Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr MSN Ahmed & Dr MB Ahmed (known as Bradford Road Medical Centre) on 13 April 2016. This was to check that the practice had taken sufficient action to address a number of significant shortfalls we had identified during our previous inspection in August 2015. Following this inspection in August 2015, the practice was rated as inadequate for providing safe, effective and well-led services; and good for providing caring and responsive services. Overall it was rated as inadequate. We also issued two warning notices and one requirement notice under the Health and Social Care Act 2008 and placed the practice into special measures as a result.

During this inspection, we found that the practice had taken sufficient action to address the breaches in regulations. For example health and safety concerns had been addressed, deficits in staff training had been rectified, clinical records had improved and systems to ensure the safe management of vaccines had been implemented. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Ensure that clinical audits are completed and that learning from them and other improvement activity is used to drive improvements in patient care.

• Address the high level of exception reporting made by the practice in reporting performance data, particularly in the area of diabetes care.

• Demonstrate how the practice intends to improve its services as reflected in the national GP survey.

I confirm that this practice has improved sufficiently to be rated ‘good’ overall. 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

This report relates to an announced focused inspection we made to this location on 29 February 2016. It was a follow-up inspection to a comprehensive inspection of this practice which took place on 25 August 2015. At that inspection, three breaches of legal requirements were found and we served warning notices against the provider. We asked the provider to submit an action plan following the publication of our report, telling us about the improvements they intended to make to address the breaches of legal requirements. These requirements are set out in the Health and Social Care Act (HSCA) 2008. The provider sent us their updated plan following the inspection in August 2015.

The focused inspection on 29 February 2016 was to check whether the provider had taken steps to comply with the legal requirements for these breaches of regulation:

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance

• Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Staffing

This report is limited to our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr MSN & Dr MB Ahmed on our website at www.cqc.org.uk . The practice will remain in special measures and the ratings will be reviewed at the next comprehensive inspection.

Our key findings were as follows:

• Improvements to patient safety had been made following our last inspection on 25 August 2015. For example; action had been taken to improve the arrangements for assessing the risk of, and controlling and preventing the spread of infection. Suitable arrangements had been made for the safe storage of prescriptions. There was a more effective system for monitoring the temperatures of refrigerators used for the storage of temperature sensitive medicines and vaccines and improvements in the transportation of temperature sensitive medicines and vaccines.

• Staff had completed training on a wide range of subjects since the last inspection. This included fire safety, infection prevention and control, health and safety, information governance, safeguarding and chaperoning.

• The practice had undertaken comprehensive risk assessments in building maintenance and fire safety- and implemented the required improvements.

• Clinical recording had significantly improved and care plans for patients with complex needs were being progressively updated.

• The practice had developed a comprehensive induction plan for new staff.

• Arrangements had been put in place to ensure that nursing staff had effective clinical supervision.

• A patient participation group had been established and was publicising patient suggestions and feedback across the patient population.

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 Butt and partner on 25 August 2015. Overall the practice is rated as inadequate. However, we recognised that there have been considerable efforts to make improvements to the service in recent months. The practice is improving but there is still some work to do to reach the required standards in some areas.

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

• Staff were clear about reporting incidents, near misses and concerns and there was evidence of learning and communication with staff.
• Arrangements to safeguard adults and children from abuse were not adequate in relation to staff training, clarity of lead roles and identification of patients considered to be at risk. Arrangements to provide chaperones for patients were in place but staff had not received training.
• Risks to patients and others were higher than necessary as systems to assess, monitor and mitigate risks, such as, policies, procedures, and appropriate training had not been provided for all staff.
• There were procedures for the management of medicines in the practice. However, there were some shortfalls in the processes to ensure the safe storage and transport of vaccines.
• Recruitment arrangements did not include all necessary employment checks for staff in that there was no process to check nurse registration to practice was current and there was no evidence in staff files that ongoing checks had been made routinely. There were no formal induction processes for new or locum staff.
• Staff had received role specific training to improve and extend services for patients. However, they had not received training such as health and safety including fire safety, basic life support, safeguarding vulnerable adults and children and infection prevention and control.
• Non-clinical staff received regular supervision and support but there was no process for practice nurses to receive clinical supervision.
• Data showed patient outcomes were average for the locality. Audits were driving improvement in some areas of prescribing practice to reduce costs but there was no evidence audits were used to improve patient outcomes.
• Clinical records were not always adequately maintained.
• The practice had received support from the CCG and had implemented initiatives to improve care for patients and they had significantly increased the number of NHS health checks performed.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice had developed a ‘Carer’s Champion’ role to support carer’s by offering health checks and referral for social services support.
• There were some services provided for patients to meet needs such as interpreter services and information in different languages. However, there was limited access for patients with a disability and/or wheelchair users. Services and adaptations for the visually or hearing impaired were not provided. Work to build a new bespoke building was due to commence and was scheduled be completed by March 2016.
• The practice had listened to patients and had made improvements to the appointment system. Patients said they were satisfied with the appointment system and told us urgent appointments were usually available on the day they were requested.
• Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
• The practice had a leadership structure but limited formal governance arrangements.
• The practice did not have a written set of aims and objectives or improvement plan. There was no maintenance programme for the building.
• The practice acted on feedback from patients and had focused on improving the patient experience of the services provided. However, there were limited systems in place to monitor the quality of services provided.
• Records, such as patient records, training and recruitment records and health and safety monitoring records, were not always adequately maintained to ensure effective management of the practice.

The provider must make improvements in the following areas:

• Ensure systems and processes are in place to assess, monitor and mitigate risks to patient’s and others health and safety. For example, policies and procedures, staff training and risk assessments in areas such as fire safety and infection prevention and control.
• Ensure the safe storage and transport of vaccines.
• Ensure induction processes are in place for new and locum staff.
• Ensure staff receive training relevant to their role such as, health and safety including fire safety, basic life support, safeguarding vulnerable adults and children and infection prevention and control.
• Ensure practice nurses work is supervised.
• Adequately maintain clinical records.
• Ensure systems are in place to assess monitor and improve the quality and safety of the services provided.
• Ensure records used for the management of the practice are accurate, up to date and where required, held securely.

The areas where the provider should make improvement are:

• Not all staff had received safeguarding vulnerable adults and children training. Patients considered to be at risk had not been identified through the use of risk registers and system alerts.

• Staff had not received chaperone training.
• There was no process to check nurse registration to practice was current and there was no evidence in staff files that ongoing checks had been made routinely.
• There was limited access for the disabled and/or wheelchair users and services and adaptations for the visually or hearing impaired were not provided.
• There was no maintenance programme for the building.
• The practice had not developed a patient participation group (PPG).

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as good overall. The previous inspection, carried out on 13 April 2016 rated the practice as good overall.

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

We carried out an announced comprehensive inspection at Dr MSN Ahmed & Dr MB Ahmed on 19 April 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.
• They ensured that care and treatment was delivered according to evidence-based guidelines and best practice.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients told us they found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Ensure all staff are receiving immunisations in line with Department of Health Guidelines
• Ensure that Medicines and Health Regulatory Agency (MHRA) and National Institute for Health and Care Excellent (NICE) alerts are discussed at regular team meetings.
• Take action to ensure that missed children’s appointments are appropriately coded on the computer system and monitored.
• Continue to improve the identification of carers to enable this group of patients to access the care and support they require.
• Review the low screening uptake for breast, bowel and cervical cancer and how targeting of patients can be improved.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice