Archived: Dr Shahid Amin Also known as St Luke's Surgery

Updated 27 July 2016

Dr Shahid Amin, also known at St Luke’s Surgery, is situated in an inner city area just outside of the city centre of Nottingham. The practice operates from the lower ground floor within a purpose-built health centre building owned by NHS Property Services and managed by the local community health Trust. The health centre accommodates four general practices and a range of community based health services.

The practice is run by a male GP working with two part-time GP associates (one male and one female). The practice also has regular sessional input from two locum GPs. The practice employs a part-time practice nurse and part-time health care assistant. The clinical team is supported by a part-time practice manager and part-time finance manager, plus a team of team of four part-time administrative and reception staff. The practice also employs an apprentice receptionist.

The registered list size of 3,879 comprises of a diverse and multi-cultural population including a high percentage of Polish, Indian and Pakistani patients. The practice is ranked in the second most deprived decile, and has much higher income deprivation scales affecting children and older people than national figures. For example, income deprivation affecting older people is 41% compared against a national average of 16%). The practice age profile has slightly higher percentages of patients aged 20-40 years old. The percentage of patients aged under 25 is in line with the national average, whilst there are lower percentages of patients aged over 60 registered with the practice.

The practice opens from 8.15am until 6.30pm Monday to Friday, apart from Thursday when the practice closes at 12.30pm. The practice also closes one afternoon each month for training purposes. GP morning appointments times are available from 9am to approximately 12 noon, and afternoon surgeries run from 3.40pm to 6pm. The practice does not currently provide any extended hours GP and nurse surgeries.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed, patients are directed to NEMS via the 111 service.

The surgery provides primary care medical services via a General Medical Services (GMS) contract commissioned by NHS England, and services commissioned by NHS Nottingham City Clinical Commissioning Group (CCG). 

Updated 27 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Shahid Amin (St Luke’s Surgery) on 30 June 2016. The overall rating for this practice is good.

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, and we saw evidence that learning was applied from events.

• 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. There was a robust staff appraisal system, and individuals were encouraged and supported to develop in their roles.
• Feedback from patients about their care, and their interactions with all of the practice staff, was positive. Patients said they were treated with compassion, dignity and respect and most said that they were involved in their care and decisions about their treatment.
• We received some mixed views with regards the practice appointment system. However, most patients said they found it easy to book an appointment with a GP. We observed that the appointment system was flexible and responsive to patients’ needs. Urgent appointments were available the same day.
• Access to the practice nurse was limited to mornings and early afternoon. Appointments were therefore not available outside of school hours for children, and this potentially created some difficulties for working parents. There was no designated cover for the practice nurse during periods of leave.
• The practice used clinical audits to review patient care and we observed how outcomes had been used to enhance quality care and improve service provision.
• The practice worked effectively with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe.
• There was strong and visible clinical and managerial leadership, supported by clear governance arrangements within the practice. Staff told us that they felt well-supported by management and enjoyed their work.
• The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were clean, tidy and well-organised.
• Information about how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concern.
• The surgery had an active patient participation group (PPG) which influenced changes within the practice. For example, the practice had re-worded the letter sent to patients who did not attend for their allocated appointment, in order to make it read more sensitively.
• The practice proactively sought patient feedback and reviewed the way it delivered services as a consequence of this.

The areas where the provider should make improvement are:

• Implement an auditable procedure for the receipt, distribution and actioning of alerts received via the Medicines Health and Regulatory Authority (MHRA), and for the receipt and acknowledgement of new guidance.
• Continue to take steps to improve outcomes for patients where Quality and Outcomes Framework (QOF) achievement is lower.
• Ensure a procedure is in place to monitor and action any uncollected prescriptions, and a sign-out procedure is in place to monitor the collection of prescriptions for controlled medicines.
• Review the availability of practice nurse hours.
• Strengthen the infection control lead role by defining key responsibilities, and ensuring additional training is undertaken to support this role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 July 2016

• Data showed patient outcomes were generally in line with averages for the locality. The practice had achieved an overall figure of 85.7% for the Quality and Outcomes Framework (QOF) in 2014-15. This was 5.7% below the CCG average, and 9% below the national average. QOF performance was monitored via clinical staff meetings, and actions were agreed to continually improve achievements.
• Performance for diabetes related indicators at 66.6% was below the CCG average of 79.1% and the national average of 89.2%. However, the level of exception reporting for diabetes patients was noted to be lower than local and national averages. The practice reviewed their achievement regularly and agreed measures to enhance their performance.
• QOF indicators for chronic obstructive pulmonary disease (COPD) achieved 92.8% and this was broadly in line with CCG and national averages (95.4% and 96% respectively).
• All patients with a long-term condition received a structured annual review to check their health and medicines needs were being appropriately met. For example 80% of patients on the practice diabetes register had received a review in the last 15 months. Designated staff members co-ordinated the reviews and followed up patients who did not attend.
• The practice held monthly multi-disciplinary meetings to review those patients with more complex needs and associated risk of hospital admission. The practice team worked closely with other local providers including the community matron, district nursing team and social services to deliver multidisciplinary packages of care.
• A health care assistant provided a weekly clinic to ensure blood tests were taken in order for the practice to monitor high risk medicines, and patients being seen as part of a shared care arrangement with the hospital consultant.
• The practice had added alerts into their computer system to ensure urgent same day appointments would be provided for high risk patients.

Updated 27 July 2016

• A baby clinic was provided within the health centre and the practice would accommodate any requests for a GP appointment by those attending the clinic on the same day.
• Appointments with the practice nurse were limited to mornings and early afternoon. This meant that appointments were not available outside of school hours.
• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated young mothers who wished to breastfeed.
• The practice held quarterly meetings with the health visitor to review any children on a child protection plan or deemed to be at risk.
• The practice provided post-natal checks for new mothers and eight week baby checks, and there was system in place to refer patients into ante-natal care and support.
• The practice had been accredited as part of the ‘You’re Welcome’ programme to support the provision of young people friendly health services. Staff had received training to support this. Patients aged 13 and over could be seen by a GP or nurse either alone or with a friend, in the strictest of confidence. Young patients were sent birthday packages when they reached 13 that included information on the practice and its services, specifically those aimed at younger patients.
• The practice were supporting a CCG led initiative ‘15 steps for young people’ which helped identify younger people’s perception of health care and aimed to help identify their needs to make services more accessible to them. Questionnaires were due to be distributed the week after our inspection.
• The practice supported sexual health for young people and supported the c-card scheme which provided a free condom distribution service and advice for people aged 13-25. Chlamydia screening was available upon request.
• The practice nurse provided contraception clinics and advice, and patients were referred into a local family planning clinic for services such as coil and implant fittings and removals.
• Vaccination rates were slightly below local averages for standard childhood immunisations. For example, vaccination rates for children at two years old ranged from 84.1% to 96% compared against a CCG average ranging from 91.1% to 96.3%. The practice team monitored uptake of childhood vaccinations to enable those who did not attend to be followed up by the health visitor. 

Updated 27 July 2016

• The practice had lower percentages of registered older people with 9.9% of patients aged 65 and over (local average 11.1%; national average 17.1%).
• Patients were assessed using a validated tool to determine if a referral was required to the memory clinic. This assessment was used as an opportunity to also assess the patient’s carer and to signpost them to any support that may be required.
• The practice ensured patients received appropriate support for their needs and referred individuals to the Nottingham City Signposting Service. This service was aimed at people aged 60 and over and aimed to promote independence, safety and security by providing access to a range of local support services.
• A care co-ordinator worked closely with the practice and facilitated referrals to other services including the falls team, carers’ assessments, and social services.
• The community consultant for health care of the elderly provided the practice with advice and support on any complex care needs.
• Monthly multi-disciplinary meetings were held to review frail patients and deliver care appropriate to their needs. However, we did not see a clear overview of unplanned admission data being utilised to influence these discussions.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those who needed them. Longer appointments could be booked if these were required.
• Flu vaccination rates for the over 65s were 63% which was lower than the local average of 72.9% and the national figure of 73.2%.

Updated 27 July 2016

• Feedback from patients we spoke with was mixed about their experience in obtaining an appointment quickly and a time that was convenient to them.

• There were no extended hours’ consultation times provided at the time of our inspection. This service had previously been available on a Monday evening but had been stopped with a review planned for April 2017.
• Patients could book appointments online although these were limited to 5% of the total appointments available. Telephone consultations were available each day for those patients who had difficulty attending the practice due, for example, to work commitments.
• The practice offered online services to order repeat prescriptions. The practice also undertook electronic prescribing so that prescriptions could be sent directly to the pharmacy of the patient’s choice.
• Health promotion and screening was provided that reflected the needs for this age group. NHS health checks were undertaken by a health care assistant and any patients requiring follow up were seen by the GP to implement the necessary care package.
• The practice’s uptake for the cervical screening programme was 69.3% which was below the CCG average of 81.3% and the national average of 81.8%. The practice was targeting ways to improve their uptake rates.

Updated 27 July 2016

• The practice had one of the highest rates of significant mental health problems (2%) within their CCG. Staff worked hard to meet the needs of these patients and upheld an ethos of ensuring services were accessible to them. For example, the practice did not remove patients from their list if they had been subject to challenging behaviour.
• The practice tailored services to accommodate patients’ needs, for example, dedicated clinics were provided to help improve physical care for patients with significant mental health illnesses. Further to a recent baseline audit, an action plan had been developed to promote healthier lifestyles and improve access to health screening services.
• The practice achieved 68.7% for mental health related indicators in QOF, which was 20% below the CCG and 24% below the national averages. However, exception reporting rates were approximately one third of the local and national averages.
• 65.2% of patients on the practice’s mental health register had received an annual health check during 2014-15. This was below the CCG and England averages (83.3% and 88.4% respectively), but there were much lower rates of exception reporting at 4.1% (compared to 11.1% and 12.6% locally and nationally).
• 70% of people diagnosed with dementia had had their care reviewed in a face to face meeting during 2014-15. This was approximately 14% lower than local and national averages. However, no patients were exception reported within this indicator.
• The practice worked with multi-disciplinary teams in the management of people experiencing poor mental health, including those with dementia. This included the mental health crisis team to ensure those patients experiencing acute difficulties received urgent assistance to manage their condition.
• The practice told patients experiencing poor mental health and patients with dementia about how to access services including talking therapies and various support groups and voluntary organisations. Information was available for patients in the waiting area.
• The practice undertook reflective learning following significant events when patients had ended their own lives, and had collaborated with other practices to peer review attempted suicides to share learning outcomes. 

Updated 27 July 2016

• All vulnerable patients were identified at the registration process and via the new patient health check. Alerts were added to the patients’ records and plans for any follow up care or support would be arranged.
• The practice registered refugees referred by the local refugee forum. These patients received a new patient health check, and any children were booked an initial appointment with the GP. Practice staff had received training about asylum seekers.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Homeless people could register with the practice.
• The practice worked with multi-disciplinary teams in the case management of vulnerable people and informed patients 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.
• The practice provided support for end of life patients and kept them under review in conjunction with the wider multi-disciplinary team. No audit information was available to determine if patients’ needs and wishes had been fulfilled including if they had died in their preferred place.
• The practice had undertaken an annual health review for 66% of patients with a learning disability in the last 12 months. Support tools designed for ease of communication with learning disability patients were used to facilitate the review, which provided a holistic assessment of each person’s individual needs. The practice worked with the local learning disabilities nurse facilitator, and training had been provided to staff to raise their awareness of learning disabilities.
• Longer appointments were available for people with a learning disability or others whose needs indicated this was required.
• There was a carers identification scheme with referral to support services when required.