The Care Quality Commission
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Archived: Dr Mohammad Salim Also known as Dr Salim's Medical Practice

Overall: Inadequate read more about inspection ratings

134 Heath Street, Birmingham, West Midlands, B18 7AL 0845 148 9037

Provided and run by:
Dr Mohammad Salim

All Inspections

11 March 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mohammad Salim’s practice on 11 March 2015. Overall the practice is rated as inadequate.

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

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

  • The practice had previously been inspected in August 2014. In August 2014 we found concerns in relation to assessing and monitoring the quality of service provision, safeguarding patients, recruitment and supporting staff, medicines management and in the management of complaints. We saw that the practice had made some progress to address these concerns. However, we still found concerns at this inspection relating to: Assessing and monitoring the quality of service; Requirements relating to workers and management of medicines. In addition we found concerns relating to the care and welfare of service users.
  • Patients were at risk of harm because systems and processes were not sufficiently robust to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment. The risks of unforeseen circumstances which might impact on the running of the service had not been identified and appropriately managed. Patients on long term medication did not always receive appropriate follow up.
  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. Some safety information was recorded but action and learning from these was not always evident.
  • There was insufficient assurance to demonstrate people received effective care and treatment. For example patients who required additional support such as those with complex needs, carers and those who had recently suffered a bereavement were not specifically identified and actively followed up to ensure care and treatment needs were being met. Patient involvement in care and treatment decisions was not evident.
  • Patients were positive about their interactions with staff and said they were treated with respect and dignity.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with urgent appointments available the same day.
  • The practice had a clear leadership structure but governance arrangements were not clearly defined resulting in inconsistent and ineffective management of risks and monitoring of performance.

The areas where the provider must make improvements are:

  • Ensure effective and robust systems are in place to protect patients and others against the risks of inappropriate or unsafe care or treatment by identifying, assessing and managing risks. This includes systems to safeguard vulnerable children, to manage incidents, significant events and safety alerts, ensuring there are sufficient staff trained to undertake their roles and safely recruited and to ensure patients receive prompt and effective treatment and assessment of their health and wellbeing.
  • Ensure effective and robust systems are in place for assessing and monitoring the quality of services provided through effective governance and patient feedback.
  • Ensure there are robust systems in place to respond to any identified risks from pre employment checks.
  • Ensure robust systems are put in place to follow up patients on repeat prescriptions particularly those on high risk medicines to protect them from risks associated with medicines.
  • Ensure care is appropriately planned involving patients who may require additional support to ensure their physical and emotional needs are met. This would include those with complex needs, in vulnerable circumstances, carers and those who have suffered recent bereavement.

In addition the provider should:

  • Ensure staff acting as a chaperone have appropriate understanding of their duties and responsibilities.

On the basis of the ratings given to this practice at this inspection, and the concerns identified at previous inspections, 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

7 August 2014

During a routine inspection

Dr Mohammad Salim’s practice provides primary medical services to patients living within two miles of the surgery.  The practice is small and has one GP, one nurse, a part time practice manager and two part time administration and reception staff. 

We spoke with six patients on the day of our inspection and looked at nine Care Quality Commission (CQC) comments cards that had been left in our comments box.  We spoke with the owner of a care home where four of the practice’s patients lived.  Patients told us that they found the practice welcoming and caring and were positive about the care and treatment they received. The comment cards also gave a positive view of patients’ experiences of the practice.

The practice was caring, friendly and welcoming and, with fewer than 1800 patients.  We found positive elements in all of the areas we looked at during our inspection and the patients we gained information from were all pleased with their care and treatment.  The staff team were committed to the practice and wanted to develop and learn.

People confirmed that their privacy and dignity were protected and that the GP fully involved them in decisions about their care and treatment.  Patients were able to get appointments easily.  The GP and their team understood the needs of local people and were respectful of patients’ diverse needs. 

Whilst the practice had a friendly and inclusive atmosphere the leadership, management and governance arrangements lacked direction and structure. The practice did not have robust arrangements for monitoring the quality of the care and treatment it provides.

We found some aspects of the way the practice operated needed improvement and the provider was in breach of some regulations.  These related to –

  • Identifying, assessing and managing risks within the practice.
  • Using incidents to identify changes and improvement that may be necessary.
  • Having suitable arrangements to safeguard people from the risk of abuse.
  • Staff recruitment.
  • Supervision, training and staff appraisal.
  • Dealing with complaints

The practice also needs to make improvements related to –

  • Policies and procedures.
  • Recording and safe keeping of information about multi-disciplinary meetings.
  • Arrangements for checking equipment used at the practice.

Older patients were given priority for appointments and the GP and nurse visited them at home if necessary.  The practice did not have effective systems for monitoring and recalling patients with long term conditions.  The practice provided services for mothers, children and young people and worked with other services when appropriate. Evening appointments were available on some days for working age patients unable to go to the surgery during the day.  The practice had some patients with learning disabilities but staff had not been trained about the Mental Capacity Act 2005 and so lacked understanding of their responsibilities in respect of gaining consent from patients who may not understand information about their care. There were no clear arrangements for the support and care that patients experiencing poor mental health might need.

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