.

• Risks to patients were assessed and well managed. Information about safety was monitored, appropriately reviewed and addressed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. There were regular multi-disciplinary team discussions to ensure patients’ care and treatment was coordinated and the expected outcomes were achieved.
• We found that staff were supported to participate in training and development which would enable them to deliver effective quality care.
• Patients said they were treated with compassion, dignity and respect, and they were involved in their care and decisions about their treatment. They were complimentary about the dedication of the doctors at the surgery. Information about services and how to complain was available and easy to understand.
• Patients said they could make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. Access on the phone and waiting times were considered too long by patients at times. We saw that actions were being taken to improve these timeframes.
• The premises were not purpose built but ongoing refurbishments maintained an acceptable standard, although access for disabled people was restricted in parts of the surgery. Plans to extend and improve the premises were in place.
• There was a clear leadership structure. All staff were appropriately qualified and competent to carry out their roles safely and effectively in line with best practice.
• The practice had a system in place for staff appraisals, and staff told us they felt valued and supported by the provider.
• The provider was aware of and complied with the requirements of the Duty of Candour. The practice sought feedback from staff and patients, which it acted on.

However, there was an area where the provider should make improvements.

The provider should strengthen systems for recording outcomes and practice changes identified from monitoring the services provided to ensure a clear audit trail that includes discussions with staff, the implementation of action plans and the cascading of learning.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

• The practice is rated as good for the care of people with long-term conditions.The practice performance for the management of long term conditions was similar to or higher than other GP practices nationally.

• Nursing staff had lead roles in chronic disease management, and patients at risk of hospital admission were identified as a priority. These patients were referred to the community care coordinator to support them at home and reduce the risk of readmission to hospital.

• Referrals for people diagnosed with a long term condition or for diagnosis of a long term condition were in line with best practice.

• The practice provided health promotion advice and information, and referred patients to support services to help them manage their condition.

• The management of people with type 1 and 2 diabetes was comparable to other practices.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured six monthly 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 10 March 2016

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

• 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 A&E attendances. Immunisation rates were relatively high 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 adequate for children and babies, although the waiting room was cramped.

• We saw positive examples of joint working with midwives and health visitors. In-house weekly midwifery services, post-natal and baby checks were available to monitor the development of babies and the health of new mothers.

• Sexual health information and a range of family planning clinics were available. Patients were signposted to local family planning and sexual health clinics as these services were not available in-house.Cervical screening data was comparable to other practices.

Updated 10 March 2016

The practice is rated as good for the care of older people.

• A register of older people who needed extra support was in place.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were above local and national averages.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• A community care coordinator worked with the surgery to oversee the care plans of older people discharged from hospital, making sure the patient (and/or their carer) was informed of changes and updated at regular intervals.

• GPs worked with local multidisciplinary teams to reduce the number of unplanned hospital admissions for patients at risk, including those with dementia and those receiving end of life palliative care.

• The percentage of people aged 65 or over who received a seasonal flu vaccination was comparable with the CCG and national averages.

Updated 10 March 2016

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

• The needs of the working age population, including those recently retired and students, had been identified. The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. This included extended hours between 7am and 8am to support commuters, and appointments at weekends with the practice nurse to improve access to patients for routine health checks and the treatment of minor illnesses.

• The practice was proactive in offering online services, for example implementing an online appointment system. The surgery also had electronic prescribing (where patients can arrange for their repeat prescriptions to be collected at a pharmacy of their choice).

Updated 10 March 2016

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

• Health promotion leaflets to support patients with mental health problems was accessible in the waiting area.

• There was evidence of shared communication between the multi-disciplinary services that the practice used when referring patients for mental health assessments. Care plans were in place for those patients suffering with dementia and poor mental health.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Systems were in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had received training and had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 March 2016

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.

• The practice proactively promoted annual health checks for patients with learning disabilities. It carried out home visits for these reviews as needed.

• The practice offered longer appointments for patients with a learning disability and worked with multi-disciplinary teams in the case management of vulnerable people.

• 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 and how to contact relevant agencies in normal working hours and out of hours.