Archived: Dr Haider Al-Hasani Also known as Lynwood Surgery

Updated 24 November 2016

Dr Haider Al-Hasani is located in Hanger Lane in the London Borough of Ealing. The practice provides care to approximately 2160 patients. The practice informed us that they have a population group from diverse backgrounds.

The practice is registered as a sole provider with the Care Quality Commission (CQC) to provide the regulated activities of: treatment of disease, disorder or injury; diagnostic and screening procedures; family planning services and maternity and midwifery services.

The practice has a General Medical Services (GMS) contract and provides a full range of essential, additional and enhanced services including maternity services, child and adult immunisations, family planning and sexual health services.

The practice has one male principal GP, a long term female locum GP and an ad hoc male locum GP working a total of 13 sessions between them.

The practice has a part time practice manager working a total of twelve hours per week. The rest of the practice team consists of one part time practice nurse working a total of four hours every fortnight, one part time health care assistant/ receptionist working seventeen hours per week and two administrative staff consisting of a medical secretaries and reception staff.

The practice was currently open five days a week from 9:00am-6:00pm on Mondays, Thursday and Fridays. On Tuesday the practice was open until 7:30pm. On Wednesdays the practice closed at 1:00pm. Consultation times were 9:00pm until 1:00pm and 3:00pm until 6:00pm. Consultation times were 09:00am until 1:00pm and 3:00 until 6:00pm.

When the practice is closed, the telephone answering service directs patients to contact the out of hours provider.

There were no previous performance issues or concerns about this practice prior to our inspec tion

Updated 24 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Haider Al-Hasani on 4 August 2016.

Overall the practice is rated as inadequate.

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

• The system of reporting incidents was not always consistently followed and there was no evidence of learning from incidents and communication with staff.

• The practice did not have adequate systems in place for medicines and infection control management.

• 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.

• Not all staff demonstrated the necessary competencies in relation to safeguarding of vulnerable adults and children.

• Not all clinical staff were aware of the requirements of the Mental Capacity Act 2005, and their duties in fulfilling it.

• There was insufficient assurance to demonstrate people received effective care and treatment. For example there was no multi- disciplinary working taking place to improve patient care.

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

• Patients we spoke with on the day of the inspection 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.

• The practice had insufficient leadership capacity and limited formal governance arrangements. As a result they had failed to identify and manage significant issues that threatened the delivery of safe and effective care.

The areas where the provider must make improvements are:

• Introduce effective processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Take action to address identified concerns with infection prevention and control practice.

• Ensure that the health care assistant only works to Patient Specific Directives to deliver care safely and that they are always supervised.

• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.

• Ensure that patients on high risk medicines are reviewed as required.

• Ensure that the process of issuing repeat prescriptions is only undertaken by qualified staff

• Ensure there is a programme of quality improvement to include completed clinical audits to drive improved outcomes for patients.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

• Ensure that the practice business continuity plan is tailored and suitable to the practice.

• Ensure there is leadership capacity to deliver all improvements.

• Ensure they have effective arrangements in place to safeguard children and vulnerable adults.

• Ensure that all clinical staff are aware of the Mental Capacity Act and their duties in fulfilling it.

• Ensure they develop a system that obtains patients views on improving the service.

The areas where the provider should make improvements are:

• Ensure that the vaccines fridges are monitored by adequately using efficient thermometers.

• Ensure there is adequate nursing staff to adequately deliver care.

• Improve the process of identifying carers to ensure they receive support and information as appropriate.

• Ensure they develop and maintain a Patient Participation Group so as to actively involve patients in developing and improving 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

Updated 24 November 2016

The practice is rated as inadequate for the care of people with long-term conditions. The provider was rated as inadequate for safe, effective, responsive and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group

• Longer appointments and home visits were available when needed.

• Annual reviews were undertaken to check that patients’ health and care needs were being met by a staff who was not always supervised.

• The practice could not demonstrate that they held meetings with the district nurses and the end of life care team on a regular basis.

Updated 24 November 2016

The practice is rated as inadequate for the care of families, children and young people. The provider was rated as inadequate for safe, effective, responsive and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Though the practice had systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people on protection plans they could not use this system effectively.

• Immunisation rates were low for standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 68%, which was lower than the CCG average of 78% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 24 November 2016

The practice is rated as inadequate for the care of older people. The provider was rated as inadequate for safe, effective, responsive and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Care and treatment of older people did not always reflect current evidence-based practice, and some older people did not have care plans where necessary.

• The practice had a named GP for all patients over 75.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 24 November 2016

The practice is rated as inadequate for working age people (including those recently retired and students). The provider was rated as inadequate for safe, effective, responsive and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. However the practice did not have its own website.

• Health promotion advice was offered but there was limited access to the practice nurse.

Updated 24 November 2016

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). The provider was rated as inadequate for safe, effective, responsive and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice carried out advance care planning for patients with dementia. The dementia diagnosis rate was comparable national average. (practice 75%; national 84%).

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• However, we found that not all clinical staff were aware of the requirements of the Mental Capacity Act 2005, and their duties in fulfilling it.

• There was no evidence of working with multi-disciplinary teams in the case management of people experiencing poor mental health.

Updated 24 November 2016

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The provider was rated as inadequate for safe, effective, responsive and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• It offered longer appointments for people with a learning disability.

• It had told vulnerable patients about how to access various support groups and voluntary organisations.

• Not all staff knew how to recognise signs of abuse in vulnerable adults and children.

• We found no evidence that the practice had worked with multi-disciplinary teams in the case management of vulnerable people.