Archived: Dr Omar Hassouna Also known as Hill Top Medical Centre

We carried out an announced focussed inspection at Dr Omar Hassouna’s practice also known as Hill Top Medical Centre on 21 October 2019 as part of our inspection programme. The practice had previously been inspected in November 2015 and was rated as Good overall.

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection primarily focused on the following key questions: Effective and Well-led, however due to the concerns identified during the inspection the Safe key question was also inspected.

Because of the assurance received from our review of information we carried forward the rating for the following key questions: Caring and Responsive.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe. We found gaps in safeguarding training and safeguarding leads were not up to date with training relevant to their role.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice had no system in place to analyse trends of incidents or significant events to minimise future risk.
• The practice were unable to demonstrate effective management of risks in relation to medicine safety alerts or updates from the Medicines and Healthcare products Regulatory Agency (MHRA).
• Some emergency medicines were available, but these did not cover all the recommended medicines for general practice. No risk assessments had been completed in the absence of emergency medicines to determine the level of risk if required in an emergency situation.

We rated the practice as inadequate for providing effective services because:

• There was limited monitoring of the outcomes of care and treatment.
• Exception reporting of patients was being used inappropriately, placing patients at risk of not receiving the appropriate monitoring of their care and treatment. We found non-clinical staff were exception reporting patients without clinical input or oversight.
• The practice did not routinely review the effectiveness and appropriateness of care provided. Care and treatment was not always delivered according to evidence- based guidelines.
• There was no programme of quality improvement activity to monitor service provision and improve patient outcomes.

We rated the practice as inadequate for providing well-led services because:

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

We rated the practice as inadequate for all population groups because:

• The clinical lead was unable to demonstrate recognised clinical guidelines were used in the management of long term conditions. We found limited knowledge of guidelines in the management of chronic obstructive pulmonary disease (COPD) and diabetes.
• The GP lead was unable to demonstrate how they managed patients with prediabetes indicators. Referrals for diabetes were made once a patient had been diagnosed as having the condition.
• We found patients were not being followed up appropriately and medicines had not been implemented to support patients’ conditions.
• Advance care planning was not provided for patients diagnosed with dementia.
• We were unable to establish what processes were in place to monitor prescription ordering and collection of medicines for patients with severe mental health concerns.
• Exception reporting rates for mental health indicators were higher than local and national averages. Administration staff were exception reporting patients from the clinical registers without any clinical oversight to ensure patients were being exception reported appropriately.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Improve the identification of carers to enable this group of patients to access the care and support they need.

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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care