Archived: Dr Iftekhar Majeed

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Dr Iftekhar Majeed’s practice at Bloomsbury Health Centre on 16 October 2017. Concerns relating to the management of safety alerts, monitoring of patients on anticoagulation therapy, ineffective systems for the monitoring emergency equipment and the appropriate management of vaccines and the recording of fridge temperatures were identified. Under Section 29 of the Health and Social Care Act 2008 a warning notice was issued in respect of the following regulated activities: Treatment of Disease, Disorder or Injury and Diagnostic and Screening Procedures.

We carried out this focused inspection on 4 December 2017 to review the actions the practice had taken following the warning notice and focussed on the areas relevant to the notice only. As a result this there is no rating awarded following this inspection. Our key findings at this inspection were as follows:

• At the inspection in October 2017 we found the practice did not have an effective process in place to monitor patients on anticoagulation therapy. At this inspection the GP had reviewed all patients on anticoagulation medicines and had reviewed each patient appropriately.
• At the previous inspection, the practice was unable to confirm if alerts received from the Medicines and Healthcare Products Regulatory Agency (MHRA) had been acted on. The practice had introduced a system to ensure safety alerts including those received from the Medicines and Healthcare Products Regulatory Agency (MHRA) alerts were actioned appropriately by clinical staff.
• At the first inspection we found vaccines were not being managed appropriately. Vaccine fridge temperatures were not recorded daily and temperatures exceeding the range were recorded with no action being taken to review the risk. We found at this inspection the practice had implemented check lists to monitor the fridge temperatures daily and the practice had also purchased a data logger to collect fridge temperature information continuously.
• At the previous inspection we found there was no system in place to monitor emergency equipment. At this inspection, the practice had introduced a monitoring system to ensure all emergency equipment was checked and monitored on a regular basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We first inspected Dr Iftekhar Majeed’s practice on 21 November 2016 as part of our comprehensive inspection programme. The overall rating for the practice was requires improvement. The full comprehensive report on November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Iftekhar Majeed on our website at www.cqc.org.uk. During the inspection, we found the practice was in breach of legal requirements; this was because appropriate processes were not in place to mitigate risks in relation to the safety and quality of the services offered. Following the inspection, the practice wrote to us to say what they would do to meet the regulations.

This inspection was an announced comprehensive inspection, carried out on 16 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified at our previous inspection. This report covers our findings in relation to those requirements.

We found minimal risks had been mitigated and further improvements were required. We also identified new breaches and as result of our inspection, a warning notice was issued under Section 29 of the Health and Social Act 2008 to the provider Dr Iftekhar Majeed in relation to the regulated activity: Treatment of disease, disorder and injury due to the ineffective systems in place to monitor patients on high risk medicines and the management of risk in relation to the vaccine fridge temperatures and out of date emergency equipment. Due to our inspection findings the practice is now rated as inadequate and has been placed into special measures.

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

• At the previous inspection we found the service could not demonstrate effective management of risks in relation to medicine safety alerts or updates from the Medicines and Healthcare products Regulatory Agency (MHRA). At this inspection we found there was a system in place to receive safety alerts but the practice were unable to demonstrate what actions had been taken and were not aware of some alerts.
• Since the last inspection the practice had reviewed patients on some high risk medicines to ensure they were monitored appropriately. However at this inspection we found there was no effective process in place to monitor patients on anti-coagulation therapy.
• Vaccines were not being managed appropriately. Vaccine fridge temperatures were not recorded daily and temperatures exceeding the range were recorded with no action being taken to review the risk. On the day of inspection we found the fridge temperature had been recorded as 14 degrees and no action had been taken to ensure the vaccines could not be used until they were confirmed as safe. Since the inspection we have received evidence from the practice that they had contacted the vaccine suppliers to ensure the vaccines were safe to use.
• There was no system in place to monitor the expiry dates of masks used in emergency situations, we found both adult and children’s masks were out of date.
• At the previous inspection we found some clinical audits had been completed, however the audits were single cycle only and the practice was unable to demonstrate improved outcomes as a result. At this inspection we found some clinical audits had been completed, none were two cycle audits and the audits we reviewed did not demonstrate improved outcomes for patients.
• We found on the day of inspection that the practice did not have on display the most recent CQC rating and the date it was given. The practice told us they were unaware that this needed to be on display; however we found that the outcome from the 2014 inspection was available on the practice website. The practice acted on this immediately and the most recent ratings were on display in the waiting room, however the information was not available on the practice website.
• The systems for safeguarding children and vulnerable adults was found not to be effective at the previous inspection as communication with other healthcare professionals needed strengthening to protect patients from the risk of harm. At this inspection we found that the practice had implemented regular communication with the health visitors and meetings had been organised to ensure information was shared appropriately. However, alerts were not added to patients’ records when safeguarding concerns had been identified.
• There was a system in place for reporting and recording significant events, however at the previous inspection we found documentation did not include actions taken or learning points. At this inspection we found this had been reviewed and actions and learning were included in the review of events and discussed at team meetings.
• There was a leadership structure and staff felt supported by management; however effective oversight to ensure governance arrangements were embedded had not been established.
• Communication between the management team needed strengthening to ensure all updates to services and changes within practice were communicated effectively to the team and patients.
• Uptake for childhood immunisations and national screening programmes were below national averages. The practice told us they had signed up to a new immunisation scheme with NHS England to improve the uptake on children’s vaccinations by completing monthly audits and following up on patients who did not attend appointments.
• 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.
• The practice proactively sought feedback from staff and patients, which it acted on. The GP encouraged a culture of openness and honesty.

However there were areas of practice where the provider must make improvements:

• 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

There were areas where the practice should make improvements:

• Encourage patients to attend immunisation and national screening programmes.
• Continue to review how the practice could proactively identify carers in order to offer them support where appropriate.

I confirm that this practice had not improved sufficiently and is rated as Inadequate overall. 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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr. Iftekhar Majeed on 21 November 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety. However, a more effective system for reporting and recording significant events was needed.

• Some risks were identified and assessed, in other cases the absence of, or ineffective systems in place generated risks for patients which had not been mitigated for example those relating to high risk medicines and home visits.

• 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.
• Patients said they found it easy to make an appointment with the GPs and there was continuity of care, with urgent appointments available the same day. There were however concerns expressed by some patients about limited access to a female GP, as appointments with this doctor were limited to two mornings per week.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 improvements are:

• Ensure effective systems are in place to support the safe prescribing of high risk medicines which require additional monitoring.

• Ensure an effective system is in place for the management of patient safety, for example the National Patient Safely Alerts.

• There must be an effective system for identifying vulnerable patients, ensuring there is a system to share information about children who are at risk of harm with health visitors.

• The areas where the provider should make improvement are:

• Consider a structured approach to clinical audits.

• Review the system in place to ensure only current Patient Group Directions are in circulation in the practice.

• Review the approach to the care planning process and review care plans to ensure they are all fully documented.

• Clarify the arrangement in place for checking emergency equipment with the neighbouring practice, as there was no formal arrangement in place to make sure this task was being carried out and by whom.

• Consider how patients can access a female GP when required.

• The practice should continue with efforts to identify carers in order to offer care and support.

• Consider how to further promote health screening in order to improve uptake.

• Review the template for the recording significant events to include actions or learning points.

• Introduce a consistent approach to dealing with home visit requests.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice