Archived: Dr AH Tak, Dr EG Stryjakiewicz & Dr M Sadik

Updated 26 March 2015

Dr Dr AH Tak, Dr EG Stryjakiewicz & Dr M Sadik is situated in the Newington Healthcare Centre in Anlaby Hull and provides primary medical care services, which includes access to GPs, minor surgery, family planning, ante and post natal care to patients living in the Anlaby area. The practice provides services to 8500 patients of all ages. There is a higher percentage of the practice population in the 65 to 74 years age group than the CCG and England average but a lower percentage in the 75 and over age group than the CCG and England average.

The practice has opted out of providing out of hours services for their patients. Information for patients requiring urgent medical attention out of hours is available in the waiting area and on the practice website. When the practice is closed patients access the Out of Hours Service at Hull Royal Infirmary.

The practice has three GP partners, all male. One GP has left the practice and is no longer working there. The remaining two partners work full time. There is one practice nurse who works 22 hours per week and a practice manager who works full time. They are supported by a team of administration, secretarial and reception staff. The partnership has another location approximately one mile from Newington Healthcare Centre which the staff also work at. CQC only inspected the Newington Healthcare Centre location on the 2 December 2014.

The CQC intelligent monitoring placed the practice in band one. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

The practice provides services to their patients through a General Medical Services (GMS) contract.

Updated 26 March 2015

Letter from the Chief Inspector of General Practice

We carried out an unannounced inspection of Dr AH Tak, Dr EG Stryjakiewicz & Dr M Sadik.on the 2 December 2014 following concerns raised by the NHS England (North Yorkshire and Humber) Area Team. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe, effective and responsive services and for being well led. It was also inadequate for providing services for the six population groups. Improvements were also required for providing caring services.

Our key findings are as follows:

• Lessons learned from significant events were not shared with staff so improvements could be made.
• Risk assessments had not been completed to identify any significant risks and the measures required to reduce harm occurring. The practice did not regularly monitor risks to patients, staff and visitors to the practice.
• Urgent appointments were usually available on the day they were requested. However, we found that the routine appointment system was not working, as patients experienced difficulty getting through on the telephone and were often waiting a long time for non urgent appointments.
• There was no evidence of completed audit cycles.
• Patients with long term conditions had not received annual reviews and medication reviews.
• Most patients were positive about their interactions with staff and said they were treated with compassion.
• Leadership within the practice was not effective.

The areas where the provider must make improvements are:

• Improve systems to so all staff receive appropriate training and are appraised annually.
• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
• Put systems in place so patients with long term conditions and those taking medication have annual reviews.
• Ensure there are formal governance arrangements in place, including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure audits of practice are undertaken, including completed clinical audit cycles.
• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements
• Ensure staff have appropriate up to date policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 March 2015

The practice is rated as inadequate the care of people with long-term conditions. Emergency processes were in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. However, not all these patients had a personalised care plan or had received an annual review to check that their health and care needs were being met.

Updated 26 March 2015

The practice is rated as inadequate for the care of families, children and young people. The practice offered comprehensive vaccination programmes which were managed effectively. Immunisation rates were relatively high for all standard childhood immunisations. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any non- attendance. Appointments were available outside of school hours and the premises were suitable for children and babies. All of the staff were responsive to parents’ concerns and ensured children who were unwell could be seen quickly by the GP or nurse. The practice did not respond to requests from local safeguarding teams when information was required with regard to children at risk.

Updated 26 March 2015

The practice is rated as inadequate for the care of older people. Some older people did not have care plans where necessary. Nationally reported data showed that the practice was performing below the CCG average for conditions commonly found in older people, for example chronic obstructive airways disease and peripheral artery disease. Longer appointments and home visits were available for older people when needed, and this was acknowledged in feedback from patients. Patients over the age of 75 had a named GP.

Updated 26 March 2015

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). The services available did not fully reflect the needs of this group. There were no early or extended opening hours for working people and telephone consultations were not available. Appointments could only be booked by telephone, there was no on-line appointment booking system. Health promotion advice was offered but there was limited accessible health promotion material available through the practice.

Updated 26 March 2015

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia).

The practice provided information for patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. The practice maintained a register of patients who experienced mental health problems. Quality Outcomes Framework (QOF) data indicated that the practice was performing at or above the CCG average for mental health indicators.

The practice was performing significantly below the CCG average for patients newly diagnosed with depression. QOF data showed that the practice was 13.5% below the CCG average for patients receiving a face to face review in a twelve month period.

No systems were in place to follow up on patients who had attended accident and emergency where they may have been experiencing poor mental health. There was no evidence to show the practice had worked with multi-disciplinary teams in the case management of people experiencing poor mental health.

Updated 26 March 2015

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. While the practice held a register of patients with a learning disability, arrangements were not in place to ensure patients with a learning disability had an annual health check. There was no information about other people who may be vulnerable; such as homeless people or travellers although the practice did see patients if needed when ‘Hull Fair’ was taking place. Staff knew how to recognise signs of abuse in vulnerable adults and children, however not all staff were adequately trained in this regard. Systems were not in place for responding to requests from local children’s safeguarding teams.