The Care Quality Commission
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Archived: Dr Hasmukhrai Makanji

Overall: Requires improvement read more about inspection ratings

Woodcroft Medical Centre, Gervase Road, Burnt Oak, Edgware, Middlesex, HA8 0NR (020) 8906 0500

Provided and run by:
Dr Hasmukhrai Makanji

All Inspections

26 January 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hasmukhrai Makanji on 3 March 2016 . During the inspection we identified a range of concerns including an absence of systems in place to keep patients safe and missed opportunities to use the learning from significant events to support improvement. ( The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Hasmukhrai Makanji on our website at www.cqc.org.uk).  

The practice was rated as requires improvement for providing caring and responsive services and was rated as inadequate for providing safe, effective and well led services. Overall the practice was rated as inadequate.

Following the publication of the inspection report in July 2016, the practice was placed in special measures for a period of six months. In November 2016, we were advised by NHS England that two GPs from a local practice (Mulberry Medical Practice) would be joining and supporting the delivery of Dr Makanji’s NHS contract; and that Dr Makanji would be retiring on 31 December 2016. We were also advised that Dr Makanji would be applying to cancel his CQC registration.

Following the period of special measures, an announced comprehensive inspection was undertaken on 26 January 2017. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

  • The supporting GPs had reviewed past failings and introduced clearly defined systems to minimise risks to patient safety. For example, since 1 January 2017, infection prevention and control audit, a health and safety risk assessment and a fire safety risk assessment had taken place.

  • Although we saw some evidence of quality improvement activity, we did not see evidence of an overall quality improvement plan to drive and monitor improvements in patient outcomes.

  • The supporting GPs had started to implement systems and protocols to monitor the effective delivery of high-quality person-centred care but it was too early to assess the results.

  • We saw some evidence of actions taken to improve low satisfaction regarding how patients were involved in decisions about their care, the extent to which they were listened to and also regarding the helpfulness of reception staff.

  • We observed staff to be compassionate and patients told us they were treated with dignity and respect.

  • New protocols had been introduced to ensure that learning from significant events was shared and used to improve the service.

  • Most patients told us it was easy to make an appointment with a named GP and that there was continuity of care with urgent appointments available the same day.

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

  • There was a clear leadership structure and staff felt supported by management.

  • Information about services and about how to complain were available.

  • The supporting GPs demonstrated an understanding of the requirements of the duty of candour (for example its complaints policy referenced the importance of supporting complainants and of apologising when things went wrong).   

    There was also an area of practice where the provider must make improvements:    

  • Ensure that there are appropriate arrangements in place to assess, monitor and improve the quality and safety of the services provided.

Importantly, the provider should also:

  • Introduce cleaning schedules in accordance with the outcomes of the supporting GPs’ recent infection prevention and control audit.

  • Introduce a fire evacuation plan including details of how staff will support patients with mobility problems to vacate the premises.

  • Ensure that the use of chaperones is routinely recorded on the practice’s clinical system.

  • Ensure that copies of the practice’s business continuity plan are kept off site.

  • Monitor the impact of recent activity aimed at improving satisfaction with how patients were involved in decisions about their care, regarding the extent to which they felt they were listened to and also regarding the helpfulness of reception staff.

  • Review systems in place to identify and provide support to carers.

       

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

3 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hasmukhrai Makanji on 3 March 2016. Overall the practice is rated as inadequate.

Dr Hasmukhrai Makanji shares a purpose built medical centre with two other GP practices.

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, appropriate recruitment checks on staff had not been undertaken prior to their employment, appropriately signed patient group directions (PGDs) were not on file for the practice nurse and we also identified concerns regarding the safe storage of vaccines.

  • There was no evidence of sharing learning from significant events to maintain or improve patient safety.

  • Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement.

  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

  • The practice’s governance arrangements did not always support the delivery of high-quality person-centred care.

The areas where the provider must make improvements are

  • Review its significant events reporting and recording systems to ensure they are being identified, recorded, used to identify risks and continuously improve patient safety.

  • Ensure that the management of medicines is in line with national guidance such as appropriately signed patient group directions (PGDs) to enable the practice nurse to legally administer medicines, and that there are appropriate systems in place for the safe storage and management of vaccines.

  • Ensure recruitment arrangements include all necessary pre-employment checks.

  • Ensure that the system for acting on patient safety alerts enables safety concerns to be quickly addressed and actioned.

  • Ensure there are processes for identifying where improvements in clinical care can be made and monitored.

  • Review systems for scanning and actioning incoming correspondence, in order to protect patients.

  • Ensure that annual fire risk assessments take place.

In addition the provider should:

  • Ensure there is a record of clinical meeting discussions so as to enable reflection on outcomes being achieved and to identity improvement areas.

  • Review its systems for identifying and providing support to carers.

  • Review latest national GP patient survey results which show that patient satisfaction on compassion, dignity and respect are below local and national averages.

  • Ensure that there are systems in place so that learning from complaints is shared with staff and used to improve the service.

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