Background to this inspection
Updated
25 September 2019
Dr Masud Prodhan is the registered individual and sole provider of services from Seymour Grove Health Centre, Old Trafford Medical Practice, Seymour Grove, Old Trafford. The practice delivers commissioned services under a General Medical Services (GMS) contract and is a member of Trafford Clinical Commissioning Group (CCG). The GMS contract is the contract between general practices and NHS England to deliver general medical services within local communities.
The practice offers primary care services to a registered list of approximately 4,500 patients. It is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning, maternity services, surgical procedures and the treatment of disease, disorder and injury.
Regulated activities are delivered to the patient population from the following address.
Old Trafford Medical Practice, Seymour Grove Health Centre, Seymour Grove, Old Trafford, M16 0LW.
The practice has a website that contains information about what they do to support their patient population and explain the in-house and online services offered.
www.Oldtraffordmedicalpractice.co.uk
The provider is currently on sick leave and medical cover is provided on a sporadic and inconsistent basis by locum GPs. There is a nursing team comprising of two part time nurses, an assistant practitioner, a health care assistant and a nurse practitioner. They are all part time, working at this practice and another practice that is registered to the provider. The practice has been through a period of instability and staffing levels remain inconsistent.
The average life expectancy and age profile of the practice population is not in line with the CCG and national averages. 25% of the population are under the age of 18 and only 7 per cent are over the age of 65. 45% suffer from long term conditions. Information taken from Public Health England placed the area in which the practice is in as the third most deprived decile (from a possible range of between 1 and 10). In general, people living in more deprived areas tend to have a greater need for health services.
Patients requiring a GP outside of normal working hours are advised to contact the surgery and they will be directed to the local out of hours service which is provided by Mastercall via NHS 111. Additionally, patients can access GP services in the evening and on Saturdays and Sundays through the Trafford GP Federation across various hubs in Trafford.
Updated
25 September 2019
This practice is rated as Inadequate overall. (Previous ratings: October 2016 Requires Improvement. September 2017 – Good)
The Doctor Masud Prodhan practice (known as Old Trafford Medical Practice) was initially inspected in July 2016 and awarded a rating of requires improvement in the Safe, Effective and Well Led areas. Concerns were around clinical safety, poor outcomes for patients and staff wellbeing. When the practice was re-inspected in September 2017 the concerns had been addressed and staff wellbeing appeared to have been resolved. During 2018, relationships between core members of staff in the practice became strained and key members of medical and managerial staff left. The practice was then in a period of instability until new management was secured in January 2019. In April 2019 the CQC received whistle blowing information from existing and from previous members of staff.
The CQC undertook an annual regulatory review because of the concerns and a decision to bring forward a full comprehensive inspection was agreed. The inspection was part of our regulatory functions to check whether the provider was maintaining the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. We looked at all the domains and all the key questions at this inspection.
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as inadequate overall.
We rated the practice as inadequate for providing safe services because:
- The practice did not have clear systems and processes to keep patients safe. . We found concerns around incident reporting, safeguarding, clinical record keeping, patient safety alerts, prescription protocols, and information sharing.
- Receptionists had not been given guidance on identifying deteriorating or acutely unwell patients. They were not aware of actions to take in respect of such patients.
- The practice did not have appropriate systems in place for the safe management of medicines. Administration, pharmacy and health care staff were working outside their competencies.
- Patient consultations were not sufficiently documented to ensure that appropriate information was available to all clinicians reviewing patients. There were gaps in alert processes for safeguarding and no evidence that information about safeguarding incidents was communicated to all clinical staff.
- Staff were not clear about reporting incidents, near misses and concerns and the practice did not learn and make improvements when things went wrong.
We rated the practice as inadequate for providing effective services because:
- There was limited monitoring of the outcomes of care and treatment. Data showed that some patient outcomes were positive but there were areas of high exception reporting.
- There were areas of significant negative variation in relation to antibiotic prescribing and prescribing of medicines that are addictive.
- There were several significantly negative responses from patients in the GP patient survey around access, appointments and the way they had been cared for.
- The practice was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.
- The practice was unable to demonstrate that it always obtained consent to care and treatment.
We rated the practice as inadequate for providing caring services because:
- Although staff dealt with patients with kindness and respect not all patients felt involved in decisions about their care.
- Not all comments from patients were positive about their interactions with staff.
- Verbally reported concerns were not escalated so that they could be dealt with and learned from.
- Carers were not proactively identified and cared for appropriately.
- We identified some patients who were offered treatment without appropriate explanation and this treatment was not within The National Institute for Health and Care Excellence (NICE) guidelines.
We rated the practice as inadequate for providing responsive services because:
- The practice was unable to organise and deliver services to meet patients’ needs.
- Not all patients receiving care and treatment in a timely way.
- Care and treatment were being provided on a reactive basis and clinics were being cancelled at short notice due to planned or unplanned periods of absence because of inconsistent locum cover.
We rated the practice as inadequate for providing well-led services because:
- There was insufficient practice leadership and leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
- Leaders were not performing tasks intrinsic to their role and the requirements of the Health and Social Care Act.
- At the time of the inspection the Provider was absent from the practice at the request of NHS England.
- At this inspection we identified concerns that put patients at risk.
- The practice culture did not effectively support high quality sustainable care.
- The overall governance arrangements were ineffective.
- The practice did not have clear and effective processes for managing risks, issues and performance.
- The practice did not always act on appropriate and accurate information.
- We saw little evidence of systems and processes for learning, continuous improvement and innovation.
These areas affected all population groups, so we rated all population groups as inadequate.
(Please see the specific details on action required at the end of this report).
The areas where the provider must make improvements are:
- Ensure that leaders can properly perform tasks that are intrinsic to their role
- Ensure that all patients are treated with dignity and respect
- Ensure care and treatment is provided in a safe way to patients
- Ensure patients are protected from abuse and improper treatment
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure specified information is available regarding each person employed and any such action as is necessary and proportionate is taken when any member of staff is no longer fit to carry out their duties
We have suspended the Provider’s registration from 29 July 2019 for a period of three months when the situation will be reviewed.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care