Archived: Dr Yousri El-Gazzar

Updated 13 November 2017

Dr Yousri El-Gazzar practice provides GP primary medical services to approximately 3,300 patients living in the London Borough of Westminster. The Borough of Westminster has a diverse population with a lower proportion of residents from White British backgrounds compared to other London boroughs. Patients registered with the practice are predominantly from ethnic minority backgrounds including the Middle East and Asia.

The practice team is made up of two male GPs, one female GP, a practice nurse, a healthcare assistant/phlebotomist, a practice manager and five administrative staff.

The practice opening hours are between 8am and 8pm on Monday, and 8am-6:30pm Tuesday to Fridays. Appointments are from 9am to 12 noon and from 5pm to 8pm on Mondays; 9am to 12 noon and 4pm to 6pm on Tuesdays and Fridays; 9am to 11am, 4pm-6pm on Wednesdays; and 9am to 12 noon on Thursdays. In addition to pre-bookable appointments that can be booked up to two weeks in advance, urgent appointments are also available on the day for people that need them. Telephone consultations are also available for patients on request. The duty doctor is available from 11:30am to 12 noon every week day to triage emergencies. The nurse is available for telephone consultations from 12 noon to 12:30pm Monday to Thursday.

The practice has a General Medical Services (GMS) contract (GMS is one of the three contracting routes that have been available to enable the commissioning of primary medical services).

The practice refers patients to a local Out of Hours service provider and the NHS ‘111’ service for healthcare advice during out of hours.

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder and injury.

Updated 13 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Yousri El-Gazzar on 5 May 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the May 2015 inspection can be found by selecting the ‘all reports’ link for Dr Yousri El-Gazzar on our website at www.cqc.org.uk.

This inspection was undertaken to check the provider had taken the action we said they must and should take and was an announced comprehensive inspection on 31 August 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. It had taken the action we said it must should take at our May 2015 inspection to ensure staff had access to a defibrillator in the event of a medical emergency. However, we found some shortcomings in the arrangements for prescription security and one of the medicines recommended in national guidance was not kept in the emergency kit.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The practice had taken the action we said it must take at our May 2015 inspection to ensure staff understood Gillick competence in relation to consent for young people under 16 years of age.
• Results from the national GP patient survey were mixed when patients were asked about being treated with compassion, dignity and respect and their involvement in decisions about their care and treatment.
• Information about services and how to complain was available and accessible to patients. Improvements were made to the quality of care as a result of complaints and concerns.
• Not all patients we spoke with said they found it easy to make an appointment with a named GP and some said there was not always continuity of care. However, the practice was taking action to improve access to appointments. Urgent appointments were available the same day.
• The practice had adequate facilities and equipment to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• Appropriate governance arrangements were in place and the practice had taken the action we said it must take at our May 2015 inspection to establish arrangements to monitor and mitigate risks including completed cycles of clinical audits and formal clinical and multidisciplinary meetings held on a regular basis and recorded.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure a record is kept of serial numbers of prescription pads to ensure full monitoring of their use.
• Complete and record a risk assessment of the practice’s decision not to stock medicine excluded from the emergency medicines kit.
• Continue action to improve QOF performance in areas where performance has been below CCG and national averages.
• Continue to monitor uptake of childhood immunisations to secure improved uptake performance.
• Review the system for the identification of carers to ensure all carers have been identified and provided with support.
• Implement an action plan to address the relatively low scores for some of the caring questions on the GP survey.
• Keep the practice’s action plan to improve patient access to appointments under close monitoring and review.
• Consider the introduction of a more structured, planned programme of clinical audit to drive improvement in patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 November 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• QOF performance for diabetes related indicators was similar to the CCG but lower than the national average: 78% compared to 80% and 90% respectively.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 13 November 2017

The practice is rated as good for the care of families, children and young people.

• There were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
• Immunisation uptake against national targets was below standard for four of the age two and under targets. For 5 year olds, uptake was higher than CCG and national averages for MMR Dose 1 and higher than the CCG but lower than the national average for Dose 2
• Children and young people were treated in an age-appropriate way and were recognised as individuals. Staff we spoke with were familiar with Gillick competencies (used to decide whether a child or young person 16 years and younger is able to consent to their own medical treatment without the need for parental permission or knowledge).
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Updated 13 November 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice also worked closely with the Primary Care Navigator and referred patients who may require input from social services, housing organisations and other external agencies.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 13 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.
• 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.

Updated 13 November 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.
• 82% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. These patients were reviewed regularly and offered an annual physical health check.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• QOF performance was comparable to the national average for mental health related indicators.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations. There was an in-house counsellor offering talking therapy and patients with severe mental health illness were seen by a specialist mental health nurse.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 13 November 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.