Archived: Dr Nisar- Ul Haque Also known as Dr. N U Haque PCHC

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Dr Nisar- Ul Haque on 17 January 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Nisar- Ul Haque on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 30 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

• We saw arrangements had been made to receive MHRA alerts and a spreadsheet demonstrated actions that were being taken following receipt and discussions that had taken place between the clinical team. The patient record system we looked at showed searches were carried out on the system to identify relevant patients following receipt of alerts.

• We were told that the practice was taking part in the CCGs Primary care Commissioning Framework (PCCF) to improve quality. As part of PCCF (standard 8) the practice was required to encourage patients to attend cancer screening. We looked at the patient record system which showed that since April 2017, 68 patients had missed their appointment to attend screening for bowel cancer. However, 58 patients had been reminded by the practice to attend their appointments. We saw evidence that there was a plan to improve and monitoring was in place.

• When we inspected the practice in January 2017, we saw results from the national GP patient survey was generally below local and national averages for questions about their involvement in planning and making decisions about their care and treatment (with both Nurses and GPs). The practice had a strategy to improve and was monitoring this through ongoing in-house patient surveys using the same questions as the national GP patient survey. We saw an analysis of the in-house patient survey conducted in October 2016 which showed further improvements were required. At this inspection, another in-house survey from March 2017 showed significant improvement in patient feedback.

• During our previous inspection we saw that the practice was collaborating with four other local practices to offer extended opening hours, including Saturday afternoon appointments. However, the practice had not informed patients of this arrangement by updating information on the practice leaflet and website. At this inspection we saw that the practice leaflet and website had been updated with current and up to date information.

• At our previous inspection we saw QOF achievement for mental health indicators were above local and national averages. However, in some areas the exception reporting was above local and national averages. We were told that that this was due to the low number of patients on the register. We looked at the patient record system which confirmed this. We saw appropriate processes were in place to ensure patients were reviewed appropriately.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Nisar- Ul Haque on11 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report for the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Nisar- Ul Haque on our website at www.cqc.org.uk.

This inspection was undertaken to follow up progress made by the practice since the inspection on 11 March 2016. It was an announced comprehensive inspection on 17 January 2017. Overall the practice is now rated as good.

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

• There was an open and transparent approach to safety and an effective system was in place for reporting and recording significant events.

• Most risks to patients were generally assessed and well managed; however, some risks were not effectively managed. For example, the practice received medical device alerts but could not evidence receipt of any drug safety alerts or updates from the Medicines and Healthcare products Regulatory Agency (MHRA). Following the inspection the practice assured us that action had been taken improve.

• Staff spoken with demonstrated a commitment to providing a high quality service to patients. Audits were used to monitor quality and to make improvements.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• During our previous inspection in March 2016 we looked at the national GP patient survey published January 2016. The results showed the practice was below average for its satisfaction scores on some areas such as consultations with GPs and nurses.

At this inspection, records we looked at showed that the practice had discussed their improvement strategy with staff and there was ongoing monitoring of this through in-house patient surveys.

• Patients could access appointments and services in a way and at a time that suited them.

  There were longer appointments available for patients when needed. The practice offered urgent access appointments for children, as well as those with serious medical conditions.

• The practice was located in a purpose built health centre and had good facilities to treat patients and meet their needs. Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• The practice had an overarching governance framework to support the delivery of the strategy and good quality care. However, during our inspection we noted that governance arrangements were not always effective in some areas. For example, the system to ensure that patient specific directions (PSDs) were in place to authorise the health care assistant (HCA) to administer the flu vaccination.

• The practice nurse administered vaccines using patient group directions (PGDs) that had been produced in line with legal requirements and national guidance. However, some PGDs had not been authorised by a manager. The practice manager signed these after we had highlighted this on the day of the inspection.

• 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 and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Assess and mitigate any risks to the health and safety of patients in response by ensuring all patient safety alerts have been appropriately considered and actioned.

• Healthcare assistants must have a patient specific prescription or direction from a prescriber in place to administer medicines to patients.

The areas where the provider should make improvement are:

• Explore ways to promote monitoring of screening and health reviews and exception reporting is appropriate in all areas care.

• Continue to monitor improvements in areas of lower patient satisfaction as identified in the national GP patient survey.

• Update information on the practice website and leaflet to ensure accuracy and to reflect current opening arrangements.

• Operate an effective system to monitor prescriptions that have not been collected. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice