Archived: Dr Mohammed Ehsan

Updated 6 October 2017

Dr Mohammed Eshan is a GP practice in the London Borough of Barking and Dagenham, to the east of London. The practice is part of the London Borough of Barking and Dagenham Clinical Commissioning Group (CCG) and provides primary medical services through a General Medical Services (GMS) contract with NHS England to around 3000 patients.

The practice is housed within a small building, situated at one end of a row of residential properties. The practice is easily accessible by local buses. It does not have a car park; however there is permit free parking on surrounding streets. The practice consists of two consulting rooms, a small reception area and a toilet. The manager’s office and reception desk are sectioned off from the main reception area. The building is single storey.

The practice’s age distribution data shows an average number of patients aged zero to 59 years and a lower than average number of patients aged 60 to 85 and above. At 75 years for men and 80 years for females the average life expectancy is below the national average of 79 years for males and 83 for females. The practice locality is in the 3rd more deprived decile out of 10 on the deprivation scale.

Clinical services are provided by one principal GP (male) who works seven clinical sessions, one sessional GP (male) who worked two clinical sessions and one full time female practice nurse. They are supported by a full time practice manager and two reception/administrative staff.

The practice officially opens at 8.30am, however the GP/ nurse is usually available from 7am to see patients on an emergency basis. The practice closes at 6.30pm every weekday except Thursday when it closes at 1pm. Surgery times are from 8.30am to 11.30am and 4.30 to 6.30pm except on Thursday when there is no afternoon surgery. Outside of these hours services are provided by the local out of hours provider.

The practice is registered to carry out the following regulated activities: Maternity and midwifery services; Family planning; Treatment of disease, disorder or injury and Diagnostic and screening procedures from 69 Oval Road North, Dagenham, RM10 9ET.

Dr Mohammed Eshan was inspected in 2013 under our previous inspection regime and was found fully complaint and in December 2016 we inspected the practice under our current inspection regime; overall the practice was rated good.

Updated 6 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mohammed Ehsan’s Practice on 5 December 2016. The overall rating for the practice was good. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Mohammed Ehsan on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 September 2017 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 5 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good. At the previous inspection we rated the practice as requires improvement for providing safe care and treatment as the registered person did not do all that was reasonably practicable to assess, monitor, manage and mitigate risks to the health and safety of services users. The practice had not ensured they held sufficient stocks of emergency medicines and some Patient Group Directions (PGDs) which allowed nurses to administer medicines were not signed by the GP. We also found that not all staff could access practice policies and staff who carried out cleaning of the premises did not receive specific training for this role.

At this inspection we found significant improvements had been made and the practice is now rated good for providing safe care and treatment.

Our key findings were as follows:

• The practice now held sufficient stocks of emergency medicines to treat patients in the event of a medical emergency.

• All patient group directions (PGDs) in place were now signed by both the practice nurse and GP.

• Practice policies including significant event forms were available in hard copy formats as well as electronically and staff knew how to access these.

• The practice’s business continuity plan had been updated and was now fit for purpose.

• At our previous inspection, the practice identified 18 patients as carers. At this inspection, 259 patients were identified as carers; this represented 8% of the practice list size.

• The practice kept a log which demonstrated the defibrillator was checked monthly to ensure it is in good working condition.

• There was a notice in the reception area which informed patients of the translation and interpreting service.

• Following the last inspection, a new first aid kit was purchased which was fit for use and contained all necessary items.

• The staff responsible for cleaning the practice had completed Control of Substances Hazardous to Health (COSHH) training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 February 2017

The practice is rated as good 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.

• At 58% performance for diabetes related indicators was below the CCG average of 81% and the national average of 90%. The practice had taken steps to address this including offerings same day appointments to these patients and employing a diabetes nurse specialist to assist in supporting them.

• Longer appointments and home visits were available when needed.

• 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.

• The practice offered in house spirometry and therefore patients did not have to be referred to have their lung function monitored.

Updated 14 February 2017

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.

• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 80% and the national average of 82%.

• 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.

• The practice referred young people to a designated counselling service which supported them with issues including stress, weight management and educational issues.

• Clinicians were able to advise about contraception and sexual health. They were aware of reporting requirements around female genital mutilation (FGM).

Updated 14 February 2017

The practice is rated as good 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 appointments for those with enhanced needs.

• Health checks for the over 75s were offered as were flu and shingles vaccinations.

• Older patients were prioritised for same day appointments.

Patients were highlighted for discussion with the integrated care team to ensure their needs were met.

Updated 14 February 2017

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, 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.

• Early morning appointments were available from 7.30am as well as a walk in service from 7am.

• Telephone advice was available for patients who were unable to attend the practice in person.

• The practice was aware of the issue of stress management for university students and was able to advise/refer appropriately.

• Vaccinations for students were offered.

Updated 14 February 2017

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG and national average of 84%.

• At 100% performance for mental health related indicators was similar to the CCG average of 88% and the national average of 93%.

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

• The practice nurse was trained in supporting patients 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.

Updated 14 February 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, travellers and those with a learning disability.

• The practice offered longer appointments and annual health checks for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.