Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Dr Abid Hussain, known as Pearl Medical Practice on 19 April 2016. As a result of our inspection the practice was rated as requires improvement in caring and responsive with an overall rating for the practice as requires improvement. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Abid Hussain on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 7 August 2017 to confirm that the practice had carried out their plan to address the areas requiring improvement that we identified in our inspection in April 2016. This report covers our findings in relation to requirements and improvements made since our last inspection.

We found the practice had carried out a detailed analysis of the previous inspection findings, involving staff and their Patient Participation Group (PPG). The practice had made extensive changes which had resulted in significant improvements. Practice staff had taken responsibility for embedding and maintaining these improvements themselves. There was evidence of a cultural and leadership change within the practice, and we saw a positive approach to performance and improvement throughout.

Our key findings were as follows:

• Risks to patients were assessed and managed through practice meetings and through discussions with the multi-disciplinary teams.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The structured, open and transparent approach to the reporting and recording of significant events and complaints had been maintained and further developed since our previous inspection. Six monthly analyses identified themes and trends. Staff were aware of and understood their responsibilities to report these. Learning was shared with staff at team meetings.
• Easy to understand information about services and how to complain was available to patients in the reception area and on the practice website. Full analysis and reviews of complaints were carried out to identify learning, themes and trends.
• Staff had completed training to ensure they had the skills, knowledge and experience to deliver effective care and treatment. Staff training needs had been identified and planned for the coming year. Assessments of clinical staff skills had been carried out with details of specific skills assessed recorded.
• Records were viewed and showed that recruitment procedures had been followed when recruiting staff. Records confirmed that the practice had obtained Disclosure and Barring Services (DBS) checks for non-clinical staff who carried out chaperone duties or had unsupervised access to patients.
• There was effective oversight, planning and responses to practice performance.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Staff were enthusiastic about improvements made to the practice and told us they had worked hard to provide the best services for patients.
• The practice sought regular feedback from staff and patients. The Patient Participation Group (PPG) worked with the practice to promote health care and the services offered by the practice. Open days took place so patients could share their views and ideas. Awareness days were held to support patients with their health management such as Diabetes Awareness, with future plans for heart disease and asthma awareness days.
• The practice had identified 4% of its patients as carers.
• Regular checks were carried out to ensure emergency equipment was available for use at all times.
• Patients confirmed on the comment cards that they were listened to, that they were given full explanations for their treatment and care, and that everyone at the practice was helpful and friendly.

The practice is now rated as good for providing safe, effective, caring, responsive services, and for being well-led. The overall rating for the practice is now good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We had previously inspected Dr Abid Hussain (known as Pearl Medical Centre) in April 2015 and had found serious concerns. As a result the practice was rated as inadequate and placed into special measures. The inspection report was published in October 2015. Specifically, we found the practice inadequate for providing safe, effective and well led services. The practice required improvement for providing a caring and responsive service. Following the inspection the practice sent us an action plan of how they were going to address the issues.

We carried out an announced comprehensive inspection at the practice on 19 April 2016 to consider whether sufficient improvements had been made by the provider, and whether the concerns we had at the previous inspection had been addressed. The practice had made significant improvements. We have rated the practice as requires improvement in providing caring and responsive services, and good for providing safe, effective and well led services. Overall the practice is rated as requires improvement at this inspection.

• There was a more structured, open and transparent approach to the reporting of and recording of significant events and complaints. Staff were aware of and understood their responsibilities to report these. Learning was shared with staff at team meetings.
• Risks to patients were assessed and well managed through practice meetings and through discussions with the multi-disciplinary teams.

• Staff had completed training that confirmed they had the skills, knowledge and experience to deliver effective care and treatment. Staff training needs had been identified and planned for the following year.

• A more robust recruitment process had been implemented since our last inspection and this had been followed when recruiting staff.
• Patients confirmed on the comment cards that they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available to patients in the reception area and on the practice website. This was easy to understand.
• The practice was proactively seeking feedback from staff and patients. The Patient Participation Group had been re-formed and an open day had been held for patients to share their views and ideas.
• Checks had been introduced to ensure emergency equipment was available for use at all times.

