Archived: Dr Zahir Mughal Also known as Mughal Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Zahir Mughal on 19 January 2016. Overall the practice was rated as requires improvement. A breach of the legal requirements was found. After the inspection the practice wrote to us to say what they would do to meet the legal requirements in relation to the safety and the leadership of the practice.

We undertook a focussed follow up inspection at Dr Zahir Mughal on 13 October 2016 to check that the practice had met the requirements. This report only covers our findings in relation to those requirements.

You can read the full comprehensive report which followed the inspection in January 2016 by selecting the 'all reports' link for Dr Zahir Mughal on our website at www.cqc.org.uk.

Our key findings across all the areas we inspected in October 2016 were as follows:

• Risks to patients were not assessed or well managed. The practice had carried out an Infection Prevention and Control (IPC) audit but had not produced an action plan in relation to this or had an appropriate IPC policy in place.
• Systems and processes were not in place in the practice to keep people safe. For example, the practice could not provide us with a fire risk assessment, an appropriate policy, or evidence of fire drills or alarm tests being carried out.
• Effective arrangements were not in place to safeguard children and vulnerable adults from abuse. The practice could not evidence a policy for safeguarding children or vulnerable adults.
• The practice had undertaken a review of the cleaning products used and we found risk assessments for the control of substances hazardous to health (COSHH) were in place. We were informed that individual areas were cleaned, for example the minor surgery suite. However, there were no records maintained or cleaning schedules in place to support this.
• In a room, we saw there were vaccines which had not been disposed of in line with the current guidance, as a result of a vaccine fridge failure in June 2016.
• Staff had not completed the appropriate training to meet their learning needs and to cover the scope of their work. There was little evidence that staff had attended the appropriate level of safeguarding training relevant to their roles, fire safety awareness or IPC training.
• Staff did not have training or development plans in place and appraisals had not been completed for non-clinical staff. Nursing staff and the lead GP told us they had received an appraisal.
• We saw evidence that since our last inspection the practice were responding appropriately to complaints and were now offering patients a written explanation or apology if appropriate.
• We were told that the practice had recruited a patient participation lead the week before our visit. A formal patient participation group had not been established yet.

The areas where the provider must make improvements are:

• Systems and processes must be established to enable the practice to assess, monitor and mitigate risks to the health, safety and welfare of their patients and staff and be able to evidence the necessary documents. For example, in relation to fire safety, child and adult safeguarding and IPC.
• The provider must ensure that there are systems in place to manage and monitor infection prevention and control.
• The practice must ensure that all vaccines are stored, managed and disposed of properly so that immunisations are carried out safely and efficiently in line with Public Health England guidance.
• The provider must ensure that persons employed by the service receive appropriate support, training and appraisal as is necessary to enable them to carry out their duties. Records of all training completed by staff must be maintained.
• The provider must seek and act on feedback from relevant people on the services provided.

The areas where the provider should make improvements are:

• The provider should continue to give consideration to best practice guidance from the British Medical Association, General Medical Council and the British association of Pediatric surgeons in relation to the non-therapeutic circumcision of male children.

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 at Dr Zahir Mughal: Mughal Medical Centre on 19 January 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events, but these issues were not always documented.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough.

• Information about services and how to complain was available and easy to understand. Patient complaints were not always documented and we did not see evidence that they received a verbal or written apology.
• Some risks to patients were assessed with the exception of those relating to infection prevention and control. Actions from risk assessments were not always acted upon for example fire, staff had not received training and fire drills had not been carried out.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported or listened to.
• Urgent appointments for vulnerable patients and children were available on the day they were requested and the practice operated a telephone triage system.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a dedicated prayer room for patients and staff to use.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff at meetings and patients, which it acted on.
• We saw evidence that the provider was aware of the requirements of the Duty of Candour but we did not see evidence that patients received a written apology or explanation following incidents.

We saw one area of outstanding practice.

• The practice’s uptake for the cervical screening programme was 97%, which was significantly better than the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test or who declined the screening. A dedicated member of administration staff reviewed attendance and the practice nurse would individually contact patients and explain the benefits of the screening programme.

The areas where the provider must make improvement are:

• It must ensure that there are systems to manage and monitor the prevention and control of infection.

The areas where the provider should make improvements are:

• Where the non-therapeutic circumcision of male children is performed, (for religious or cultural reasons) the practitioner should give consideration to British Medical Association good practice guidelines which state that “usually and where applicable both parents must give consent for non-therapeutic circumcision”.
• Where non-therapeutic circumcision is performed the practitioner should review General Medical Council and the British Association of Paediatric Surgeons guidance which states that doctors must use appropriate measures including anaesthesia to minimise pain and discomfort. On the day of inspection, our GP specialist was told that anaesthesia was not given to patients under 4 weeks old unless the person consenting to the procedure requests this. The practice leaflet confirms this.

• The practice should explore further ways of involving patients in the governance arrangements of the practice.

• The practice should review its cleaning regimes; the products used and ensure that a risk assessment for the control of substances hazardous to health (COSHH) is available.

• The practice should undertake a full review of all the policies and procedures of the practice and ensure that they are practice specific, fit for purpose and keep people safe, including fire procedures. 
• The practice should ensure that a record of all staff training attended is maintained within the practice, and that staff are trained to the appropriate standards for their role.
• The practice needs to ensure that it positively engages with its patients and improves patient satisfaction scores. Patient satisfaction was below average for consultations with GPs and nurses, treating patients with care and concern, contacting the surgery and accessing appointments. The practice should review if it has the right amount of staff with the appropriate skills to meet patient needs.
• The practice should assure itself that it is compliant with its own policy with respect to the management of complaints. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice