Archived: Dr Safderali Lalji Datoo Also known as Watford Way Medical Centre

Updated 13 October 2017

Dr Safderali Lalji Datoo, also known as Watford Way Medical Centre, is located in Hendon in the London Borough of Barnet. It is one of the 62 member GP practices in NHS Barnet CCG. The practice holds a Primary Medical Services contract (an agreement between NHS England and general practices for delivering primary medical services). The practice provides enhanced services for adult and child immunisations and extended hours.

The practice is registered with the Care Quality Commission to carry on the regulated activities of Treatment of disease, disorder or injury; Diagnostic and screening procedures; Maternity and midwifery services.

The practice has approximately 2,150 registered patients at the time of our inspection.

The staff team at the practice included one principal GP (male) working four sessions a week, a female salaried GP working four sessions a week and another female salaried GP working one session a week. One practice nurse (female) working 20 hours a week, a full time practice manager and two full time receptionists one of which was also the trained healthcare assistant.

The practice’s reception opening times are:

Monday 9am – 12pm and 4pm – 6pm

Tuesday 9am – 12pm and 5pm – 7pm

Wednesday 9:am – 12pm

Thursday 9am – 12pm and 4pm – 6pm

Friday 9am – 12pm and 4pm – 6pm

The practice’s GP consulting times are:

Monday 9am - 11:30am and 4pm – 6pm

Tuesday 9am - 11:30am and 5pm - 7:30pm

Wednesday 9am - 11:00am

Thursday 9am - 11:30am and 4pm – 6pm

Friday 9am - 11:30am and 4pm – 6pm

Nurse appointments were available on a Monday, Tuesday, Thursday and Friday between 9.30am and 12.30pm and between 4pm and 6.30pm on a Thursday. Urgent appointments are available each day and GPs also complete telephone consultations for patients. There is an out of hour’s service provided to cover the practice when it is closed. If patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on their circumstances. Information on the out-of-hours service is provided to patients on the practice leaflet as well as through posters and leaflets available at the practice.

The practice serves a predominantly White British population (64%). A further 19% identifies itself as Asian / Asian British and 8% as Black / African /Caribbean / Black British. The practice has a lower than average percentage than the national average of people with a long standing health conditions (42% compared to 49%). At 81 years, male life expectancy is above than the England average of 79 years. At 87 years, female life expectancy is above the England average of 83 years.

The practice was previously inspected on 26 August 2015 when it was rated inadequate overall and placed in special measures. After a further inspection on 18 May 2016, the practice was rated overall as requires improvement and remained in special measures.

Updated 13 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Safderali Lalji Datoo (also known as Watford Way Medical Centre) on 14 June 2017 and an unannounced focussed inspection on 19 June 2017. Overall the practice is rated as inadequate.

This inspection was a follow up to our earlier inspections on 26 August 2015 where the practice was rated inadequate overall and 18 May 2016 where the practice was rated requires improvement overall. At the inspection on 18 May 2016 there were breaches in legal requirements relating to the provision of safe, effective and well led services. Safe was rated as inadequate due to issues with medicines management and issues with processing pathology results. The practice was placed into special measures in November 2015 and remained in special measures after the May 2016 inspection. Following the latter inspection, a warning notice was served on the provider to address the issues with inadequate medicines management.

At our inspection on 14 and 19 June 2017 we found that the provider had not taken sufficient steps to address the issues in the warning notice. Significant improvements were still required in the areas of medicines management, record keeping and following national guidance.

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

• We were not assured from both our interviews with GPs and the review of patient records that GPs had read or implemented relevant nationally recognised guidance, particularly in relation to medicines management.

• The system and process in place for prescription management was inadequate. There was a risk that patients would receive medicines that were not appropriate to their current needs due to out of date prescriptions being given to patients.

• Patients were at risk of harm, particularly those taking high risk medicines, because if patients did not collect their prescriptions, there was no follow up by the practice

• We found examples of poor care for vulnerable patients with a lack of detail in patient notes and no care plans were in place.

• It was difficult to ascertain what improvements had been made to the care of patients following a clinical audit being undertaken.

• Information about services and how to complain was available. However there was confusion with regard to what was documented as a complaint.

• There was a system in place for reporting and recording significant events. However the practice did not undertake any analysis of these to aid further learning.

• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their treatment.

• Patients 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.

• There was a clear leadership structure though this did not support adequate governance. Staff felt supported by management.

The areas where the provider must make improvements are:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Improve staff understanding of what constitutes a complaint and record accordingly.

• Look at ways to improve QOF figures in relation to the management of patients with diabetes.

• Look at ways to improve on the results of the national GP patient survey.

Following the inspection the practice informed us that some steps have been made to improve systems within the practice, including reviewing policies in line with national guidelines and further training for clinical staff.

On 21 July 2017 because of significant concerns we took urgent enforcement action to suspend Dr Safderali Lalji Datoo as the provider of services from providing general medical services under Section 31 of the Health and Social Care Act 2008 for a period of six months to protect patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 13 October 2017

The provider was rated as inadequate for being safe, effective and well led, requires improvement for being responsive and good for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• There was insufficient assurance to demonstrate people with long term conditions received effective care and treatment which reflected current evidence based practice.

• Performance for diabetes related indicators was comparable to the national average.

• Longer appointments and home visits were available when needed.

Updated 13 October 2017

The provider was rated as inadequate for being safe, effective and well led, requires improvement for being responsive and good for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. However we were not assured that these systems were effective as the practice stated that there were currently no children on the practice child protection watch list.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice’s uptake for the cervical screening programme was 79% which was comparable to the national average of 72%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 13 October 2017

The provider was rated as inadequate for being safe, effective and well led, requires improvement for being responsive and good for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 13 October 2017

The provider was rated as inadequate for being safe, effective and well led, requires improvement for being responsive and good for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• There was insufficient assurance to demonstrate working age people (including those recently retired and students) received effective care and treatment which reflected current evidence-based practice.

• Patients could book appointments and order repeat prescriptions online.

• Health promotion advice was available in the waiting area.

Updated 13 October 2017

The provider was rated as inadequate for being safe, effective and well led, requires improvement for being responsive and good for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group

• There was insufficient assurance to demonstrate people experiencing poor mental health (including people with dementia) received effective care and treatment which reflected current evidence based practice.

• The lead GP showed a lack of awareness of consent procedures, including Gillick and Fraser competency. We were therefore not assured when providing care and treatment that relevant consent was being sought.

• Performance for dementia related indicators were above the national average. One hundred percent of patients diagnosed with dementia had had their care reviewed in the preceding 12 months compared to the national average of 85%.

• Performance for mental health related indicators were above the national average. For example, one hundred percent of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the last 12 months compared with a national average of 91%.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 13 October 2017

The provider was rated as inadequate for being safe, effective and well led, requires improvement for being responsive and good for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• There was insufficient assurance to demonstrate people whose circumstances may make them vulnerable received effective care and treatment.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. However the practice had not completed care plans for those patients that required them.

• The practice informed vulnerable patients about how to access various groups and voluntary organisations.