Dr Zaheer Hussain in Fulham, London is a Doctors/GP specialising in the provision of services relating to diagnostic and screening procedures, maternity and midwifery services, services for everyone and treatment of disease, disorder or injury. The last inspection date here was 17th December 2018
Dr Zaheer Hussain is managed by Dr Zaheer Hussain.
Contact Details:
Address:
Dr Zaheer Hussain 322 Lillie Road Fulham London SW6 7PP United Kingdom
Telephone:
02073851964
Ratings:
For a guide to the ratings, click here.
Safe: Inadequate
Effective: Inadequate
Caring: Good
Responsive: Inadequate
Well-Led: Inadequate
Overall: Inadequate
Further Details:
Important Dates:
Last Inspection
2018-12-17
Last Published
2018-12-17
Local Authority:
Hammersmith and Fulham
Link to this page:
Inspection Reports:
Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.
We did not review the ratings awarded to this practice at this inspection.
We carried out an announced focused inspection at Dr Zaheer Hussain’s practice on 8 October 2018. The purpose was to follow up on breaches of regulations identified at our previous inspection which was carried out on 24 July 2018 and 6 August 2018. Following that inspection, CQC placed urgent conditions on Dr Zaheer Hussain’s registration due to breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). The provider was given set timescales to report on the actions it had taken in response to the conditions. We carried out this focused inspection to assess the immediate safety of the practice during this period and to assess the provider’s progress in addressing the identified breaches.
At this inspection we found:
The practice had taken action to improve safety including its monitoring of medicines and arrangements to respond to medical emergencies. However, safeguarding arrangements remained under-developed.
A review of recent consultations indicated that the clinicians were aware of current evidence-based guidance and were delivering effective care and treatment. The practice had not yet undertaken its own reviews or work to demonstrate competence in its management of patients with long-term conditions.
The practice had increased its nursing and health care assistant capacity as part of its plans to increase cervical screening coverage. There was sufficient clinical capacity to enable patients to access the service in a timely way.
The provider had systems in place to record, monitor, analyse and share learning from significant events and patient safety alerts.
The practice had taken action in response to our previous concerns and conditions. However, it did not yet have an overarching strategy to improve and we remained concerned about the lack of consistent, clinical leadership in the practice.
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.
Overall summary
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 Zaheer Hussain (Fulham Cross Medical Centre) on 10 November 2015. The overall rating for the practice was inadequate and the practice was suspended for a period of three months. We inspected the practice again on 4 February 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. We inspected the practice on 15 September 2016. The overall rating was requires improvement. The full comprehensive reports for November 2015, February 2016 and November 2016 inspections can be found by selecting the ‘all reports’ link for Dr Zaheer Hussain on our website at www.cqc.org.uk.
This inspection was an announced comprehensive inspection carried out on 17 July 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 15 September 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.
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.
The practice had clearly defined and embedded systems to minimise risks to patient safety.
Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
Survey information we reviewed showed patients felt the practice offered an excellent service and staff were friendly, caring, polite and professional and treated them with dignity and respect.
Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
Patients we spoke with 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.
The practice had good facilities and was well equipped to treat patients and meet their needs.
Since the last inspection the practice staffing structure had been strengthened and most improvements previously made had been sustained. There remained areas of weakness in relation to clinical outcomes and clinical leadership capacity.
The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
However, there were also areas of practice where the provider needs to make improvements.
The provider should:
Continue to monitor and improve Quality and Outcomes (QOF) performance.
Continue to encourage the uptake of cervical smear screening and childhood immunisations.
Continue to review how carers are identified to ensure information, advice and support is made available to them.
Review the arrangements for the documentation, investigation and monitoring of all complaints, including those received verbally.
Letter from the Chief Inspector of General Practice
We carried out an announced follow up inspection Dr Zaheer Hussain at Fulham Cross Medical Centre on 15 September 2016. Overall the practice is rated as requires improvement.
Dr Hussein’s surgery was placed into special measures following an inspection in February 2016, which was carried out to establish if the required improvements had been made since our first inspection and subsequent enforcement action to suspend the provision of regulated activities at the practice in November 2015.
Following the inspection in February 2016 the practice received an overall rating of inadequate. Four breaches of the Health and Social Care Act 2008 were identified. These breaches related to regulation 11 - Need for consent, regulation 12 - Safe care and treatment, regulation 13 - safeguarding service users from abuse and improper treatment and regulation 17 - good governance. Four requirement notices were issued and the practice submitted an action plan to CQC outlining the action they would take in response to our findings.
At our follow-up inspection on 15 September 2016 we found that the practice had made significant improvement having employed and worked with external consultants and the Royal College of General Practitioners (RCGP). The four requirement notices we issued following our previous inspection had all been met. The practice is now rated as requires improvement overall.
Our key findings across all the areas we inspected were as follows:
The system for reporting and recording significant events had been reviewed and further developed. Staff we spoke with understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. We saw evidence to demonstrate that learning from incidents was shared amongst staff.
Results from the national patient survey showed that patients rated the practice better than local and national averages to questions about patient involvement in planning and treating them with care and concern in GP consultations.
Clinicians were kept up to date with national guidance and guidelines and updates were shared within the clinical team at weekly meetings to improve whole practice care.
Clinical staff demonstrated an understanding of the Mental Capacity Act 2005 and Gillick competences.
Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
Care plans were in place for vulnerable patients, however they did not contain enough relevant information about treatment plans and reviews.
The practice did not hold regular multidisciplinary meetings to meet patient’s needs and manage complex cases.
There was no evidence to demonstrate how the practice monitored and improved patient outcomes.
Significant improvements had been made since our last inspection but the practice could not demonstrate how they would be sustained as key members of the leadership team held temporary contracts.
The areas where the provider must make improvements are:
Carry out quality improvement activity such as clinical audits including re-audits to ensure improvements have been achieved
Implement formal processes to ensure the practice works effectively with other service providers to meet patient’s needs and manage complex cases.
Clarify the leadership structure and ensure there is leadership capacity to deliver and sustain all improvements.
The areas where the provider should make improvements are:
Care plans for patient groups such as for those patients on the mental health register or those with a learning disability were in place, however require further development in relation to clearly stating treatment plans and review information/dates.
Implement appropriate systems to identify patients who are carers so their needs can be identified and met.
Formalise the succession plans to ensure continuity of care and future planning.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Zaheer Hussain practice, also known as Fulham Cross Medical Centre on 10 November 2015. Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
Patients were at risk of harm because inadequate systems were in place to keep patients safe including those for dealing with emergencies, safeguarding, incident reporting, infection control, medicine management and health and safety.
Staff were not clear about reporting significant events, incidents and near misses and there was no evidence of learning and communication with staff.
There was insufficient assurance to demonstrate people received effective care and treatment which reflected current evidence-based practice.
Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others, either locally or nationally.
Patients were positive about their interactions with staff and said they were treated with compassion.
Patients were at risk of not receiving timely care when they needed it as information for patients when the practice was closed did not provide appropriate advice.
The practice had limited formal governance arrangements.
The areas where the provider must make improvements are:
Develop and implement a vision and strategy to improve services for patients and ensure governance processes are in place to monitor safety and risks.
Ensure appropriate arrangements are in place for managing medical emergencies including: availability of an automated external defibrillator (AED) or undertake a risk assessment if a decision is made to not have an AED on-site; a full complement of emergency medicines; staff training in basic life support.
Develop an explicit telephone answerphone message which directs patients to appropriate care and advice when the practice is closed.
Ensure arrangements are in place for annual testing of all electrical equipment and calibration of clinical equipment.
Put systems in place for the secure storage of prescription pads and the monitoring of their use.
Ensure all clinical staff understand the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.
Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses. Ensure staff are aware of and comply with the requirements of the Duty of Candour in the event of a notifiable safety incident.
Take action to address identified concerns with infection prevention and control.
Ensure recruitment arrangements include all necessary employment checks for all staff. Undertake Disclosure and Barring Service (DBS) checks for all staff providing a chaperone service for patients and ensure staff are suitably trained to perform this role.
Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines. Carry out clinical audits including re-audits to ensure improvements have been achieved. Make arrangements for clinical staff to attend multi-disciplinary team (MTD) meetings.
Provide clinical curtains within consulting rooms to maintain patients’ privacy and dignity during examinations, investigations and treatments. Provide staff training in information governance and patient confidentiality to ensure patient privacy is maintained.
Ensure Care Quality Commission ratings of the practice are displayed to patients and users of the service.
The areas where the provider should make improvement are:
Develop an effective system for clinicians to follow at the end of clinical sessions to ensure important information is received and actioned by the next GP on duty.
Make arrangements to improve the uptake and access to; cervical screening for patients at the practice.
The GP should undertake training on the clinical systems to have a comprehensive understanding of the performance of the practice.
Consider improving communication with patients who have a hearing impairment. Advertise within the practice the provision of the translation service for patients.
On 11 November 2015 we took urgent enforcement action to suspend Fulham Cross Medical Centre from providing general medical services under Section 31 of the Health and Social Care Act 2008 ("the Act) for a period of three months as a minimum to protect patients. This enforcement action is subject to a right of appeal.
Where a practice is rated as inadequate for one of the five key questions or one of the six population groups the practice will be re-inspected within six months after the report is published. If, after re-inspection, the practice has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place the practice into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Zaheer Hussain also known as Fulham Cross Medical Centre on 7 October 2014. Overall the practice is rated as requires improvement.
Specifically, we found the practice to require improvement for providing safe, effective, responsive and well led services. It also required improvement for providing services for the Older people, People with long-term conditions, Families, children and young people, Working age people (including those recently retired and students). It was good for providing a caring service.
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.
Records did not demonstrate information about safety was monitored, appropriately reviewed and addressed.
Data showed patient outcomes were average for the locality. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
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.
Urgent appointments were usually available on the day they were requested.
The practice had a number of policies and procedures to govern activity, but these were not service specific.
There were limited records to demonstrate governance and no evidence that the practice held regular governance meetings.
The practice had not proactively sought feedback from staff or patients.
The areas where the provider must make improvements are:
Ensure staff receive training relevant to their job role.
Demonstrate that staff can respond appropriately to medical emergencies.
Ensure there are mechanisms in place to seek feedback from staff and patients and this feedback is responded to.
Ensure staff who act as a chaperone have an appropriate DBS check.
Ensure equipment is properly maintained.
Ensure all aspects of infection control are identified and effectively managed
Ensure potential risks are identified and where possible eliminated through the use of appropriate risk assessments.
Ensure women are offered services appropriate to their needs.
Ensure clinical audits cycles are completed and are used to drive improvements in patient care.
In addition the provider should:
Ensure all significant events are recorded and demonstrate how learning from significant events have influenced practice and improved patient outcomes.
Develop a formal procedure to respond to national patient safety alerts.
Ensure the chaperone policy should provide sufficient detail to enable staff to understand and carry out the role of a chaperone.
Introduce a back-up checking system to ensure that treatment recommendations and prescription changes made in hospital discharge letters have been responded to in a timely manner.
Improve patient access and information sharing through the introduction of a website.
Ensure policies and procedures are service specific.
Ensure all staff are aware of the practices whistleblowing policy.
We carried out an announced comprehensive inspection at Dr Zaheer Hussain, also known as Fulham Cross Medical Centre, on 7 October 2014 under section 60 of Health and Social Care Act 2008 as part of our regulatory functions. The overall rating for the practice was requires improvement in safe, effective, responsive and well-led domains, and good in the caring domain. A second announced comprehensive inspection was planned for 5 November 2015; however, the inspection team was refused entry by the Registered Provider, Dr Hussain. The inspection team attended the practice on 10 November 2015 and conducted a comprehensive inspection. This resulted in the practice being rated as inadequate across all domains and the practice was suspended for three months. The suspension was stayed following representations to the Judge, on condition that a repeat inspection be conducted and if found to be "good enough" the practice would be allowed to re-open. A further inspection was conducted on 4 February 2016, the practice was rated inadequate overall, inadequate in well-led, safe and effective domains and requires improvement in responsive and caring domains. The practice was placed in Special Measures. A six-month inspection following Special Measures was carried out on 15 September 2016 and the practice was rated overall as requires improvement, requires improvement in effective and well-led domains and good in safe, caring and responsive domains. The practice was taken out of special measures. A twelve-month follow-up CQC inspection took place on 17 July 2017, at which the practice was rated as being good overall, with requires improvement in well-led domain.
The full comprehensive reports of the previous inspections can be found by selecting the ‘all reports’ link for Dr Zaheer Hussain on our website at www.cqc.org.uk.
This inspection, on 24 July 2018 was an announced comprehensive inspection with a second unannounced visit on 6 August 2018 to confirm that the practice was now meeting the requirements we had identified in well led domain at our previous inspection on 17 July 2017.
At this inspection we found the practice demonstrated some improvements from previous inspections, for example, significant events, managing complaints and sharing learning with staff, and duty of candour and whistleblowing policies were in place and staff understood what is meant by those terms. However, improvement overall had not been sustained, the provider had failed to respond to issues we have previously identified and raised with them. We found breaches in regulations 12 and 17. In particular:
The practice did not have clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice did not always learn from them. Risk assessments were not being completed; staff recruitment was not in line with requirements; improvements were required to infection control and there was no recent audit; equipment was not all calibrated; there were fewer GP sessions provided than at our last inspection when patient numbers had increased; there was no system to manage medicines and safety alerts; prescribing and the management of patients being prescribed high risk medicines was not always in line with guidance and requirements.
There was limited evidence the practice reviewed the effectiveness and appropriateness of the care it provided. We found there was no induction for new staff, staff did not receive training needed to carry out their role, no appraisal, minimal evidence of quality improvement, no process to monitor consent. There were low numbers of women attending for a cervical smear and low child immunisations.
Staff generally involved patients in their care and treatment and treated patients with compassion, kindness, dignity and respect.
The practice did not respond to patient needs by providing safe and effective care and treatment. There was no evidence the practice had considered patient feedback regarding access and taken action to improve patient experience.
There was a lack of governance and no systems in place to assess, monitor and improve quality and safety, while clinical meetings were taking place, these were not recorded so there was no evidence of discussions or actions, the practice did not work with other health and social care services to provide joined up care and treatment for patients.
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.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 varying the terms of their registration within six months if they do not improve.
This 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 this provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
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