We previously carried out an announced comprehensive inspection of Dr Dauod Yosuf Abdulrahman Shantir on 14 November 2018 and found that the practice was in breach of Regulation 17: ‘Good governance’ of the Health and Social Care Act 2008. In line with the Care Quality Commission’s (CQC) enforcement processes, we issued a warning notice which required the practice to comply with the Regulations by 11 March 2019.

The full report of the 14 November 2018 inspection can be found by selecting the ‘all reports’ link for the Dr Dauod Yosuf Abdulrahman Shantir practice on our website at .

We carried out this announced focussed inspection on 9 April 2019 to check whether the practice had addressed the issues in the warning notice and now met the legal requirement. This report covers our findings in relation to those requirements and will not change the current ratings held by the practice.

At this inspection on 9 April 2019 we found the provider had taken action to address the requirements of the Regulation 17 warning notice.

Our key findings were as follows:

• The practice had completed a number of risk assessments including infection prevention and control and a fire risk assessment. All actions in relation to these had been completed.
• There was a system for managing and maintaining the cold chain.
• Inadequate rates for cervical cytology was effectively monitored.
• There was a new suite of policies and procedures including safeguarding and infection prevention and control, these were version controlled and accessible to all staff on the practice computer shared drive.
• The practice had carried out its own patient satisfaction survey, the results of which were higher than the national GP patient survey.
• The practice had reviewed their exception reporting practices.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as inadequate overall. (Previous rating 10 2017 – Requires Improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Inadequate

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Dr Daoud Yosuf Abdulrahman Shantir on 10 October 2017, to follow up on breaches of regulations identified in medicines management, clinical governance and patient satisfaction, identified in a comprehensive inspection in December 2016.

This inspection in November 2018 was an announced comprehensive inspection to confirm that the breaches in clinical governance and documentation and patient satisfaction, identified in the inspection carried out in October 2017 had been rectified.

At this inspection we found:

• Safeguarding systems were not clear and did not keep patients safe and safeguarded from abuse.
• The practice did not have systems to monitor or manage the outcomes and ongoing actions associated with risk assessments such as fire and infection prevention and control.
• Insufficient improvement had been made in relation to patient satisfaction with access to the practice.
• Policies and procedures were not effectively maintained, managed or stored.
• The vaccine refrigerator temperature was not effectively monitored.
• Inadequate smear rates were not monitored or managed.
• There was no evidence that calibration of clinical equipment had taken place.
• The practice did not effectively maintain personnel records for some clinical members of staff, including training records, professional indemnity and professional registration status.
• There was an effective system to monitor uncollected prescriptions.
• The practice monitored patient safety alerts and made effective use of clinical guidelines when making decisions.
• There was an open transparent approach to reporting and recording significant events.
• Information about services and how to complain was readily available. Improvements were made to the quality of care as a result of complaints and concerns.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.
• Consider ways to improve confidentiality in the reception area.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

Special measures will give people who use the service the reassurance that the care they get should improve.

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 Dauod Yosuf Abdulrahman Shantir on 7 December 2016. The overall rating for the practice was requires improvement. We rated the practice overall requires improvement due to lack of satisfactory regular monitoring of patients on high-risk medication, low National GP Patient Survey scores, a lack of clinical governance to ensure that clinical audits were used as a system to make quality improvements to patient outcomes and not maintaining accurate records in respect of care plans for patients. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Dauod Yosuf Abdulrahman Shantir on our website at www.cqc.org.uk.

This inspection undertaken following the December 2016 inspection was an announced comprehensive inspection on 10 October 2017. Overall the practice remains rated as requires improvement.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Not all of the patients we received feedback from said they found it easy to make an appointment with the practice.
• Results from the National GP Patient Survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The practice did not always deliver care in line with relevant and current evidence based guidance and standards. We saw evidence that the practice did not act on a recent NICE guidelines and corresponding patient safety alert.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns and this learning was shared with relevant staff.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Patients rated their overall experience at the practice lower than the Clinical Commissioning Group (CCG) and national averages.
• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas of practice where the provider must make improvements are:-

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas of practice where the provider should make improvements are:-

• Establish effective systems and processes to address continuing patient concerns highlighted in the National GP Patient Survey scores.

• Continue to review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.
• Review systems relating to the monitoring of uncollected prescriptions kept at the practice.

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 Dauod Shantir on 7 December 2016. Overall the practice is rated as Requires Improvement.

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.
• There was limited evidence that care plans for patients were being completed with all required details.
• The provider was aware of and complied with the requirements of the duty of candour.
• Patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
• The practice had good facilities and was equipped to treat patients and meet their needs.
• There had been no recent annual clinical review of patients with learning disabilities.
• There was a lack of clarity surrounding responsibility of monitoring of patients on certain types of high risk medication.
• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• On the day of the inspection, we found out of date medicines stored in the vaccine fridge. These medicines were destroyed by the practice on the same day.
• The National GP Patient Survey revealed that the practice was performing below both CCG and national averages for several aspects of care. For example, 39% of patients stated they found it easy to get through to the surgery compared to the national average of 73%.
• Not all non-clinical staff had received a recent staff appraisal.

The areas where the provider must make improvements are:

• Ensure effective and sustainable clinical governance systems and processes are implemented to aseess the quality of services provided. This must include completed clinical audits which show improvement in patient outcomes. In addition, make renewed efforts to ensure that information contained within patient notes on the online clinical system is correct, up-to-date and complete.
• Assess the risks to the health and safety of service users receiving care and treatment in respect to the safe management of medicines. This includes the monitoring of patients on high-risk medication.
• Establish a programme of annual reviews which incorporates an assessment of the needs, care and treatment of patients with learning difficulties.

In addition the provider should:

• Identify ways to increase the practice uptake for breast and bowel screening.
• Ensure annual staff appraisals are undertaken.
• Establish a system of monitoring the usage of prescription pads.
• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.
• Review the GP Patient Survey results and put a plan in place to improve patient satisfaction with services provided.
• Maintain the continued monitoring of all medicines kept at the practice, to ensure the timely disposal of relevant medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We found the service had taken into account the diverse needs of patients with information and support to suit people's sexual orientation, gender, ethnicity and languages spoken. Patients told us, “the doctor explains things very well" and “they go out of their way to help" although one person said, “the locum upset me a bit. They didn’t look at me and didn’t listen.” Patients said doctors respected their choices.

Patients told us their individual needs were taken into account and we saw evidence that medical history was recorded. Patients told us the quality of care was good. One person said “I speak highly of the staff and doctor.” However, patients said they had difficulty getting appointments when they needed to.

We found the service was part of an integrated care team to discuss patients who used several services. People told us they were happy with the referral process. One person said "they kept me informed about my referral.”

We found the service had policies relating to infection control and weekly checks were carried out by a nurse, although records were not detailed. Patients said they had "no concerns" about cleanliness.

Patients spoke positively about staff. One said “I get anything I ask for.” We found staff were appropriately skilled and experienced.

All patients we spoke to said they had taken part in surveys and we found evidence that people's views were acted on. There was evidence that the practice discussed learning outcomes from incidents.