This practice is rated as Good overall. (Previous inspection September 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Dr Ahmed El Safy on 16 February 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Quality Outcomes Framework (QOF) for 2016/17 showed the practice had achieved 100% of the points available to them for providing recommended treatments for the most commonly found clinical conditions.
• Staff involved treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation.
• The practice had taken action to address the areas we told them they should improve when we inspected the practice in September 2016.
• Relationships between staff and the management of the practice were positive and supportive.

The areas where the provider should make improvements are:

• Review the arrangements for the recruitment of locum GPs to ensure it included checks of the GP’s mandatory training and verification of identity.
• Complete the process of recording the immunisation status for non-clinical members of staff.
• Carry out a recorded risk assessment to determine the list of emergency medicines that will be stocked locally.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ahmed El Safy on 8 September 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.
• Patients said 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 and easy to understand.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• The practice offered pre-bookable evening appointments one day per week with the GP. The practice was also one of 16 practices in the West locality of Sunderland who were part of the extended access scheme. Patients could pre-book appointments with a GP at a local health centre between 6pm and 8pm Monday to Friday and between 10am and 2pm at weekends due to the scheme. This improved access for patients who worked full time.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.
• Staff throughout the practice worked well together as a team.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Formalise arrangements for the routine checking of professional registrations
• Formulate, implement and embed a policy and guidance for staff to follow for the identification and reporting of significant events. The practice was potentially missing the opportunity to learn and improve from positive and near miss events, as well as those that were detrimental to the outcome.
• Review the areas covered by the infection control audit used, in line with the latest guidance.
• Ensure that clinical audits include at least two cycles. The practice should aim to demonstrate an on-going audit programme where they have made continuous improvements to patient care in a range of clinical areas as a result of clinical audit.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We spent time observing the way the practice worked and spoke to patients and staff. We spoke with three patients who told us they were treated with care and respect and we saw positive exchanges between patients and staff. One person told us the service was “Excellent”. Another person said the doctor always gave them “Plenty of time to discuss my problems”.

We saw that the provider had taken reasonable steps to identify the possibility of abuse from happening. The practice was clean and had the appropriate standards of cleanliness.

The provider had recruitment procedures in place but did not carry out all of the necessary checks required on staff. Staff had received some training but some had received no training and basic training had not been carried out for some time.

There were limited systems in place to identify assess and manage the risks to the health safety and welfare of those who used the service.

At the previous inspection in September 2013 we found that Dr Ahmed El Safy was not meeting the standards in three areas. These were that not all appropriate employment checks had been carried out for staff employed by the practice; staff were not supported to undertake their roles as they had not received appropriate training and appraisal support; and, there were insufficient systems in place to regularly assess and monitor the quality of service that people received.

The practice sent us an action plan which had been completed following our inspection. This included the actions they were going to take to meet the regulations and the timescale within which this would be achieved. We returned to the practice on 24 June 2014 to review whether they had made improvements. We also spoke with three patients from the practice on the telephone on 27 June 2014.

At this inspection we found the practice had started to make improvements to their approach to assessing and monitoring quality. The practice had made good progress with addressing the areas where they had not met the standard at the last visit.

Dr Ahmed El Safy had carried out appropriate employment checks to ensure the suitability of staff. We found that significant improvements had been made for access to training and appraisal support for staff.