Background to this inspection
Updated
24 May 2018
Dr Falak Naz (known locally as Burley Street Surgery) is situated at Burley Street, Elland, HX5 0AQ.
There are currently 2,183 patients registered on the practice list. The practice provides General Medical Services (GMS) under a locally agreed contract with NHS England. The practice is registered with the Care Quality Commission to provide the following regulated activities:
- Treatment of disease, disorder or injury
- Diagnostics and screening procedures
- Minor surgery
- Maternity and midwifery services
The practice is housed in single storey purpose built premises, and has been established since 1982. Prior to 2004 the practice was run by a husband and wife team of General Practitioners; and since 2004 has been run as a single handed practice.
The Public Health General Practice Profile shows that approximately 5% of the practice population are of Asian ethnicity; with approximately 2% of mixed ethnic origin. The level of deprivation within the practice population is rated as five, on a scale of one to ten. Level one represents the highest level of deprivation, and level ten the lowest.
The age/sex profile of the practice is largely in line with national averages. The average life expectancy for patients at the practice is 78 years for men and 82 years for women, compared to the national averages of 79 years and 83 years respectively.
The practice offers a range of enhanced services, including childhood vaccination and immunisations, minor surgical procedures and rotavirus and shingles immunisation.
The practice is open between 8am and 6.30pm Monday to Friday. Extended opening hours are available on Tuesday and Wednesday between 7.30am and 8am.
The practice is run by a single handed male GP. Locum cover is provided by a female GP during times of planned GP absence. In addition a nearby surgery is able to offer cover in the event of any unplanned GP absence. There are two part-time practice nurses. Supporting the clinical team is a newly appointed practice manager and a range of reception, secretarial and administrative staff.
Out of hours care is provided by Local Care Direct and can be accessed by calling the surgery telephone number or by calling the NHS 111 service.
When we returned for this inspection we checked, and saw that the previously awarded ratings were displayed, as required, on the practice website. At the time of our visit the ratings were not on display in the practice premises. This was rectified before we left the premises.
Updated
24 May 2018
This practice is rated as Inadequate overall. The previous inspection, carried out on 19 January 2016 rated the practice as good overall.
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – Good
Are services responsive? – Requires Improvement
Are services well-led? - Inadequate
We carried out an announced comprehensive inspection at Dr Falak Naz on 4 April 2018. We prioritised this inspection in response to concerns raised by Calderdale Clinical Commissioning Group (CCG) and NHS England.
At this inspection we found:
- Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, high risk medicines were being prescribed by the practice without the necessary monitoring; medicines and other patient safety alerts were not actioned and the patient clinical record did not include key information, such as allergies in the appropriate places.
- Recording systems for significant events were not appropriate. Significant events and near misses were not captured in most cases. There was a lack of dissemination of learning to prevent recurrence of incidents.
- Multidisciplinary meetings did not take place. Patients were at risk of harm as information sharing relating to patients at end of life, or patients on the child safeguarding register was not occurring.
- The practice had very limited formal governance arrangements. Staff meetings were held infrequently and staff appraisals were overdue.
- Clinical staff cover for nurses and succession planning arrangements were not effectively established.
- Little or no reference was made to audits or other quality improvement activity within the practice. We saw no evidence that the practice was comparing its performance to others, either locally or nationally. Clinical audit activity was incomplete and did not address key issues of performance and improvement.
- The practice was not complying with up to date clinical guidance in relation to patient care, for example National Institute of Health and Care Excellence (NICE) guidance
- Patient Group Directions (PGDs) used for vaccination and immunisation purposes were being used without the correct authorisation.
- Procedures to monitor temperature sensitive medicines (vaccinations and immunisations) were not appropriate.
- We observed patients being treated with compassion and respect. The national GP patient survey results were consistently high across all areas. Patients told us they received a caring and personalised service. They told us they could access care when they needed it.
The areas where the provider must make improvements as they are in breach of regulations are:
- Care and treatment must be provided in a safe way for service users
- Systems and process must be established and operated effectively to ensure compliance with the requirements of the fundamental standards of care.
I am placing this service in special measures. We are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. The service will be kept under review and if needed could be escalated to urgent enforcement action
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice