Archived: Dr Ijaz Hayat Also known as Hayat Medical Centre

Updated 24 September 2015

Hayat Medical Centre is situated at 273 Boundary Road, London, E17 8NE. The practice provides primary care services through a General Medical Services (GMS) contract to approximately 5000 patients in the local area. The practice is part of the NHS Waltham Forest Clinical Commissioning Group (CCG) which is made up of 45 GP practices that serve a population of 292,000.

The practice is located in a converted terraced property with all patient accessible areas on the ground floor; a ramp provides access for wheelchair users. The practice serves a younger adult population group with patients predominantly in the 25-34 years age range. Twenty five percent of patients are young people and children under 18 years of age which is higher than both the CCG and national averages, whilst only 7.6% of patients are over 65 years of age, below the CCG and national averages.

The practice serves a multi-cultural population including patients of Bengali and Arabic origin. The practice is situated in an area of high deprivation. There is a high prevalence of diabetes among patients at the practice.

At the time of our inspection and prior to cancellation the practice was registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures and the treatment of disease, disorder and injury.

The practice staff comprised of one male lead GP, Dr Hayat, who is both the “provider” and “registered manager” of the practice, a nurse, a practice manager, office manager and three administrators. At the time of the inspection Dr Hayat was not able to carry out clinical activity at the practice as a consequence of conditions on his General Medical Council (GMC) registration. Approximately 12 locum GPs had made up the clinical establishment in the month preceding our inspection.

Hayat Medical Centre, did not provide an out of hours service and patients calling the surgery when it is closed are directed to NHS 111 if they require the services of a GP. If surgery appointments are full in working hours patients are directed to either the local walk in centre or to the accident and emergency department at Whipps Cross Hospital

Appointments were available from 9am to 12pm and 3pm to 6pm on weekdays except Wednesdays when the practice closed at 12.00pm. The last appointment time was 5.50pm.

Updated 24 September 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of this practice in October 2014 where we found the practice to be inadequate for providing safe, effective, caring, responsive and well-led services. It was also inadequate for providing services for the care provided to older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia). You can view the full report by selecting the 'all reports' link for Hayat Medical Centre on our website at www.cqc.org.uk

We undertook this focussed inspection on 17 June 2015 to check that the provider had made improvements and now met legal requirements. This report only covers our findings in relation to those requirements.

We found some minor improvements had been made:

• Staff had attended child protection and adult safeguarding training
• Staff had been trained to carry out chaperone duties
• Suitable arrangements were in place to ensure medicines were appropriately stored and that fridge temperatures were recorded in line with recognised guidance.

However, we found that overall the practice was still providing inadequate care that was not safe, caring, effective, responsive or well-led.

We found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulations breached were:

• Regulation 7 – Requirements relating to registered managers
• Regulation 17 – Good governance
• Regulation 12 – Safe Care and treatment
• Regulation 18 – Staffing
• Regulation 15 – Premises and equipment
• Regulation 16- Receiving and acting on complaints

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

• The practice had no clear leadership structure and limited formal governance arrangements.

• Suitable arrangements for leadership, training and implementation of effective infection control measures were not in place

• There were no systems in place to manage risk, including procedures and audit to monitor effective risk assessment of any actions that had been taken to mitigate the risks

• Clinical audit cycles were not completed undertaken.

• There were no systems to ensure that patients received treatment and care relevant to their condition, including routine reviews of patients with long term conditions.

• Appropriate arrangements were not in place to respond to medical emergencies

• Patients receiving repeat prescriptions were not regularly reviewed by the GP

• There were no arrangements in place for working with other health and social care professionals to ensure patients with complex needs or priority conditions were discussed and appropriate action taken

• Patients felt they were not able to make or participate in decisions relating to their care or treatment.

• Recruitment checks were not carried out for all staff prior to employment.

• Staff were not appropriately trained, supervised and appraised.

• There were no arrangements in place for annual testing of electrical equipment.

• There were no systems in place to audit, manage, respond to and learn from incidents, complaints and occasions when things went wrong

If the provider had continued to be registered with the Care Quality Commission, the provider would have been placed into special measures. The areas where the provider must have made improvements are:

• Put in place systems to audit, manage, respond to and learn from incidents, complaints and occasions when things go wrong.
• Ensure that recruitment checks are carried out for all staff prior to employment.
• Ensure that patients receiving repeat prescriptions are regularly reviewed by the GP.
• Make suitable arrangements for leadership, training and implementation of effective infection control measures.
• Ensure arrangements are in place for annual testing of all electrical equipment.
• Ensure appropriate arrangements are in place to respond to emergencies.
• Put in place systems to ensure that patients receive the treatment and care relevant to their condition, including routine reviews of patients with long term conditions.
• Ensure that all staff are appropriately trained, supervised and appraised.
• Put in place systems to manage risk, including procedures and audit to monitor effective assessment and implementation of actions identified.
• Ensure audit cycles are undertaken.
• Implement clear leadership structures and ensure staff are made aware of governance arrangements.
• Ensure patients are enabled to make or participate in decisions relating to their care or treatment.
• Make suitable arrangements for working with other health and social care professionals to ensure patients with complex needs or priority conditions are discussed, and agreed appropriate action taken

We believed that there was a serious risk to patients’ lives, health or wellbeing so we took immediate enforcement action. The registration of Dr Hayat to provide Diagnostic and Screening Procedures and Treatment of Disease Disorder or Injury, at this location, was cancelled with immediate effect by an order of the Court on 19th June 2015.

As part of this action CQC liaised with NHS England to ensure measures were put in place to provide support, care and treatment for the patients affected by this closure. Patients previously registered with Hayat Medical Centre were transferred to another local practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice