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Dr Raphael Rasooly Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 2 February 2021

Dr Raphael Rasooly is a provider registered with CQC. Following a comprehensive inspection on 5 March 2020, we rated the practice inadequate overall and in safe, effective and well-led and across all population groups. Responsive and caring were rated requires improvement.

At the inspection, we found concerns in relation to systems and processes to keep people safe, the safe management of medicines, systems for learning and making improvements when things went wrong, monitoring of the outcomes of care and treatment, staff training, leadership and overall governance. The practice was placed in special measures and issued warning notices for breaches of Regulation 12 and 17 of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014.

We carried out an unannounced focused inspection of Dr Raphael Rasooly on 3 August 2020 to follow-up on information of concern we received, and the warning notices issued following the March 2020 inspection.

At this inspection, we found the provider had made some improvement in providing safe, effective and well-led services. However, we identified further concerns in relation to structured reviews of people with long-term conditions and general governance systems. The practice was issued Requirement notices for breaches of Regulation 12 and 17 of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014.

We carried out a comprehensive inspection of the practice on 7 December 2020. Following this inspection, we rated this practice requires improvement overall. Safe, effective, caring, responsive and well-led key questions were rated requires improvement along with all the population groups.

We also reviewed remotely specific documentation including policies and audits. (In light of the current Covid-19, CQC has looked at ways to fulfil our regulatory obligations, respond to risk and reduce the burden placed on practices by minimising the time inspection teams spend on site. In order to seek assurances around potential risks to patients, we are currently piloting a process of remote working as far as practicable. This provider consented to take part in this pilot and some of the evidence in the report was gathered without entering the practice premises).

The report of the previous inspections can be found by selecting the 'all reports' link for Dr Raphael Rasooly on our website at www.cqc.org.uk.

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 providers, patients, the public and other organisations

We rated the practice requires improvement for providing safe services because:

  • Although some improvement was evident since the previous inspections. We found continuing concerns in relation to medicine reviews, the effectiveness of the monitoring system for people on Direct Oral Anticoagulants (DOACs) and compliance with safety alerts.

We rated the practice requires improvement for providing effective services because:

  • We found continuing concerns in relation to structured medicine reviews for people with asthma.
  • Cervical screening and childhood immunisation achievement rates were below national targets although there was some improvement since the last inspection.
  • The provider did not monitor the clinical practice of sessional GPs.
  • The provider did not monitor the process for seeking consent.

We rated the practice requires improvement for providing caring services because:

  • National GP Patient Survey results for caring indicators were below local and national averages.
  • Feedback we received from people who used the service showed that people were not always treated with kindness and respect and their privacy upheld.

We rated the practice requires improvement for providing responsive services because:

  • Although nurse capacity had been increased, and there had been some improvement in uptake, cervical screening and childhood immunisation achievement rates remained below national targets.
  • Feedback we received from people who used the service was predominantly negative in relation to access to the service.

We rated the practice requires improvement for providing well-led services because:

  • The provider demonstrated some improvement in leadership and overall governance. However, concerns remained particularly in relation to clinical governance and leadership capacity to sustain improvement.

The areas where the practice must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the practice should make improvements are:

  • Ensure safeguarding policies consider people accessing online services and relevant safeguarding information is shared with the Out of Hours service.
  • Develop a comprehensive program of quality improvement including clinical audit to drive improvement in care and treatment outcomes.
  • Improve patient satisfaction with the caring aspects of the service provided and continue to improve the identification and support of patients with carer responsibilities.
  • Improve confidentiality arrangements at the reception desk.
  • Improve patient satisfaction with access to the service.
  • Further develop systems to ensure compliance with the requirements of the duty of candour.
  • Take steps to improve patient engagement and involvement in the development of the services provided.

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

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection areas

Safe

Requires improvement

Effective

Requires improvement

Caring

Requires improvement

Responsive

Requires improvement

Well-led

Requires improvement
Checks on specific services

People with long term conditions

Requires improvement

Families, children and young people

Requires improvement

Older people

Requires improvement

Working age people (including those recently retired and students)

Requires improvement

People experiencing poor mental health (including people with dementia)

Requires improvement

People whose circumstances may make them vulnerable

Requires improvement