Archived: Dr Zaheer Hussain Also known as Fulham Cross Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced follow up inspection Dr Zaheer Hussain at Fulham Cross Medical Centre on 15 September 2016. Overall the practice is rated as requires improvement.

Dr Hussein’s surgery was placed into special measures following an inspection in February 2016, which was carried out to establish if the required improvements had been made since our first inspection and subsequent enforcement action to suspend the provision of regulated activities at the practice in November 2015.

Following the inspection in February 2016 the practice received an overall rating of inadequate. Four breaches of the Health and Social Care Act 2008 were identified. These breaches related to regulation 11 - Need for consent, regulation 12 - Safe care and treatment, regulation 13 - safeguarding service users from abuse and improper treatment and regulation 17 - good governance. Four requirement notices were issued and the practice submitted an action plan to CQC outlining the action they would take in response to our findings.

At our follow-up inspection on 15 September 2016 we found that the practice had made significant improvement having employed and worked with external consultants and the Royal College of General Practitioners (RCGP). The four requirement notices we issued following our previous inspection had all been met. The practice is now rated as requires improvement overall.

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

• The system for reporting and recording significant events had been reviewed and further developed. Staff we spoke with understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. We saw evidence to demonstrate that learning from incidents was shared amongst staff.

• Results from the national patient survey showed that patients rated the practice better than local and national averages to questions about patient involvement in planning and treating them with care and concern in GP consultations.
• Clinicians were kept up to date with national guidance and guidelines and updates were shared within the clinical team at weekly meetings to improve whole practice care.
• Clinical staff demonstrated an understanding of the Mental Capacity Act 2005 and Gillick competences.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Care plans were in place for vulnerable patients, however they did not contain enough relevant information about treatment plans and reviews.
• The practice did not hold regular multidisciplinary meetings to meet patient’s needs and manage complex cases.
• There was no evidence to demonstrate how the practice monitored and improved patient outcomes.
• Significant improvements had been made since our last inspection but the practice could not demonstrate how they would be sustained as key members of the leadership team held temporary contracts.

The areas where the provider must make improvements are:

• Carry out quality improvement activity such as clinical audits including re-audits to ensure improvements have been achieved

• Implement formal processes to ensure the practice works effectively with other service providers to meet patient’s needs and manage complex cases.

• Clarify the leadership structure and ensure there is leadership capacity to deliver and sustain all improvements.

The areas where the provider should make improvements are:

• Care plans for patient groups such as for those patients on the mental health register or those with a learning disability were in place, however require further development in relation to clearly stating treatment plans and review information/dates.

• Implement appropriate systems to identify patients who are carers so their needs can be identified and met.
• Formalise the succession plans to ensure continuity of care and future planning.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Following a comprehensive inspection of Dr Zaheer Hussain at Fulham Cross Medical Centre on 10 November 2015, the practice was given an overall inadequate rating and due to serious concerns about patient safety a decision was made to suspend the registration of the provider for a period of three months from 11 November 2015 to 08 February 2016 under s31 of the Health and Social Care Act. The provider appealed to a first-tier tribunal and after written and verbal hearings, this was stayed by the judge pending another inspection to be arranged prior to the end of the suspension period. We re-inspected the practice on 4 February 2016. During this inspection we found sufficient improvements had been made to allow the suspension to lapse however there were still serious concerns in relation to the management and leadership of the practice.

We carried out an announced follow up inspection of Dr Zaheer Hussain at Fulham Cross Medical Centre on 4 February 2016 Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken.

• There was no evidence of learning and communication with staff about significant events.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.

• Clinicians were not kept up to date with national guidance and guidelines and updates were not shared within the clinical team to improve whole practice care.

• Clinical staff did not understand and implement the key principles of the Mental Capacity Act 2005 and Gillick competences.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• The practice had limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure effective leadership is in place to include oversight and understanding of all the systems in place to deliver a high standard of care to patients.

• Introduce procedures to ensure all clinicians are kept up to date with national guidance and guidelines and updates shared within the clinical team to improve whole practice care

• Ensure all staff understand and implement the key principles of the Mental Capacity Act 2005 and Gillick competences.

• The GP should undertake training on the clinical systems to have a comprehensive understanding of the performance of the practice.

• Develop a clear vision for the practice and a strategy to deliver it. Ensure it is shared with staff and ensure all staff knows their responsibilities in relation to it.

• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Take action to address identified concerns with infection prevention and control practice such as ensure all staff receive infection control training, clarify the cleaning arrangements so that all staff are aware of them and ensure audits are regularly undertaken.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Carry out clinical audits including re-audits to ensure improvements have been achieved.

• Implement processes to ensure the practice works effectively with other service providers to meet patient’s needs and manage complex cases

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements

• Ensure all staff that carry out chaperone duties are trained to do so and a risk assessment is undertaken to determine the need for DBS checks.

• Ensure that legionella testing is carried out in line with recommended guidance.

The areas where the provider should make improvement are:

• Make arrangements to improve the uptake and access to cervical screening for patients at the practice.

This practice will remain in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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 practice 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.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice