Dr Shamsee, Ward and Associates

Updated 29 March 2017

Dr Shamsee, Ward and Associates (Oaklands Health Centre) Huddersfield Road, Holmfirth, Huddersfield, HD9 3TP, provides services for 9,100 patients. The surgery is situated within the Greater Huddersfield Clinical Commissioning Group (CCG) and provides primary medical services under the terms of a personal medical services (PMS) contract. Services are provided within a purpose built and accessible building which is owned by the partners. The practice, located in Holmfirth serves the village and the surrounding rural area.

Oaklands Health Centre is a dispensing practice and has an onsite pharmacy employing a pharmacist and four dispensers. The dispensary provides this service to those who live more than one mile from their nearest pharmacy and was used by a third of the patient population.

The patient group experiences low levels of deprivation and the population is mainly White British.

Dr Shamsee, Ward and & Associates is registered as a partnership, both partners are male and work full time. They are supported by four salaried GPs (three female and one male) who are all part time. The provider has four advanced nurse practitioners (all female). The practice also has a full time female practice nurse and two part time health care assistants. The practice manager is supported by reception and administrative staff.

The practice is a teaching and training practice. They are accredited to train qualified doctors to become GPs and to support undergraduate medical students, with clinical practice and theory teaching sessions. They also support the training and mentoring of nursing students and pharmacists.

The practice is open Monday and Thursday from 8am to 8pm, Tuesday and Wednesday from 8am to 6.30pm, Friday from 8am to 6pm and Saturday from 8.30am to 11.30am. The provider also opens on a Bank Holiday Monday. Out of hours treatment is provided by Local Care Direct.

Updated 29 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Shamsee, Ward and Associates on 20 October 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Feedback from patients about their care was consistently highly positive and every aspect of the national GP patient survey was higher than local and national averages. For example, 99% of patients said they would recommend this GP practice to someone who had just moved to the local area

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, in providing enhanced training to nurses to enable them to undertake complex dressings in-house.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example by providing additional training to reception staff and the introduction of nurse led triage services to improve the overall telephone experience for patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The provider was aware of and complied with the requirements of the duty of candour. This was shown through a clear policy statement and regular reference to duty of candour issues at operational meetings that reviewed complaints and significant events. Openness was a highly valued part of the provider’s ethos.

We saw several areas of outstanding practice including:

• The practice used every opportunity to learn from internal and external incidents, to support improvement. The practice produced a comprehensive annual report which it publicised, sharing learning and actions across the whole team and the patient group. Where applicable the practice shared learning across the wider health network.

• The provider maintained the highest standards in relation to Infection Prevention and Control (IPC) and published an annual statement of compliance within the practice, notifying the patient population of any infection control incidents that had occurred.

• We saw that learning from complaints was embedded into the practice ethos with all team members engaged in reviewing and learning from complaints on a monthly basis. Learning was shared between the providers’ two locations in order to maximise opportunities for reflection. Complaints were anonymised and published at the location to both encourage patients to offer their feedback, feel encouraged to make a complaint and see evidence of the provider’s engagement.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 March 2017

The practice is rated as outstanding for the care of people with long-term conditions.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was in line with or higher than the national average. For example 72% of diabetic patients on the register had achieved a blood sugar result of 59 mmol or less in the preceding 12 months. This demonstrated that their diabetes was being well controlled for these patients. This was 1% higher than the local average and 2% higher than the national average. In addition, 92% of diabetic patients had received a foot examination to check for nerve or skin damage associated with their condition. This was 6% higher than the local average and 3% higher than the national average.

• Longer appointments and home visits were available when needed. Telephone reviews were available for patients that would benefit from them.

• A GP had a special interest in supporting patients with chronic pain associated with headaches.

• Diagnostic services including ECGs, blood pressure monitoring, spirometry and bladder ultrasound were available at the provider. The provider was also able to initiate insulin for newly diagnosed diabetes patients.

• All these patients had a named GP and 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 29 March 2017

The practice is rated as outstanding 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. The practice maintained a register for children and families at risk and health visitors met with the safeguarding lead to discuss these cases regularly.

• 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.

• Uptake for the cervical screening programme was 85%, which was equal to the CCG average of 85% and higher than the national average of 81%.

• A full family planning service was offered which included coils and implant fitting. A vasectomy service was offered on a Saturday morning for patients registered across Huddersfield.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses. Baby clinics were integrated with ante-natal and post-natal clinics to give convenient continuity of care for mothers and babies.

Updated 29 March 2017

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

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

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

• A proactive weekly visit took place to a local care home to review patient needs.

• Nursing staff had additional skills in managing complex dressings in-house reducing the need for patients to attend secondary care services.

• The practice pharmacist conducted medication reviews for housebound patients.

Updated 29 March 2017

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

• 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.

• The practice had introduced an online consultation service for non-urgent consultations that allowed adult patients to seek advice via a web form and where appropriate receive an email reply or telephone call back within one working day.

• The provider was open on Saturday morning and on Bank Holiday Monday which was of particular benefit to this patient group.

Updated 29 March 2017

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

• Performance for mental health related indicators overall was higher than the national average. For example 93% of patients with a serious mental illness had a comprehensive care plan in place. This was 2% higher than the local average and 4% higher than the national average.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice 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.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia. This included offering text reminders and following up patients who missed appointments.

Updated 29 March 2017

The practice is rated as outstanding for the care of people who circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. Regular visits were undertaken with a local care provider to support patients with a learning disability and de-sensitisation visits were offered to those who found attending the surgery difficult.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients and had adopted the Palliative Care Gold standards framework, including a register for these patients in their end of life care.

• 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.