We carried out an announced comprehensive inspection at Dr Yousef Rashid also known as Shifa Medical Practice on 29 December 2017 and rated the practice as requires improvement for the safe, effective and well-led key questions. This led to an overall rating of requires improvement. Breaches of legal requirements were found and requirement notices were issued in relation to patient safety and governance.

The reports of all the previous inspections can be found by selecting the ‘all reports’ link for Dr Yousef Rashid on our website at www.cqc.org.uk.

This inspection was an announced focused inspection which we undertook on 30 January 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 12 December 2017. This report covers our findings in relation to those requirements. We found that there had not been an improvement and the practice is now rated as inadequate overall and has been placed in special measures for a period of six months.

We have rated this practice as inadequate overall.

We based our judgement of the quality of care at this service on a combination of:

• What we found when we inspected
• Information from our ongoing monitoring of data about services and;
• Information from the provider, patients and the public.

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

• The practice had still failed to carry out Disclosure and Barring Service (DBS) checks on staff who acted as chaperones.
• Checks of medicines and related equipment stored in the practice were not carried out consistently to ensure that they remained safe and effective. We found some expired medical emergency equipment.
• The practice’s performance remained below local and national averages for management of diabetes.
• Verbal complaints were not formally recorded and we did not see evidence that they had been discussed with staff. The practice did not carry out formal, minuted staff meetings.
• Practice policies had not been updated annually.
• Staff did not have all the required training and recruitment files did not contain the appropriate recruitment checks.
• There was no evidence that the practice nurse had medical indemnity insurance.
• Patient’s medication reviews were not formalised and did not contain the required information.
• There was a lack of governance arrangements to ensure that quality assurance processes were in place which led to improvements in patient outcomes.

The areas where the provider must make improvements 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.
• Ensure that persons employed at the practice have received appropriate training.

(Please see the specific details on action required at the end of this report). Note: Warning notices were issued to the provider following the inspection undertaken on 30 January 2019. This was to ensure that the provider was aware of our concerns and that action was taken quickly to address these concerns and mitigate risks to patients.

Requirement notices were issued for the additional concerns which related to breaches identified. The level of risk stemming from these concerns was not deemed to be sufficient to require additional enforcement action.

The areas where the provider should make improvements are:

• Take steps to improve the uptake of childhood immunisations rates.
• Develop a process aimed at identifying patients with caring responsibilities to be able to provide appropriate support and signposting.
• Review staffing levels at the practice to ensure that there is sufficient capacity to complete all necessary tasks.
• Consider developing a structure for minuted staff meetings to take place, to facilitate lessons learned and improvements to be made.
• Take steps to develop and maintain care plans for patients with learning disabilities.

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.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Yousef Rashid also known as Shifa Medical Practice on 5 December 2016 and rated the practice as requires improvement for safe, effective and well-led key questions. This led to an overall rating of requires improvement. Breaches of legal requirements were found and requirement notices were issued in relation to patient safety and governance. The full comprehensive report can be found by selecting the http://www.cqc.org.uk/provider/1-199797857 link for Shifa Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection which we undertook on 6 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 5 December 2016. This report covers our findings in relation to those requirements. The overall rating from this visit remains requires improvement. Our key findings across all the areas we inspected were as follows:

• The practice had few policies to govern activities and those we reviewed were not fit for purpose as they were outdated and/or contained incorrect information.

• Verbal complaints were not formally recorded and we did not see evidence they were discussed during staff meetings.

• Staff who acted as chaperones were not trained for the role and had not received a Disclosure and Barring Service (DBS) check.

• We found the practice was still failing to carry out appropriate recruitment checks prior to employment.

• This practice’s performance was below local and national averages for management of diabetes.

• At the inspection of 5 December 2016, the practice had identified two patients as carers. At this inspection, 11 patients were identified as carers which was less than one percent (1%) of the practice list.

Importantly, the provider must:

• 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:

• Update business continuity plan to include contact details for all members of staff so that they can be contacted should an emergency arise.

• Take steps to improve the practice’s performance in the management of diabetes.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

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 Shifa Medical Practice on 5 December 2016. Overall the practice is rated as requires improvement.

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

• Staff understood their responsibility for reporting and recording incidents.

• We saw examples of incidents, which were reviewed identifying the lessons learned.

• The practice carried out regular medicines audits, with the support of the local CCG pharmacy team, to ensure prescribing was in line with best practice guidelines for safe prescribing.

• Data from the Quality and Outcomes Framework (QOF) showed most patient outcomes were at or above average comparable to the national average.

• Members of staff were courteous and very helpful to patients and treated them with dignity and respect. We saw staff treated patients with kindness and consideration.

• All relevant new clinical guidelines were forwarded to the practice nurse and the GP made sure new guidelines were put into practice.

• The practice analysed their A&E attendances and hospital admissions to identify where they could be reduced.

• Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect. The practice was above average for its satisfaction scores on consultations with the GP and nurse

• Access to appointments was good. Patients said they were usually offered an appointment within a couple of days and could book on line.

• The lead GP demonstrated they had the experience, capacity and capability to run the practice and ensure good quality care.

The areas where the provider must make improvements are:

• Ensure all staff carrying out chaperoning duties are trained for the role.

• Ensure all staff have a DBS check or are risk assessed and references are obtained for all new staff.

• Patient Group Directions are implemented for all procedures carried out by the practice nurse.

• Ensure all policies and procedures which govern activity within the practice are up to date.

• Develop a clear governance framework and structure which clarifies the roles and responsibilities of all staff.

In addition the provider should:

• Improve the management of long term conditions including CHD, COPD and diabetes.

• Secure blank prescription forms kept behind the main reception desk.

• Provide all staff with appraisals to provide feedback on progress and development.

• Review the number of carers being supported by the practice because less than 1% of the practice’s list had been identified as carers.

• Keep written records of verbal complaints in addition to complaints received in writin

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice