This practice is now rated as Good overall. (Previous rating August 2018 – requires improvement and remained in special measures)

On 6 December 2017 we carried out a full comprehensive inspection of Oldham Family Practice (then registered as Dr Ahmed Choudhury), Integrated Care Centre, New Radcliffe

Street, Oldham, OL1 1NL. The practice was given an overall rating of inadequate and placed into special measures.

A requirement notice was issued in respect of Regulation 18, (staffing), of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, and warning notices were issued in respect of Regulation 12 (safe care and treatment), Regulation 13 (safeguarding service users from abuse and improper treatment), Regulation 16 (receiving and acting on complaints and Regulation 17 (good governance).

On 6 April 2018 we carried out a focused inspection to check that the practice had met the requirements of the warning notices. We found that the required improvements had been made.

On 10 August 2018 we carried out a full comprehensive inspection of Oldham Family Practice to assess all domains and determine if the required improvements had been made in order for the practice to be taken out of special measures. We found that although some improvements had initially been made these had not been sustained. The practice was rated overall requires improvement and special measures were to be kept in place for a further six 

months.

The domain ratings were:

Safe – Requires improvement

Effective – Requires improvement

Caring – Good

Responsive – Requires improvement

Well-led – Inadequate

A warning notice was issued in respect of Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance). This stated improvement must be made by 31 December 2018.

On 24 January 2019 we carried out a focused inspection to check that the practice had met the requirements of the warning notices. We found that the required improvements had been made.

We carried out this most recent announced comprehensive inspection at Oldham Family Practice on 9 April 2019 to assess all domains and determine if the required improvements had been made in order for the practice to be taken out of special measures.

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, the public and other organisations.

We have rated this practice as good overall and good for all population groups, except Families, children and young people which was requires improvement.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice had recruited a number of additional reception and clinical staff which allowed them to organise and deliver services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice had a new management team in place and we found the way the practice was now led and managed had resulted in significant improvements and the new partners and management team promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Continue to improve childhood immunisation uptake rates to meet the World Health Organisation (WHO) targets.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service. We will re-inspect the practice within 12 months to ensure they maintain quality care.

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

On 6 December 2017 we carried out a full comprehensive inspection of Oldham Family Practice (then registered as Dr Ahmed Choudhury), Integrated Care Centre, New Radcliffe Street, Oldham, OL1 1NL. The practice was given an overall rating of inadequate and placed into special measures. The domain ratings were:

Safe – Inadequate

Effective – Inadequate

Caring – Requires improvement

Responsive – Requires improvement

Well-led – Inadequate.

A requirement notice was issued in respect of Regulation 18 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (staffing), and warning notices were issued in respect of Regulation 12 (safe care and treatment), Regulation 13 (safeguarding service users from abuse and improper treatment), Regulation16 (receiving and acting on complaints and Regulation 17 (good governance).

On 6 April 2018 we carried out a focused inspection to check that the practice had met the requirements of the warning notices. We found that the required improvements had been made.

On 10 August 2018 we carried out a full comprehensive inspection of Oldham Family Practice to assess all domains and determine if the required improvements had been made in order for the practice to be taken out of special measures. We found that although some improvements had initially been made these had not been sustained. The practice was rated overall requires improvement and special measures were to be kept in place for a further six months. The domain ratings were:

Safe – Requires improvement

Effective – Requires improvement

Caring – Good

Responsive – Requires improvement

Well-led – Inadequate

A warning notice was issued in respect of Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance). This stated improvement must be made by 31 December 2018.

This inspection, on 24 January 2019, was to check the requirements of the warning notice had been met. We found that all the requirements had been met.

In particular:

• We saw that a programme of audits was in place that was monitored. Audits were repeated, and we saw evidence of improvement being made.
• Staff had been trained in how to deal with verbal and written complaints. The process had been reviewed, was monitored, and evidence of learning documented.
• The process for dealing with significant events had been reviewed and was monitored. Training on how to deal with significant events had been given to staff and we saw evidence that significant events were discussed within the team, with learning documented. Where an apology was required this would be documented.
• A process had been put in place to ensure the equipment of all clinicians was calibrated.
• A process had been put in place to ensure that all emergency medicines and emergency equipment was regularly checked.
• New staff had been recruited which alleviated the need for informal secondment of staff from another practice.

The rating of requires improvement awarded to the practice following our full comprehensive inspection on 10 August 2018 remains unchanged. The practice will be re-inspected and their rating revised if appropriate in the future.

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

Please refer to the detailed report and the evidence tables for further information.

This practice is rated as requires improvement overall. (Previous rating 6 December 2017 – Inadequate)

At the December 2017 inspection the key questions were rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

At this August 2018 the key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Oldham Family Practice on 10 August 2018. This was a full follow up inspection carried out six months after the report placing the practice into special measures was published. There had been a follow-up inspection carried out on 6 April 2018 to check the progress of warning notices issued in January 2018 regarding breaches in regulations 12 (safe care and treatment), 13 (safeguarding service users from abuse and improper treatment), 16 (receiving and acting on complaints) and 17 (good governance). The April 2018 inspection showed that improvements had been made. However, this inspection in August 2018 showed that the improvements had not been sustained in all areas.

At this inspection we found:

• 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 consider how they could learn from the events. Patients were not always informed of significant events that involved them.
• A large percentage of administrative staff, including the practice manager, had recently left. The practice relied on staff from the partners’ other practice helping on an informal basis.
• We found required improvements relating to staffing had been dealt with. These related to staff training and appraisals. We saw training was now well-monitored and staff received support and appraisals.
• The practice had below average overall Quality and Outcome Framework (QOF) scores, and areas such as cancer screening and childhood vaccinations were below average.
• Some safety checks were not completed. For example, some salaried GPs and locum GPs used their own equipment that had not been calibrated and there was no system to check emergency medicines and equipment when the practice nurse was off work.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and most reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation. There was no arrangement to use clinical audit for improvements.

The areas where the provider must make improvements as they are in breach of regulations are:

• 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:

• The practice should review their appointments to make sure they are accessible to the practice population.
• The practice should make sure all staff know who the safeguarding lead is and have a process to contact them if they are not based at the practice.

This service was placed in special measures in February 2018. Insufficient improvements have been made such that there remains a rating of inadequate for well-led. Therefore, we are taking 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 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

We carried out an announced comprehensive inspection at Oldham Family Practice (then registered as Dr Ahmed Choudhury) on 6 December 2017. The overall rating for the practice was inadequate, and the practice was placed in special measures. The full comprehensive report on the December 2017 inspection can be found by selecting the ‘all reports’ link for Oldham Family Practice on our website at www.cqc.org.uk.

The inspection of 6 December 2017 resulted in four warning notices being issued against the provider.

On 11 January 2018 we issued warning notices to the provider in relation to a breach of:

• Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe care and treatment.

• Regulation 13 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safeguarding service users from abuse and improper treatment.

• Regulation 16 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Receiving and acting on complaints.

• Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

This inspection was an announced focused inspection carried out on 6 April 2018 to confirm that the practice had made improvements and met the requirements of the warning notices. At this inspection we found that all aspects of the warning notices had been met.

The rating awarded to the practice following our full comprehensive inspection on 6 December 2017 remains unchanged, and the practice will remain in special measures. The practice will be re-inspected in relation to their rating and being removed from special measures within six months of the report being published from the December 2017 inspection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate. (Previous inspection March 2015 – Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions - Inadequate

Families, children and young people - Inadequate

Working age people (including those retired and students) - Inadequate

People whose circumstances may make them vulnerable - Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at Dr Ahmed Choudhury (also known as Oldham Family Practice) 0n 6 December 2017. This inspection was part of our inspection programme.

At this inspection we found:

• 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 record or investigate, so learning from them was not demonstrated.

• The practice did not routinely review the effectiveness and appropriateness of the care it provided. Care and treatment was not always delivered according to evidence- based guidelines.

• Patients commented that appontments were usually available and they could access care when they needed it.

• Staff treated patients with kindness, dignity and respect.

• There was little innovation or service development and improvement had not been a priority among staff and leaders.

The areas where the provider must make improvements as they are in breach of regulations are:

• The provider must ensure safe care and treatment is provided.

• The provider must ensure patients are safeguarded from abuse and improper treatment.

• The provider must have a system in place to ensure all complaints are recorded, investigated and appropriately responded to.

• The provider must improve their governance arrangements.

• The provider must ensure all staff are suitably qualified, skilled, trained and supported.

The area where the provider should make improvements are:

• The provider should accurately identify patients who are carers so appropriate support can be offered.

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