Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Dr Raphael Rasooly’s practice on 7 October 2016. The overall rating for the practice was good.

However we rated the practice as requires improvement for being effective and issued a requirement notice in relation to a breach of regulation 18. This was because the practice could not demonstrate it had sufficient nursing capacity to meet the needs of patients. We rated the practice as requires improvement for providing care to working age people (including those recently retired and students) because the practice’s cervical screening uptake rate was low.

We also noted that the practice:

• had not fully embedded completed clinical audit cycles as a quality improvement tool
• was not always implementing non-clinical safety alerts
• carried out checks of its emergency medicines but had not identified a missing medicine
• had identified fewer than 1% of its patients as carers
• and did not actively share its vision and values with patients.

The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Raphael Rasooly on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 7 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 7 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good. We have also rated the practice as good for providing effective care and for the care provided to working age people (including those recently retired and students).

Our key findings were as follows:

• The practice had recruited a practice nurse since our previous inspection. The practice provided evidence to show it now had sufficient nurse capacity to meet the needs of patients.

• Since the recruitment of the nurse, the practice could demonstrate marked improvement in the cervical screening coverage of eligible patients.

• The practice carried out clinical audit as part of its quality improvement work. The practice provided evidence that audit was used to ensure that effective practice was being sustained.

• The practice provided evidence that it routinely circulated information about non-clinical safety alerts and acted on these when relevant.

• The practice carried out monthly checks of the emergency medicines which included a specific check of the quantity held in addition to expiry dates.
• The practice had increased the number of patients identified as carers from 67 at our previous inspection to 91 patients by the end of November 2017. The practice provided carers with appropriate support.

• The practice made information about its vision and values available to patients, for example in the patient waiting areas.

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 covering Dr Raphael Rasooly's practices, Neasden Medical Centre and Greenhill Park Medical Centre, on 7 October 2016.

The inspection was carried out to follow up our previous inspections carried out  at Neasden Medical Centre on 30 October 2014 and at Greenhill Park Medical Centre on 26 March 2015. Both services were rated as 'requires improvement' overall and we identified a number of breaches of regulations. (The previous reports can be read by selecting the ‘all reports’ link for Dr Raphael Rasooly on our website at www.cqc.org.uk).

After the inspections the practice drew up action plans to improve its performance and meet all relevant regulations in response to our findings. At the follow up inspection on 7 October 2016, we reviewed the practice’s progress in implementing these plans. We found that the practice had made improvements and overall the practice is now 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• Most 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients said they found it easy to make an appointment with urgent appointments available the same day.
• The practice was equipped to treat patients and meet their needs. The practice was planning to extend the main surgery to better meet the needs of the practice population.
• There was a clear leadership structure and staff felt supported by the partners, the lead GP and management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice had effectively acted on most of the concerns identified at our previous inspections.

The areas where the provider must make improvement are:

• The provider must ensure there are sufficient staff with suitable skills available in the main surgery to undertake health screening activities for example cervical screening to improve rates to CCG and national levels and reduce the risk of patients developing avoidable cancers.

The areas where the provider should make improvement are:

• The practice should ensure that it reviews non-clinical safety alerts. For example it should risk assess its use of vertical blinds with looped cords in line with the relevant alert issued by NHS England.
• The practice should complete two-cycle clinical audits to ensure that observed improvements to clinical practice are sustained as part of the quality improvement programme.
• The practice should ensure that staff carrying out monitoring checks of the emergency medicines check that all items are present within packaging and are available for use in an emergency.
• The practice should make information about its vision, values and strategy more widely available to patients.
• The practice should continue to actively identify patients who are carers to ensure that they receive appropriate support and their needs are met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Dr Raphael Rasooly, also known as Neasden Medical Centre. The practice is registered with the Care Quality Commission to provide primary care services.

We carried out a comprehensive inspection on 30 October 2014. We spoke with patients and staff, including the management team.

The practice is rated as ‘requires improvement’ for the service being safe, effective, caring, responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including all the population groups. We gave the practice an overall rating of ‘requires improvement’.

Our key findings were as follows:

• Procedures were in place to report and record safety incidents
• The practice used up to date best practice guidance to ensure good outcomes for patients
• The practice met with local providers to share best practice and improve patient outcomes
• Patients found it easy to access the service and make an appointment
• Patients said they were treated with kindness and respect

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

Importantly, the provider must:

• Have a system to regularly assess and monitor the quality of the service, and manage risks relating to the health and safety of patients and staff.
• Ensure that the appropriate pre-employment checks are carried out before staff commence work at the practice. Ensure that all staff acting as chaperones have had a Disclosure and Barring Service check.
• Ensure that confidential information is stored securely.

In addition the provider should:

• Keep records to show that learning from serious events, safety incidents, complaints, and feedback is shared with staff.
• Provide relevant staff with chaperone training and make patients aware they can request a chaperone during their consultation.
• Carry out a legionella risk assessment to identify and monitor the risks associated with legionella bacteria.
• Complete audit cycles to monitor and improve quality of care.
• Formalise their vision and values and share these with patients and staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice