- GP practice
Dr Abid Hussain
All Inspections
7 August 2017
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
We previously carried out an announced comprehensive inspection of Dr Abid Hussain, known as Pearl Medical Practice on 19 April 2016. As a result of our inspection the practice was rated as requires improvement in caring and responsive with an overall rating for the practice as requires improvement. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Abid Hussain on our website at www.cqc.org.uk.
This inspection was an announced comprehensive inspection carried out on 7 August 2017 to confirm that the practice had carried out their plan to address the areas requiring improvement that we identified in our inspection in April 2016. This report covers our findings in relation to requirements and improvements made since our last inspection.
We found the practice had carried out a detailed analysis of the previous inspection findings, involving staff and their Patient Participation Group (PPG). The practice had made extensive changes which had resulted in significant improvements. Practice staff had taken responsibility for embedding and maintaining these improvements themselves. There was evidence of a cultural and leadership change within the practice, and we saw a positive approach to performance and improvement throughout.
Our key findings were as follows:
- Risks to patients were assessed and managed through practice meetings and through discussions with the multi-disciplinary teams.
- The practice had clearly defined and embedded systems to minimise risks to patient safety.
- The structured, open and transparent approach to the reporting and recording of significant events and complaints had been maintained and further developed since our previous inspection. Six monthly analyses identified themes and trends. Staff were aware of and understood their responsibilities to report these. Learning was shared with staff at team meetings.
- Easy to understand information about services and how to complain was available to patients in the reception area and on the practice website. Full analysis and reviews of complaints were carried out to identify learning, themes and trends.
- Staff had completed training to ensure they had the skills, knowledge and experience to deliver effective care and treatment. Staff training needs had been identified and planned for the coming year. Assessments of clinical staff skills had been carried out with details of specific skills assessed recorded.
- Records were viewed and showed that recruitment procedures had been followed when recruiting staff. Records confirmed that the practice had obtained Disclosure and Barring Services (DBS) checks for non-clinical staff who carried out chaperone duties or had unsupervised access to patients.
- There was effective oversight, planning and responses to practice performance.
- There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
- Staff were enthusiastic about improvements made to the practice and told us they had worked hard to provide the best services for patients.
- The practice sought regular feedback from staff and patients. The Patient Participation Group (PPG) worked with the practice to promote health care and the services offered by the practice. Open days took place so patients could share their views and ideas. Awareness days were held to support patients with their health management such as Diabetes Awareness, with future plans for heart disease and asthma awareness days.
- The practice had identified 4% of its patients as carers.
- Regular checks were carried out to ensure emergency equipment was available for use at all times.
- Patients confirmed on the comment cards that they were listened to, that they were given full explanations for their treatment and care, and that everyone at the practice was helpful and friendly.
The practice is now rated as good for providing safe, effective, caring, responsive services, and for being well-led. The overall rating for the practice is now good.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
19 April 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We had previously inspected Dr Abid Hussain (known as Pearl Medical Centre) in April 2015 and had found serious concerns. As a result the practice was rated as inadequate and placed into special measures. The inspection report was published in October 2015. Specifically, we found the practice inadequate for providing safe, effective and well led services. The practice required improvement for providing a caring and responsive service. Following the inspection the practice sent us an action plan of how they were going to address the issues.
We carried out an announced comprehensive inspection at the practice on 19 April 2016 to consider whether sufficient improvements had been made by the provider, and whether the concerns we had at the previous inspection had been addressed. The practice had made significant improvements. We have rated the practice as requires improvement in providing caring and responsive services, and good for providing safe, effective and well led services. Overall the practice is rated as requires improvement at this inspection.
- There was a more structured, open and transparent approach to the reporting of and recording of significant events and complaints. Staff were aware of and understood their responsibilities to report these. Learning was shared with staff at team meetings.
- Risks to patients were assessed and well managed through practice meetings and through discussions with the multi-disciplinary teams.
- Staff had completed training that confirmed they had the skills, knowledge and experience to deliver effective care and treatment. Staff training needs had been identified and planned for the following year.
- A more robust recruitment process had been implemented since our last inspection and this had been followed when recruiting staff.
- Patients confirmed on the comment cards that they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- Information about services and how to complain was available to patients in the reception area and on the practice website. This was easy to understand.
- The practice was proactively seeking feedback from staff and patients. The Patient Participation Group had been re-formed and an open day had been held for patients to share their views and ideas.
- Checks had been introduced to ensure emergency equipment was available for use at all times.
However there were areas of practice where the provider should make improvements:
- When an assessment of clinical staff skills is being carried out details of specific skills assessed should be recorded.
- Take steps to ensure that recent improvements to quality monitoring are embedded and sustained.
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
27 May 2015
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Pearl Medical Centre on 28 May 2015. Overall the practice is rated as inadequate.
Specifically, we found the practice inadequate for providing safe, effective and well led services. The practice requires improvement for providing a caring and responsive service.
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. Recruitment checks were not robust. Risks such as fire and health and safety had not been assessed and managed.
- The arrangements in place to identify, review and monitor patients with some long term conditions and at risk groups were not effective. The most recent national data for the year 2013-2014 showed that the practice was below the national average for diabetes.
- The practice did not have a robust and formal process in place to manage staff performance or their training needs
- The practice had limited formal governance arrangements that enabled the monitoring of performance, quality and risks.
The areas where the provider must make improvements are:
- Establish effective systems to assess, monitor and mitigate risks relating to the health, safety and welfare of patients, staff and visitors to the practice.
- Develop systems to seek feedback from staff and patients at the practice and ensure this feedback is recorded and acted upon.
- Implement a robust complaints policy and procedure that is accessible and understood by all patients and demonstrates a commitment to responding to and resolving all complaints where possible. Where any trends are identified, actions are taken to improve the quality of care for patients.
- Ensure that all staff receive appropriate training, professional development and supervision appropriate to their role.
- Ensure that all non clinical staff who administers vaccines uses Patient Specific Directions that have been produced by the prescriber.
- Ensure that non-clinical staff receive appropriate training, professional development and supervision in the administration of vaccines.
- Review the availability of emergency medicines so that emergencies are managed effectively.
- Ensure that all relevant staff including those who carry out chaperone duties has either undergone a Disclosure and Barring Service check or have a risk assessment in place.
- Operate effective recruitment procedures in order to ensure that no person was employed for the purposes of carrying out a regulated activity unless that person is of good character, has the qualifications, skills and experience which are necessary for the work to be performed and is physically and mentally fit for that work.
In addition the provider should:
- Ensure that lessons learned from all significant events, incidents and complaints are shared and recorded.
- Develop robust training needs and analysis systems to ensure that all staff are up-to-date with training such as chaperone, fire safety awareness and infection control.
- Ensure that all policies and procedures/protocols are up to date and are understood and implemented by staff.
- Conduct an analysis of required staffing levels to ensure that enough staff, particularly clinical staff are employed to safeguard the health, safety and welfare of patients.
- Ensure that systems to undertake regular checks on emergency equipment are in place.
- Research best practice guidance to determine those medicines most appropriate to include in emergency medicine kits.
- Put plans in place to demonstrate and monitor action in relation to improving outcomes for patients with long term conditions such as diabetes.
- Ensure that the practice leaflet for patients is updated to include current details about the surgery opening times.
- Ensure that all staff receive regular supervision and annual appraisals which identify learning needs from which action plans are documented when required
- Develop an up-to-date leadership structure which clearly identifies lead roles and responsibilities for each staff member.
- Develop ways to improve patient satisfaction and develop an action plan in response to information from the national patient survey information.
- Update the business continuity plan.
- Develop robust health and safety systems and complete risk assessments.
I am placing this practice in special measures. Practices 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 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 by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
24 February 2014
During a routine inspection
At this inspection we spoke with the practice manager. We also looked at the arrangements that had now been put in place for recruitment of new staff members.
We found that the provider had put appropriate systems in place to ensure staff were recruited appropriately.
25 July 2013
During a routine inspection
We found that care and treatment was planned and delivered in a way that met patients' needs and protected their rights. Patients were able to be involved in decisions about their treatment. Patients we spoke with told us they were happy with the level of care they had received.
We saw systems were in place for the safe keeping and dispensing of medication. Patients told us they had no difficulties in getting their repeat medication on time.
The provider did not have a robust recruitment system to ensure only appropriate people were employed.
The staff we spoke with said they had received training appropriate to their role. This supported staff to deliver care to an appropriate standard.
The provider had systems in place for monitoring the quality of service provision. We saw that the practice carried out a range of audits on a regular basis to monitor the quality of its own performance and to learn from any mistakes made.