The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Nader Lewis Also known as St Marks Medical Centre

Overall: Requires improvement read more about inspection ratings

75 Brunswick Road, London, W5 1AQ (020) 8810 5545

Provided and run by:
Dr Nader Lewis

Important: The provider of this service changed. See new profile

All Inspections

6 February 2018

During a routine inspection

This practice is rated as requires improvement overall.

The practice was previously inspected on 10 May 2017. At that inspection the rating for the practice was inadequate overall. Following the inspection the practice was placed into special measures for six months and warning notices were issued. The full comprehensive report can be found by selecting the Dr Nader Lewis ‘all reports’ link on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 6 February 2018. The practice is now rated as requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) – Requires improvement

Since our previous inspection, the GP (who was a sole provider at that time) has entered into a partnership with another GP who has taken on a leadership role within the practice. At this inspection we found:

  • Improvements had been made since our previous inspection. There was a clearer understanding of risk and the practice was systematically reviewing and updating its risk assessments, policies and procedures. The practice needed to strengthen its arrangements for identifying and assessing the signs of potential sepsis.
  • When incidents or near misses occurred, the practice was learning from them and had taken action to prevent reoccurrence.
  • The practice had improved its arrangements to safeguard children and vulnerable adults from abuse.
  • The practice was able to provide evidence that it was now maintaining appropriate clinical records of patient care and treatment.
  • The practice had improved its clinical performance since our previous inspection, particularly in relation to the management of diabetes.
  • The practice reviewed the effectiveness and appropriateness of the care it provided . However, it had made little use of clinical audit to monitor and improve clinical quality.
  • The practice encouraged healthier lifestyles and preventative care. However, its cancer screening rates remained lower than average.
  • Staff told us they were committed to treating patients with compassion, kindness, dignity and respect. The national patient survey results remained lower than average however.
  • Patient feedback was positive about the ease of obtaining an appointment. However patients scored the practice lower than average for satisfaction with its opening hours which were relatively restricted.
  • The practice had a clear strategy for its longer term development and sustainability and was increasingly involving patients in its planning.

The area where the provider must make improvements are:

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

The areas where the provider should make improvements are:

  • Review its approach to cancer screening with the aim of improving uptake and coverage.
  • Review its emergency procedures and training to ensure that the practice responds to cases of potential sepsis in line with current guidelines.
  • Continue to review patient experience of GP and nurse consultations and take action to improve this as appropriate.
  • Review its opening hours to ensure patients have reasonable access to their GP and other practice based services.
  • Review its use of clinical audit to ensure this is appropriately embedded in its approach to quality improvement.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

30 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Dr Nader Lewis' practice on26 August 2015. The practice was rated as requires improvement for providing safe, effective and caringservices and for being well-led. It was rated as good for providing responsive services. Overall the practice was rated as requires improvement. The full comprehensive report on the August 2015 inspection can be found by selecting the ‘all reports’ link for Dr Nader Lewis on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Dr Nader Lewis’ practice on 30 May 2017. Overall the practice is rated as inadequate.

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, we identified weaknesses in practice arrangements on safeguarding and obtaining consent.
  • Governance arrangements were insufficient to provide a safe, effective service. We were particularly concerned about the quality and integrity of patient record keeping. This was an issue that we highlighted at our previous inspection in August 2015.
  • The practice had improved its performance on the Quality and Outcomes framework since our previous inspection. However its performance and high exception reporting on diabetes was concerning.
  • Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
  • The practice received mixed patient feedback. The national patient survey results were consistently below average for patient experience of GP consultations and patient involvement in decisions.
  • We received negative feedback about the practice from the manager of a local care home.
  • The practice had a large working population but offered restricted opening hours and had failed to open on at least one occasion in the previous 12 months.
  • The practice had identified succession arrangements as an immediate priority but the strategy for achieving this was confused.
  • The practice had not established a patient participation group.

The areas where the provider must make improvements are:

  • The practice must ensure that care and treatment of patients is only provided with the consent of the relevant person. The practice must act to protect the right of patients (who do not lack capacity) to make an informed decision about their care.
  • The practice must ensure care and treatment is provided in a safe way to patients.
  • The practice must ensure patients are protected from abuse and improper treatment.
  • The practice must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. This includes maintaining securely an accurate, complete and contemporaneous record in respect of each patient and of decisions taken.

The areas where the provider should make improvement are:

  • The provider should continue to identify carers to ensure their needs are met.

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

26 August 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the practice of Dr Nader Lewis (also known as St Marks Medical Centre) on 26 August 2015. Overall the practice is rated as requires improvement.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

  • The practice had effective systems in place to manage some risks but procedures in relation to staff recruitment and induction, infection control and medical emergencies required improvement.

  • Patients’ needs were assessed and care was planned in line with national guidance. We found that care for long-term conditions was being managed in line with guidance but the practice was carrying out little in the way of care planning. The practice had identified the management of diabetes as an area for improvement.

  • Patients we spoke with were very positive about the practice and reported being treated with care and respect. They said they were involved in their care and decisions about their treatment. However, the practice tended to score below average in the national GP patient satisfaction survey for questions on care and compassion and patient involvement.

  • The practice provided information about its services in the form of a practice leaflet. The practice did not have a website although this was under development. Information about how to complain was available at the practice and easy to understand.

  • Patients said they found it easy to make an appointment and they were able to see the same GP regularly. National patient survey scores were better than average for this aspect of care.

  • The practice had suitable facilities and was equipped to treat patients and meet their needs.

  • There was a clear leadership structure and staff were supported by management. However, while the practice had recruited a patient participation group, it was not yet actively engaging with this group.

  • Staff told us they were well supported and had access to the training they needed to develop in their role.

The areas where the provider must make improvements are:

  • The practice had migrated to a new electronic patient records system in October 2014. All staff and clinicians working in the practice must be trained to ensure that they are competent at using the system effectively. In the case of clinicians, this includes being able to add relevant ‘Read codes’, alerts or flags, and be able to make use of ‘safety-netting’ tools within the system. Clinicians must also be able to complete relevant electronic templates for health checks, advanced decisions and care planning. The practice staff must have the capability to run data reports on the system so as to accurately monitor its performance and patient outcomes.

  • The practice must have a supply of oxygen ready for use in an emergency or carry out a risk assessment to show why this is not necessary.

  • The practice must ensure that it effectively monitors and manages risks in relation to health and safety, for example by commissioning fire safety and legionella risk assessments and acting on any recommendations.

  • Practice procedures in relation to health and safety must be checked, inspected and tested as appropriate, for example by holding periodic fire drills.

  • The practice lead for infection control should ensure that the practice infection control policy and procedures meet required standards for primary care and that infection control in the practice is audited annually and that any recommendations are acted on.

  • The practice must ensure recruitment arrangements including all necessary employment checks for all staff are undertaken.

In addition the provider should:

  • Maintain a stock of emergency medicines that meets with current recommendations for general practice, for example including glucagon and antibiotics for the treatment of suspected meningitis.
  • Record any instances of chaperoning in the relevant patient notes.
  • Consider making more information about the practice and its services available to patients, for example through a website.
  • Explore ways of actively engaging with the patient participation group and practice patients more widely.
  • Review information displayed in the waiting and reception area and remove information that is out of date. The practice should consider providing the practice leaflet and complaints leaflet in other languages commonly spoken by practice patients such as Arabic and Polish.
  • Introduce an induction programme for new and temporary staff and record staff progress and any assessment of competencies as appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

13 March 2014

During an inspection looking at part of the service

When we inspected the service on 3 February 2014 we had concerns about the provider's arrangements for safeguarding adults using the practice and staff recruitment procedures. Following the inspection the provider told us our concerns had been addressed by the end of February 2014. We carried out this inspection to make sure the provider had made the changes necessary to achieve compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We did not speak with people using the service during this inspection.