Archived: Dr Mohamedtaki Walji

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement.
The provider had a clear vision and positive culture that was shared by all the staff. A diverse workforce was in place which reflected the local population. Strong links with other healthcare services in the locality had been established and maintained. However, there were gaps in governance and management systems, which prevented leaders from having oversight of information about risks, performance and outcomes. This limited opportunities to identify improvements. Systems for identifying, capturing and managing organisational risks and issues were ineffective. The service had some shortfalls in governance including a lack of clinical supervision, a lack of clinical audit and adherence to some national guidelines
The provider was in breach of legal regulation in relation to good governance.
 

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on the practice philosophy of treating everyone the same regardless of age, race, gender, religion, sexuality, culture, nationality, disability or background. Staff told us they treated people as they would want a member of their family to be treated. Staff we spoke with described a caring, supportive and motivating workplace where leaders embodied the values of the practice. The provider was aware of the projected increase in the local population and the uptake of digital consultation tools. Further work was required to ensure the resilience of systems and capacity to manage these digital processes as the usage of them increased.

We found the leadership team was experienced and credible. They understood the context in which the provider delivered care and they embodied the culture and values of the organisation. Staff told us leaders in the practice were approachable and responded to any concerns raised. The leadership team worked with other practices in their federation and were engaged in the development of primary care providers within the local area.

However, we identified some knowledge gaps during our inspection which had not been recognised by the team. For example, we highlighted that some important mandatory training topics were missing from the provider’s training matrix. The leadership team had not identified this omission when reviewing training records and as a result staff had not completed important safety training. It is the responsibility of each provider to determine what the minimum training requirements are for their staff, but certain core topics such as health and safety are considered as standard within NHS organisations. However, leaders were unclear about what training staff were required to complete. We found that leaders lacked the capability to define the training requirements, communicate these clearly to staff, and exercise sufficient oversight of compliance.

Leaders had not clearly identified and carried out their responsibilities with regard to managing risk within the practice premises. Several risk assessments had not been completed and when we asked leaders about this it was evident that they erroneously believed that some of these risk assessments were the responsibility of the landlord. The providers did not have robust systems to identify which risk assessments they had to complete or to ensure they were completed on a regular basis. Although the provider acted to complete these risk assessments following our inspection, they were not comprehensive. It was not clear that leaders had the capability and skills to manage and mitigate risk effectively.

Although the provider fostered a positive culture where people felt they could speak up and their voice would be heard, they did not have suitable freedom to speak up guardians in place. The freedom to speak up guardians were retired, former employees of the practice who had not completed training for the role and were not registered with the National Guardians Office. Staff were aware of how to raise concerns, but not all staff were clear about who the freedom to speak up guardians were.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.
Policies and procedures to promote diversity and equality were in place. The provider employed a diverse workforce which reflected the local population and supported service delivery. For example, some staff were multilingual and could provide translation support.
 

The provider did not always have clear responsibilities, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes.
Leaders and managers supported staff and all staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. Staff could access all required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff.
However, we found that the provider did not always have clearly embedded, systematic governance processes in place. In some areas the use of paper records meant that information was disorganised and not always easily available. For example, staff provided paper certificates when they had completed a training course which were filed in no particular order and compliance was recorded on a tick sheet within each staff members record. Files we reviewed had some training certificates missing and although some staff subsequently produced certificates the system was not effective to ensure leaders maintained oversight.
The way some systems were structured did not provide the leadership team with sufficient oversight. For example, complaints and significant event paperwork was stored in folders and no log was maintained so information was not easily available and there was no means of identifying trends.
There was insufficient governance regarding the security of prescription paperwork which exposed the provider to the risk of fraud or theft. Leaders did not clearly understand their responsibilities or have a working knowledge of the guidance published by the NHS Counter Fraud Authority about how to maintain prescription paperwork security.
 

The provider understood their duty to collaborate and work in partnership, so providers work seamlessly for people. They shared information and learning with partners and collaborated for improvement.
The provider worked with other practices within their GP federation to offer extended access and some specialist services. Staff worked with members of the community multidisciplinary team to ensure that vulnerable people or those at the end of life received high-quality, integrated care.
 

The provider was committed to continuous learning, innovation and improvement across the organisation and local system, but this was not always well-supported by their systems and processes. They actively contributed to research and had been involved in three research projects in the last 12 months. This included ‘Restore’ a program designing a communication tool for patients with anxiety and depression and a randomised controlled trial of a new medicine used to prevent serious cardiovascular complications in patients with atherosclerotic vascular disease (narrowing of the arteries). The provider had a program of clinical and environmental audits, which had resulted in improvements in patient care. However, some important quality audits were not being undertaken such as prescribing audits. The provider did not have an overarching quality improvement program and internal quality assurance processes were not effective in identifying all areas where gaps that were identified during the inspection, for example, in the area of medicines management or the absence of core staff training.