However there were areas of practice where the provider should make improvements:

• When an assessment of clinical staff skills is being carried out details of specific skills assessed should be recorded.

• Take steps to ensure that recent improvements to quality monitoring are embedded and sustained.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Dr Abid Hussain, known as Pearl Medical Practice on 19 April 2016. As a result of our inspection the practice was rated as requires improvement in caring and responsive with an overall rating for the practice as requires improvement. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Abid Hussain on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 7 August 2017 to confirm that the practice had carried out their plan to address the areas requiring improvement that we identified in our inspection in April 2016. This report covers our findings in relation to requirements and improvements made since our last inspection.

We found the practice had carried out a detailed analysis of the previous inspection findings, involving staff and their Patient Participation Group (PPG). The practice had made extensive changes which had resulted in significant improvements. Practice staff had taken responsibility for embedding and maintaining these improvements themselves. There was evidence of a cultural and leadership change within the practice, and we saw a positive approach to performance and improvement throughout.

Our key findings were as follows:

• Risks to patients were assessed and managed through practice meetings and through discussions with the multi-disciplinary teams.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The structured, open and transparent approach to the reporting and recording of significant events and complaints had been maintained and further developed since our previous inspection. Six monthly analyses identified themes and trends. Staff were aware of and understood their responsibilities to report these. Learning was shared with staff at team meetings.
• Easy to understand information about services and how to complain was available to patients in the reception area and on the practice website. Full analysis and reviews of complaints were carried out to identify learning, themes and trends.
• Staff had completed training to ensure they had the skills, knowledge and experience to deliver effective care and treatment. Staff training needs had been identified and planned for the coming year. Assessments of clinical staff skills had been carried out with details of specific skills assessed recorded.
• Records were viewed and showed that recruitment procedures had been followed when recruiting staff. Records confirmed that the practice had obtained Disclosure and Barring Services (DBS) checks for non-clinical staff who carried out chaperone duties or had unsupervised access to patients.
• There was effective oversight, planning and responses to practice performance.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Staff were enthusiastic about improvements made to the practice and told us they had worked hard to provide the best services for patients.
• The practice sought regular feedback from staff and patients. The Patient Participation Group (PPG) worked with the practice to promote health care and the services offered by the practice. Open days took place so patients could share their views and ideas. Awareness days were held to support patients with their health management such as Diabetes Awareness, with future plans for heart disease and asthma awareness days.
• The practice had identified 4% of its patients as carers.
• Regular checks were carried out to ensure emergency equipment was available for use at all times.
• Patients confirmed on the comment cards that they were listened to, that they were given full explanations for their treatment and care, and that everyone at the practice was helpful and friendly.

The practice is now rated as good for providing safe, effective, caring, responsive services, and for being well-led. The overall rating for the practice is now good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We previously inspected Dr Abid Hussain on 25 July 2013. During this inspection we found that appropriate recruitment processes were not in place.

At this inspection we spoke with the practice manager. We also looked at the arrangements that had now been put in place for recruitment of new staff members.

We found that the provider had put appropriate systems in place to ensure staff were recruited appropriately.

We visited the surgery to establish that the needs of people using the service were being met. On the day of the inspection we spoke with five staff members, the principal GP, the practice manager and the strategic manager. We also spoke with six patients who had arrived for their appointment. All the patients we spoke with were generally complimentary about the service.

We found that care and treatment was planned and delivered in a way that met patients’ needs and protected their rights. Patients were able to be involved in decisions about their treatment. Patients we spoke with told us they were happy with the level of care they had received.

We saw systems were in place for the safe keeping and dispensing of medication. Patients told us they had no difficulties in getting their repeat medication on time.

The provider did not have a robust recruitment system to ensure only appropriate people were employed.

The staff we spoke with said they had received training appropriate to their role. This supported staff to deliver care to an appropriate standard.

The provider had systems in place for monitoring the quality of service provision. We saw that the practice carried out a range of audits on a regular basis to monitor the quality of its own performance and to learn from any mistakes made.