The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Safderali Lalji Datoo Also known as Watford Way Medical Centre

Overall: Inadequate read more about inspection ratings

278 Watford Way, Hendon, London, NW4 4UR (020) 8203 1166

Provided and run by:
Dr Safderali Lalji Datoo

All Inspections

14 and 19 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Safderali Lalji Datoo (also known as Watford Way Medical Centre) on 14 June 2017 and an unannounced focussed inspection on 19 June 2017. Overall the practice is rated as inadequate.

This inspection was a follow up to our earlier inspections on 26 August 2015 where the practice was rated inadequate overall and 18 May 2016 where the practice was rated requires improvement overall. At the inspection on 18 May 2016 there were breaches in legal requirements relating to the provision of safe, effective and well led services. Safe was rated as inadequate due to issues with medicines management and issues with processing pathology results. The practice was placed into special measures in November 2015 and remained in special measures after the May 2016 inspection. Following the latter inspection, a warning notice was served on the provider to address the issues with inadequate medicines management.

At our inspection on 14 and 19 June 2017 we found that the provider had not taken sufficient steps to address the issues in the warning notice. Significant improvements were still required in the areas of medicines management, record keeping and following national guidance.

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

  • We were not assured from both our interviews with GPs and the review of patient records that GPs had read or implemented relevant nationally recognised guidance, particularly in relation to medicines management.

  • The system and process in place for prescription management was inadequate. There was a risk that patients would receive medicines that were not appropriate to their current needs due to out of date prescriptions being given to patients.

  • Patients were at risk of harm, particularly those taking high risk medicines, because if patients did not collect their prescriptions, there was no follow up by the practice

  • We found examples of poor care for vulnerable patients with a lack of detail in patient notes and no care plans were in place.

  • It was difficult to ascertain what improvements had been made to the care of patients following a clinical audit being undertaken.

  • Information about services and how to complain was available. However there was confusion with regard to what was documented as a complaint.

  • There was a system in place for reporting and recording significant events. However the practice did not undertake any analysis of these to aid further learning.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their treatment.

  • 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.

  • There was a clear leadership structure though this did not support adequate governance. Staff felt supported by management.

The areas where the provider must make improvements are:

  • Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

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

In addition the provider should:

  • Improve staff understanding of what constitutes a complaint and record accordingly.

  • Look at ways to improve QOF figures in relation to the management of patients with diabetes.

  • Look at ways to improve on the results of the national GP patient survey.

Following the inspection the practice informed us that some steps have been made to improve systems within the practice, including reviewing policies in line with national guidelines and further training for clinical staff.

On 21 July 2017 because of significant concerns we took urgent enforcement action to suspend Dr Safderali Lalji Datoo as the provider of services from providing general medical services under Section 31 of the Health and Social Care Act 2008 for a period of six months to protect patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

18 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Safderali Lalji Datoo (also known as Watford Way Medical Centre) on 18 May 2016. Overall the practice is rated as Requires improvement.

This inspection was a follow-up to our earlier inspection on 26 August 2015 at which the practice was rated inadequate overall. There were breaches in legal requirements relating to the provision of safe and well-led services and these key questions were rated inadequate. Effective was rated requires improvement because there were no completed clinical audit cycles. The practice was placed into special measures in November 2015. Subsequent to this the provider submitted an action plan detailing how it would make improvements and when the practice would be meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At our inspection on 18 May 2016 we found the provider had made some improvements, however further improvements are still required in the areas of medicines management, pathology management and securing patient records.

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

  • Patients were at risk of harm because the systems and processes in place were ineffective and were not implemented in a way that kept patients safe. For example, arrangements for managing medicines through medication review and repeat prescribing processes were not robust.
  • Arrangements for managing patient pathology results were not always robust. For example, we reviewed systems for managing test results and found that results were not always actioned in a timely way and the patient record system was not always updated to show that all necessary actions had been completed.
  • Information about services and how to complain was available and easy to understand.
  • There was an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Progress had been made in relation to clinical audit. The practice had completed one two cycle audit with completion due on another by the end of the year.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • 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.
  • 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 areas where the provider must make improvements are:

  • Ensure that arrangements for managing medicines (obtaining, prescribing, recording, handling, storing, security and disposal) are robust; including systems for ensuring that medicines reviews and repeat authorisation functions are undertaken in accordance with recognised guidelines.
  • Ensure that patient records are kept secure at all times and that they remain accurate, complete and up to date in respect of each patient. For example, ensure that pathology results are seen and reviewed and that patient records reflect actions taken.

In addition the provider should:

  • Review new systems in place to monitor the use of prescription pads.

  • Progress plans to develop a practice website to help share information about the practice and the services it provides.
  • Ensure that verbal as well as written complaints are recorded, in line with the practice’s complaints procedure.

The practice was placed into special measures in November 2015. While improvements have been made since then, the practice continues to be rated as inadequate for one of the five key questions and so remains in special measures for a further six months. The practice 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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

26 August 2015

During a routine inspection

We carried out an announced comprehensive inspection at Dr Safderali Lalji Datoo (also known as Watford Way Medical Centre) on Wednesday 26 August 2015.

Overall the practice is rated as inadequate.

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

  • The practice did not have a systematic approach to identifying risks, assessing the extent and probable impact of the risks, and putting in place effective control measures to maintain and improve patient safety.
  • Some risks to patients were not well managed including risks associated with cross-infection, fire, Control of substances hazardous to health (COSHH) and medical emergencies.
  • There was no clinical audit programme to monitor quality and systems to identify where action should be taken.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.
  • Urgent appointments were available on the day they were requested and patients were usually seen within 48 hours of requesting a routine appointment.
  • Information about services and how to complain was available and easy to understand.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • The practice had limited formal governance arrangements in place. The practice had a number of policies and procedures to govern activity, but these had not been reviewed and did not reflect latest good practice.

The areas where the provider must make improvements are:

  • Ensure systems and processes are in place in relation to fire safety and ensure staff know what to do in the case of a fire.
  • Ensure systems and processes are in place to prevent cross infection.
  • Ensure all staff have received the appropriate level of training in order to fully understand their roles and responsibilities in relation to protecting patients from the of risk of abuse.
  • Ensure that staff acting as chaperones are appropriately trained and have the required Disclosure and Barring service (DBS) checks. Ensure arrangements for chaperoning do not put patients at risk of abuse.
  • Ensure emergency medical procedures are effective and protect people from harm. For example, having oxygen in place and an assessment of the risks associated with not having an Automated External Defibrillator (AED).
  • Ensure policies and procedures enable staff and the provider to deliver safe and effective care and treatment. Policies and procedures must be up to date and in line with regulations. .
  • Ensure clinical audits are undertaken in the practice, including completed clinical audit or quality improvement cycles.
  • Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.

The areas where the provider should make improvement are:

  • Review the contents of the emergency doctor’s bag to ensure all medications included are suitable and can be administered if needed in line with Resuscitation UK guidelines.
  • Ensure a patient participation process is developed encouraging patients to get directly involved in the development of improved patient safety and access to the practice. For example, through the re-establishment of a patient reference group.
  • Ensure that appropriate translation services are available to patients who require them.
  • Ensure other records are maintained in relation to the management of the service, for example notes of clinical meetings.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice