The Care Quality Commission
  • Doctor
  • GP practice

Dr Azim and Partners

Overall: Inadequate read more about inspection ratings

67 Elliot Road, Hendon, London, NW4 3EB (020) 8457 3950

Provided and run by:
Dr Azim and Partners

All Inspections

04 May 2023

During an inspection looking at part of the service

We carried out a focused inspection of Dr Azim and Partners practice on 4 May 2023. This was an unrated inspection to follow-up non-compliance. Following our previous inspection on 16 November 2022, the practice was rated Inadequate for the key questions of Safe, Effective and Well Led; and Requires Improvement for Caring and Responsive. The practice was rated Inadequate overall.

We issued two Warning Notices to the practice requiring it to improve the safety of its service by 1 April 2023. The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Azim and Partners on our website at www.cqc.org.uk.

Why we carried out this inspection

We carried out this inspection to follow-up breaches of regulations from our previous inspection on 16 November 2022. We focused specifically on safeguarding, staff recruitment processes and training, assessment and mitigation of risks, infection control, medicines management, significant events, the management of patients with long-term conditions, cervical smear test systems and processes, quality improvement activity, patient toilet facilities and complaints.

We did not rate any key questions at this inspection.

How we carried out the inspection

This inspection was carried out with a site visit on 4 May 2023 alongside remote clinical searches. The methods included:

  • Conducting a mix of online and face-to-face interviews with the provider and staff.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Reviewing other documentary evidence of policies and processes.
  • Observation of the safety of the premises and equipment.

Our findings

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 found that the practice had addressed the vast majority but not all of the concerns identified from the previous inspection.

For example:

  • The practice had developed clear systems and processes to keep people safeguarded from abuse.
  • Recruitment checks were carried out in accordance with the regulations.
  • Appropriate standards of cleanliness and hygiene were met.
  • There were adequate systems to assess, monitor and manage risks to patient safety.
  • Monitoring patients prescribed high risk medicines had improved.
  • The management of patients with hypothyroidism had improved but we found continuing issues in relation to the management of patients with acute exacerbations of asthma and patients prescribed Benzodiazepines.
  • The practice had satisfactorily implemented one of the national patient safety alerts that we reviewed.
  • The system in place for the safety netting of cytology results was effective.
  • The practice had improved its quality improvement activity.
  • The practice had addressed the issues we identified with the patient toilet facilities at our previous inspection.
  • The system for listening and learning from complaints had been improved.

We found a continuing breach of regulations.

The provider must:

  • Ensure care and treatment is provided in a safe way to patients.

This practice was placed in special measures following our previous inspection on 16 November 2022. The practice will be kept under review and a comprehensive inspection will be carried out at the end of the special measures period. If necessary we shall 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 the registration or to varying the terms of the registration if the practice does not improve.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

16 November 2022

During a routine inspection

We carried out an announced comprehensive at Dr Azim and Partners on 16 November 2022. Overall, the practice is rated as Inadequate.

Safe - Inadequate

Effective - Inadequate

Caring – Requires Improvement

Responsive – Requires Improvement

Well-led – Inadequate

Following our previous inspection on 2 June 2017, the practice was rated Good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Azim and Partners on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection on 16 November 2022 to follow up concerns reported to us in line with our inspection priorities. Concerns received related to safety systems and processes and governance of the practice. In response to these concerns, we carried out an announced site visit inspection on 16 November 2022.

This report covers our findings in relation to the inspection.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

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 found that:

  • The practice did not have adequate systems, practices and processes to keep people safe and safeguarded from abuse.
  • Appropriate standards of cleanliness and hygiene were not fully met.
  • There were gaps in systems to assess, monitor and manage risks to patient safety.
  • The practice did not have effective systems for the appropriate and safe use of medicines.
  • The practice did not have a robust system to learn and make improvements when things went wrong.
  • Patients’ needs were not always assessed, and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
  • There was limited monitoring of the outcomes of care and treatment.
  • The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
  • Feedback from patients was mixed about the way staff treated people.
  • The practice did not have a formal action plan to address any areas of lower than average performance scores from the GP National Patient Survey.
  • Services did not always meet patients’ needs.
  • People were not always able to access care and treatment in a timely way.
  • Complaints were not used to improve the quality of care.
  • Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
  • The practice culture to effectively support high quality sustainable care required improvement.
  • The practice had a clear vision but it was not supported by a credible strategy to provide high quality sustainable care.
  • There were inadequate governance arrangements.
  • There were inadequate processes for managing risks, issues and performance.

