This practice is rated as inadequate overall. (Previous rating August 2017 – Good overall, requires improvement for Caring)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Good

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Dr Hafeez and Partner on 2 October 2018. The practice was inspected on 20 January 2015 and was placed in special measures in respect of breaches of the Health and Social Care Act Regulations 2014. We found that improvements had been made when we inspected again on 12 October 2015, so the practice was rated as requires improvement. The key questions that still needed improvement were effective and caring. CQC inspected the practice on 13 June 2017 and found effective had improved, but services had not improved for the caring key question. Although the practice was rated good overall, the caring key question remained requires improvement.

This inspection was arranged to check that the practice improved in the areas identified at the last inspection and sustained the improvements previously made.

At this inspection we found:

• Recruitment systems, designed to ensure that only staff appropriate for their roles were employed, were not operating effectively to mitigate the risks.
• The practice did not have effective systems to ensure that high risk medicines were always safely prescribed.
• The practice was not taking the action required in response to patient safety alerts.
• Significant events were not being identified, analysed and recorded to ensure that lessons were learnt.
• There were some areas of the practice’s clinical performance that were below average or below target and there were no substantive plans to ensure improvement.
• The practice had failed to take effective action on negative patient feedback.
• The practices GP patient survey results were above local and national averages for questions relating to access to care and treatment (although the difference was not statistically significant).
• Practice leaders had not established sufficient policies, procedures and activities to ensure safety and assured themselves that they were operating as intended. Some of the issues we identified at this inspection had been raised with the practice previously, but had not been effectively addressed.

We also found that although some concerns highlighted on our last inspection had been addressed there were some areas where sufficient improvement had not been made:

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:

• Take action to assess and improve the guidance for non-clinical staff on identifying deteriorating or acutely unwell patients and whether the practice needs a paediatric oximeter.

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.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

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 undertook a comprehensive inspection of Dr Hafeez and Partner on 20 January 2015 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as inadequate for providing safe and well led services and was placed into special measures for a period of six months.

We also issued a warning notice to the provider in respect of good governance and informed them that they must become compliant with the law. We undertook a follow up inspection on 12 October 2015 to ensure improvements had been made and to assess whether the practice could come out of special measures. The practice was rated as requires improvement and removed from special measures.

The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for Dr Hafeez and Partner on our website at www.cqc.org.uk.

We undertook this further announced comprehensive inspection of Dr Hafeez and Partner on 13 June 2017.

Overall the practice is now rated as good.

Our key findings were as follows:

• There was an effective system in place for reporting and recording significant events.
• Lessons were shared to make sure action was taken to improve safety in the practice.
• Risks to patients were assessed and generally well managed, although there were some areas of monitoring and record keeping that could be strengthened to ensure that safety was maintained.
• Data from the last published Quality and Outcomes Framework (QOF) showed some patient outcomes were below the national average. The practice had taken action to improve and from (unverified and unpublished) data provided by the practice showed that outcomes had improved to in line with average.
• Although the overall QOF exception rate was comparable with average, in 2015/16 some individual exception rates were higher than average. Unverified and unpublished data provided by the practice showed that most had improved to in line with average, although the exception rate for cervical screening remained above average.
• Staff assessed needs and delivered care in line with current evidence based guidance.
• Clinical audits demonstrated quality improvement.
• Data from the national GP patient survey showed patients rated the practice higher than others for most aspects of care. Satisfaction with GP consultation had improved in the last survey (published July 2016) but satisfaction with some aspects remained below average. The practice had taken action and hoped for improvement in the survey published in July 2017.
• Patients we spoke to said they were treated with compassion, dignity and respect.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. Some patients we spoke to or received comments cards from told us of long waits after appointment times.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
• The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

At the last inspection we said that the practice should improve patient outcomes (as measured by QOF) and respond to areas of below average satisfaction in the national GP patient survey. We found that the practice had taken action to address these.

However, there were also areas of practice where the provider should still make improvements.

The provider should:

• Review the systems to monitor risks relating to the health, safety and welfare of service users (including those related to infection, action on safety alerts, and employment of non-permanent staff) to ensure that safety is maintained.
• Continue to monitor and take action to improve patient outcomes (including exception rates).
• Continue to monitor and take action to improve patient satisfaction with GP consultations (as reflected in national GP patient survey).
• Monitor and take action to improve the time patients wait after their appointment time.

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 Sutton Medical Practice on 12 October 2015. Overall the practice is rated as requires improvement.

We carried out this inspection to check that the practice was meeting regulations . Our previous comprehensive inspection carried out in January 2015 found breaches of regulations relating to the safe, effective and well led domains.

In addition all population groups were rated as inadequate due to the concerns found in safe, effective and well led. The overall rating from this inspection in January 2015 was inadequate and the practice was placed into special measures for six months. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

The inspection carried out on 12 October 2015 found that the practice had made significant improvements and they were meeting all three regulations they were previously in breach of.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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 and any further training needs had been identified and planned.

•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 found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

•The practice had good facilities and was well equipped to treat patients and meet their needs.

•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.

The areas where the provider should make improvement are:

• Ensure QOF scores are improved and address poor performance that have been identified to the care of patients with diabetes.

• Ensure the practice improves and responds to the national GP patient survey results in areas they have scored low.

Following the inspection in October 2015, the practice is rated as requires improvement for effective and caring. They are rated as good for providing safe, responsive and well led care services. All population groups have been rated as requires improvement due to ratings in effective and caring. Overall the practice is rated as requires improvement. We have changed the ratings for this practice to reflect these changes and the improvements made and the practice will be removed from special measures.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Dr Hafeez and Partner also known as Sutton Medical Practice is a medium sized practice based in Sutton. The practice has a list size of 4200 patients.

We carried out an announced comprehensive inspection at Sutton Medical Practice on 20 January 2015 .Overall the practice is rated as inadequate.

We found numerous issues in relation to the safe delivery of patient care. There were inadequate systems in place to monitor and respond to risks. The extent of the issues identified indicated that there was a lack of systems to adequately manage the service. For the key questions of whether the practice provided a, safe, effective and well-led service we rated it as inadequate. We rated responsive and caring as requires improvement.

Due to inadequate ratings in safe, effective and well led .The concerns which led to these ratings apply to all population groups using the practice.

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

• Though staff understood their responsibilities to raise concerns, and report incidents and near misses, safety was not sufficiently prioritised and there were inadequate systems in place to monitor and manage risks.
• Not all incidents and complaints had learning points identified that were acted on and shared with staff. As a result, there were recurring themes in the complaints that were received.
• Patients were at risk of unsafe care as the practice did not have equipment to use in emergencies such as oxygen and an automated external defibrillator and no risk assessments had been carried out.
• Not all staff demonstrated the necessary competencies in relation to safeguarding of vulnerable adults and children and the administrative staff were acting as chaperones without training and a Disclosure and Barring Service check.
• There was insufficient assurance to demonstrate people received effective care and treatment. For example there was no multi- disciplinary working taking place to improve patient care.
• There were insufficient systems in place to protect patients from the risk of healthcare associated infections.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice had a lack of clear leadership structure and there were limited formal governance arrangements.

The areas where the provider must make improvements are

• Ensure significant events are recorded appropriately and discussed regularly.
• Ensure learning from incidents is identified and shared with all practice staff.
• Ensure a regular review of complaints takes place, learning is identified and issues addressed.
• Ensure the practice has the required medical equipment to respond in an emergency.

• Take action to address identified concerns with healthcare associated infection prevention and control practice.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure audits of practice are undertaken, including completed clinical audit cycles.
• Ensure formal governance arrangements are in place including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.
• The practice must ensure that all clinical and administrative staff are suitably trained, supervised and appraised.
• Ensure that reception staff acting as chaperones have Disclosure and Barring Checks (DBS).

The areas where the provider should make improvement are:

• The practice should also work with other professionals and organisations involved in patients’ care to ensure the patients receive care that is well co-ordinated and effective.
• Actively seek to involve patients in developing and improving the service.
• The practice should ensure they have risk assessments in place and are able to justify the reason for not undertaking location specific Disclosure and Barring Service Checks (DBS) checks such as those for temporary staff.
• Ensure a business continuity plan for the practice is in place.
• Ensure patient feedback is obtained pro-actively
• Ensure an up to date whistleblowing policy is in place and staff are aware of how to raise concerns.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

During our inspection we spoke with the services’ practice manager and deputy, a locum General Practitioner (GP), a nurse and two receptionists.

We also spoke with six people and a relative of a patient using the surgery on the day of our inspection. They told us that staff who worked there treated them with respect and that overall they felt happy with the service they received.

The practice was in an unusual position, in that two senior GPs had retired and now continued to offer locum support to the surgery. This had considerable benefits in terms of consistency and continuity to the patients who were positive that generations within the family had been treated by the same GP. One patient told us, “they’ve been good to me….I’ll keep coming if they keep seeing me.”

All the patients that we spoke with told us that they could get an appointment within two days and sooner if it was urgent. Once at the surgery, patients told us that they never waited more than 15 minutes for an appointment.

Patients we met told us the staff at the surgery were “friendly”. One patient told us, “don’t mind who we see they (GPs) are all really nice.”