Archived: Dr Abdul-Razaq Abdullah

We previously carried out an announced comprehensive inspection of Dr Abdul-Razaq Abdullah on 4 and 13 June 2019 and found the practice was in breach of Regulation 12: ‘Safe care and treatment’ and Regulation 17 ‘Good governance’ of the Health and Social Care Act 2008. In line with the Care Quality Commission’s (CQC) enforcement processes, we imposed conditions on the providers registration which required Dr Abdul-Razaq Abdullah to comply with the conditions Regulations by 31 July 2019. In addition, the practice was put in special measures.

We carried an announced focused inspection on 5 August 2019 to check whether the practice had taken action to satisfy the conditions we imposed on the providers registration. Where we found the provider had taken sufficient action relating to the conditions we imposed on the providers registration.

The full reports of the 4, 13 June and 5 August 2019 inspection can be found by selecting the ‘all reports’ link for Dr Abdul-Razaq Abdullah on our website www.cqc.org.uk.

We carried out an announced comprehensive inspection on the 8 and 16 January 2020, in line with the CQC schedule of inspection, to review whether the practice remained in breach of the regulations.

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 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 requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

Although, we found the practice had reviewed and improved areas of concern found in the inspection on the 4 and 13 June 2019, the practice had not fully embedded or completed the improvements in some areas. For example, regarding the health and safety of the premises, the failure to ensure the practice had enough clinical staff and the continual review of safety alerts.

We rated the practice as inadequate for providing effective services because:

Although we found the practice had ensured that all staff were trained for their role and had improved the system for the recall of patients with long-term conditions.

The practice response to the monitoring of long-term conditions and mental health, immunizations and cervical screening continued to require further improvements to ensure a consistent approach. In addition, we found the practice had not completed all patient care plans and had not consistently reviewed the palliative care register.

We rated the practice as requires Improvement for providing a caring service because:

Although, we found that the patient feedback from speaking with patients and the CQC comment cards was positive, the management team had not reviewed or responded to the national GP survey prior to the inspection.

We rated the practice as requires improvement for providing responsive services because:

Although, we found that the practice had learnt from complaints. We rated the population groups for long-term conditions and working age people as requires improvement due to the restricted access for patients to the practice nurse.

We rated the practice as requires Improvement for providing well-led services because:

We found the practice had made improvements to the governance of the practice but some of these areas had not been fully embedded and the practice had not reviewed and fully mitigated the risks to the practice.

These areas affected all population groups we have rated People experiencing poor mental health (including people with dementia and Families, children and young people as inadequate and the other population groups requires improvement.

The areas where the provider must continue to make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Due to our findings the practice will remain 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.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care.

We previously carried out an announced comprehensive inspection of Dr Abdul-Razaq Abdullah on 4 and 13 June 2019 and found that the practice was in breach of Regulation 12: ‘Safe care and treatment’ and Regulation 17 ‘Good governance’ of the Health and Social Care Act 2008. In line

with the Care Quality Commission’s (CQC) enforcement processes, we imposed conditions on the providers registration which required Dr Abdul-Razaq Abdullah to comply with those conditions Regulations by 31 July 2019. The full report of the 4 and 13 June 2019 inspection can be found by selecting the ‘all reports’ link for Dr Abdul-Razaq Abdullah on our website www.cqc.org.uk.

We carried out this announced focused inspection on 5 August 2019 to check whether the practice had taken action to satisfy the conditions we imposed on the providers registration. This report covers our findings in relation to those conditions and will not change the current ratings held by the practice.

At the inspection on 5 August we found the provider had taken sufficient action relating to the conditions we imposed on the providers registration.

Our key findings were as follows:

• The practice had met the condition of not registering any new patients at Rainham Health Centre except newly born babies, newly fostered or adopted children of patients already registered at Rainham Health Centre.
• The practice kept people safeguarded from abuse, it had undertaken a review to ensure all patients identified with safeguarding concerns were appropriately acted on and coded on the clinical system.
• The practice had formalised their arrangements for the ongoing monitoring of patients being prescribed medicines which require regular blood tests and did not prescribe high risk medicines without prior necessary blood tests being undertaken for patients.
• Medication reviews for patients prescribed high risk medicines and controlled drugs and patients with diabetes and chronic obstructive pulmonary disease had been undertaken.
• There was a system ensure that backlogs of overdue medication reviews did not reoccur, but it had not yet been evaluated to ensure it was sustainable.
• There was an effective system for the collection of prescriptions and to ensure prescriptions overdue for collection were escalated to the lead GP for action.
• Arrangements for the management of patient’s blood test results were appropriate including a system to prevent backlogs of unprocessed blood test results.
• Systems were in place for the management of patient safety alerts, including Medicines and Healthcare products Regulatory Authority (MHRA) alerts but reviews of historical patient safety and MHRA alerts were limited.
• The practice had arrangements for appropriate summarising and coding of patients records and an action plan with timeframes detailing how and when this work will be completed.
• The practice had a system for the identification, recording and learning from significant events that needed to be further developed to ensure identification of trends and related action to improve safety.
• The practice had improved arrangements to ensure that all staff employed by the practice were appropriately trained and competent for the roles they performed, but further work was required such as to ensure sufficient staff training on sepsis.
• The practice had updated its recruitment process but further improvement was needed to ensure consistent compliance with the regulations, and to ensure effective induction arrangements for future new starter staff.

The areas where the provider should make improvements are:

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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

On 4 June 2019 the Commission carried out an unannounced focused inspection at Dr Abdul-Razaq Abdullah, located at Rainham Health Centre, Upminster Road South, Rainham, RM13 9AB. Due to the findings during this inspection, the CQC then carried out an announced comprehensive inspection of the practice on the 13 June 2019.

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 inadequate overall.

• Our review of patient records evidenced an inconsistent management of patients’ medicine reviews and records. We also found ineffective systems for the management of patient blood test results, safety alerts, and safeguarding concerns, which put patients at risk of harm. This demonstrated that the overall governance arrangements at the practice were ineffective.

We rated the practice as inadequate for providing safe services because:

• The practice did not have an effective system in place to keep people safe and safeguarded from abuse.
• Recruitment checks were not carried out in accordance with the regulations.
• The practice did not have systems for the appropriate and safe use of medicines, including medicines optimisation.
• There were serious gaps in systems to assess, monitor and manage risks to patient safety.
• Staff did not have the information they needed to deliver safe care and treatment.
• The practice did not have an effective system in place to report, investigate and learn from significant events.
• The provider did not have an effective system in place for the management and action of safety alerts.

We rated the practice as inadequate for providing effective services because:

• A review of patients records demonstrated patients’ needs were not always assessed and care and treatment were not always delivered following evidence-based guidelines.
• There was limited monitoring of the outcomes of patients’ care and treatment.
• The provider did not have a system in place to assure that staff had the necessary training to carry out their work or to review the competency of the locum advanced nurse practitioner.

We rated the practice as inadequate for providing well-led services because:

• Our review of the patient records evidenced an inconsistent management of patients’ medicine reviews and records. We found ineffective systems for the management of patient test results, safety alerts, and safeguarding concerns, which demonstrated that: -
• Leaders did not have the capacity and skills to deliver high quality sustainable care.
• The practice did not have a clear vision and was not supported by a credible strategy to provide high quality sustainable care.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The overall governance arrangements were ineffective.

The inadequate areas in the safe key question have impacted all population groups and so we have rated all population groups as inadequate.

We rated the practice as requires improvement for providing a caring service because:

• The practice had not sought any direct patient feedback.
• Feedback from the national GP patient survey and on the NHS choices website was mixed about the way staff treated people.

We rated the practice as requires improvement for providing responsive services because:

• The service did not always meet patients’ needs. This was because inconsistent management of patients’ medicine reviews and ineffective systems for the management of patient test results demonstrated that patients’ care and treatment was not regularly reviewed and updated, which put patients at risk.
• People were not always able to access care and treatment in a timely way.
• The practice did not learn from complaints.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

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.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care