Archived: Dr Yousri El-Gazzar

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