Archived: Dr Sharif Hossain

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sharif Hossain on 22 September 2016. Overall the practice is rated as inadequate.

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

• There was an open and transparent approach to safety but systems in place for reporting and recording significant events were not effective.
• Risks to patients were not always assessed or well managed. For example the practice had taken adequate steps to ensure that risk presented by fire and infection control had been assessed. We also found that appropriate recruitment and monitoring checks were not being completed for all staff and that three of the practice’s nurses did not have medical indemnity insurance in place. The practice had no system in place to monitor the use of handwritten prescriptions.
• Safeguarding processes and procedures were not sufficiently robust to ensure that vulnerable patients were kept safe.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance in most areas. However practice performance for the management of diabetic patients and identification of patients with coronary heart disease was below local and national averages and antibiotic prescribing was higher than the local and national average.
• Staff had completed requisite clinical update training to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, some staff had not completed all required training and some staff had not received an annual appraisal.
• 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. However we noted that the complaint policy provided to patients and the one stored for internal reference contained conflicting information about what to do in the event that a patient was unhappy with the practice’s response to a complaint. We also noted that one complaint was not responded to in an appropriate manner.
• Patients we spoke with on the day 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. However patient survey scores indicated that patients had problems accessing their preferred GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Some practice policies were not fit for purpose or missing. For example the practice did not have a policy for dealing with the spillage of bodily fluids and their recruitment policy was from another organisation.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Put in place effective systems and processes which assess, monitor, manage and mitigate risks to the health and safety of service users arising from significant events and patient safety alerts and ensure that all staff are involved in subsequent discussion and learning.

• Ensure that practice safeguarding processes are effective at keeping vulnerable individuals safe from abuse and harm.

• Ensure that action is taken to assess and mitigate risk including those associated with infection control, fire safety and medicines management.

• Ensure all staff have professional indemnity insurance and that robust recruitment processes are in place.

• Ensure that all staff have completed appropriate mandatory training in accordance with current guidelines and best practice and ensure that all staff employed by the practice are appraised every 12 months.

• Ensure policies and procedures are up to date and contain all relevant information to ensure they are effective.

The areas where the provider should make improvement are:

• Improve awareness of chaperoning, translation and bereavement services in the practice waiting area as well as the reviewing the processes used to identify and support patients who act as carers.

• Ensure the practice’s business continuity plan to including all relevant information including emergency contact numbers of all staff working at the practice and document details of patients and discussions had at multidisciplinary meetings.

• Work to improve patient survey scores regarding access to a preferred GP.

• Introduce care planning for patients where this is required.

• Ensure that complaint responses are appropriate and timely.

• Assess the need and frequency of portable appliance testing.

• Continue to work to improve outcomes for diabetic patients, increase the identification of patients with coronary heart disease and reduce antibiotic prescribing.

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