We found breaches of regulations. The provider must:

  • 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.

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 tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

22 June 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Azim and Partners on 31 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Dr Azim and Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • The practice appraised all members of staff on an annual basis. New members of staff have three formal reviews within the first six months of employment as well as an annual appraisal.

  • All staff had access to training via an online training programme. All staff had completed mandatory training such as basic life support training and fire safety training.

  • The practice updated their recruitment policy and all new members of staff had appropriate pre-employment checks in place.

  • The practice enhanced their induction programme and all new members of staff had a comprehensive six month induction with support in place.

  • The practice had a system in place to ensure patient safety alerts were monitored and acted upon.

  • The practice took actions to increase the uptake in cervical screening. For example the practice increased the number of clinicians trained to provide cervical screening from one nurse to three nurses and two GPs. The practice targeted patients whose first language is not English and provided an educational workshop on the importance of participating in cervical screening.

  • The practice displayed a health and safety poster in the reception area with appropriate contact information.

  • The practice identified 97 carers, more than 1% of the patient population.

  • The practice developed a three year business plan to enable management to monitor future development of services within the practice.

  • The practice developed a business continuity plan which included a neighbouring practice which can provide temporary space for clinical consultations and emergency contact numbers. All staff had access to the plan.

  • The practice developed a mission statement; all staff were included in creating the mission statement. The practice posted the core values in the administration area as a reminder to all staff, the mission statement was on display in the patient waiting area.

At our previous inspection on31 August 2016, we rated the practice as requires improvement for providing safe and effective services as there was gaps in the recruitment and induction process for new staff, the system for managing patient safety alerts did not have a fail-safe mechanism and not all staff were supported with training relevant to their role and annual appraisals. At this inspection we found that the practice had taken action to improve all the areas we identified as required improvement at the inspection in August 2016. Consequently, the practice is now rated as good for providing safe and effective services which means the overall rating of the practice is good.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

31 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Azim and Partners on 31 August 2016. Overall the practice is rated as requires improvement.

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

  • There were a number of areas where risks to patients were not suitably assessed and managed including those relating to: recruitment checks for all staff; mandatory training for all staff; a lack of evidence that all staff had followed a suitable induction programme when starting with the practice; or of all staff receiving an annual appraisal.

  • There was no fail-safe system for ensuring that clinical staff reviewed medicines alerts.

  • Most 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. A few patients said it was difficult to make an appointment via the phone.

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • 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.
  • 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 that all staff are supported via a programme of annual appraisals.

  • Ensure that systems are in place for all staff to undertake and to be kept up to date with mandatory training in line with national guidance and guidelines.
  • Ensure the procedure for all staff recruitment includes undertaking all relevant pre-employment checks as specified in Schedule 3 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
  • Ensure that a suitable system is introduced to manage medicines alerts so that these are reviewed and actioned in a timely manner by all clinical staff.
  • Ensure that all staff follow an induction programme when starting with the practice to provide them with the skills and knowledge appropriate to their roles.

In addition the provider should:

  • Consider ways to improve uptake of its cervical screening programme for the benefit of female patients.

  • Display a Health and Safety poster incorporating appropriate contact information in the reception area so that staff are aware of who to contact in the event of needing to report a health and safety issue.
  • Review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to all.
  • Prepare a business plan to assist in forming and reviewing its future plans for development of the practice.
  • Develop a business continuity plan so that staff are able to contact appropriate sources of assistance in the event of disruption to services to patients.
  • Prepare a mission statement so that staff and patients are aware of the practice’ overarching purpose.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice