Archived: Dr Abul Kashem Mohammed Zakaria Also known as Upper Road Medical Centre

Updated 12 January 2018

Dr Abul Kashem Mohammed Zakaria, also known as Upper Road Medical Centre, is located in Plaistow in east London. It is one of the 62 member GP practices in NHS Newham CCG.

The practice serves a diverse community: 40% Asian, 21.5% Black, 5% mixed and 3% other non-white ethnic groups. The practice is located in the second more deprived decile of areas in England. At 77 years, male life expectancy is lower than the England average of 79 years. At 82 years, female life expectancy is lower than the England average of 83 years.

The practice has approximately 3,400 registered patients. It has many more male patients in the 20 to 44 years age range than the England average, and comparatively few patients in the 60 to 85+ years age range.

Services are provided by Dr Abul Kashem Mohammed Zakaria, a Registered Individual, who provides services under a General Medical Services (GMS) contract with NHS England (a General Medical Services (GMS) contract is the contract between general practices and NHS England for delivering primary care services to local communities).

The practice is in purpose built premises. All the patient areas are on the ground floor which is accessible to wheelchair users. There is a reception area, two waiting areas, two GP consulting rooms and the practice nurse’s treatment room. The practice is close to public transport and there is on street parking nearby.

Three GPs work at the practice, one male and two female. Together they provide up to 10 clinical sessions a week. A part time practice nurse (who was also an independent prescriber) and part time healthcare assistant each work 12 hours per week. There is a full time practice manager and medical administrator and five part time receptionist staff.

The practice’s opening times are:

• 8.00am to 6.30pm on Monday and Friday

• 8.00am to 7.30pm on Tuesday (additional capacity scheme)

• 8.00am to 8.30pm Wednesday (extended hours scheme)

• 8.00am to 2.00pm on Thursday

Outside these times patients are directed to a GP out of hour’s service.

GP consulting hours are:

• 10.00am to 12.00pm and 4.00pm to 6.30pm on Monday and Friday

• 10.00am to 12.00pm and 4.00pm to 7.30pm on Tuesday

• 10.00am to 12.00pm and 4.00pm to 8.30pm on Wednesday

• 10.00am to 12.00pm on Thursday

Dr. Abul Kashem Mohammed Zakaria is registered with the Care Quality Commission to carry on the following regulated activities at 50 Upper Road, Plaistow, London E13 0DH: Treatment of disease, disorder or injury and Surgical procedures.

The practice was previously inspected on 17 November 2016. This inspection was a follow up to earlier inspections carried out on 17 June 2015 where the practice was placed in special measures for six months and 25 February 2016 where it remained in special measures for a further six months. The overall rating for the practice was inadequate and the practice remained in special measures for a period of six months and was served with a warning notice. There was a further focussed inspection on the 31st March 2017 where the practice provided evidence that they had complied with the warning notice, they remained in special measures.

Updated 12 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Abul Kashem Mohammed Zakaria on 17 November 2016. This inspection was a follow up to earlier inspections carried out on 17 June 2015 where the practice was placed in special measures for six months and 25 February 2016 where it remained in special measures for a further six months. The overall rating for the practice was inadequate and the practice remained in special measures for a period of six months and was served with a warning notice. There was a further focussed inspection on the 31 March 2017 where the practice provided evidence that they had complied with the warning notice, they remained in special measures. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Abul Kashem Mohammed Zakaria on our website at www.cqc.org.uk.

Some of the issues found were;

• The practice did not ensure processes were in place to maintain complete records in respect of each patient, including a record of the care and treatment provided and of decisions taken in relation to the care and treatment provided.
• The practice did not ensure the proper and safe management of medicines.
• The practice did not have an effective system for recording action taken on patient safety alerts.
• The practice did not have arrangements for the identification and support of carers amongst its patient list.
• The practice failed to provide appropriate information about the complaints process, advocacy help and routes for escalation.

As a result of this inspection the practice had enlisted help from the General Medical Council (GMC) who monitored the consultation notes; they had also implemented the NHS England support for vulnerable GP practices programme action plan which provided support and advice for practices.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 14 September 2017. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

• Data from the 2017 national GP patient survey showed patients rated the practice lower than others for some aspects of care, for example, 27% (previously 31%) of patients said that they usually wait 15 minutes or less after their appointment time to be seen compared to the CCG average of 50% and the national average of 64%.
• 55% (previously 63%) of patients described their experience of making an appointment as good compared with the CCG average of 62% and the national average of 73%.
• Patient records were looked at and there was considerable improvement in how they were completed, including recording of the care and treatment provided and of decisions taken in relation to the care and treatment provided.
• Patients on high risk medicines such as methotrexate and warfarin were well managed with documented blood testing and monitoring. There was a good policy for high risk medicines.
• Safety alerts were recorded and the assistant practice manager highlighted these to relevant staff who signed the log book to confirm that they had read it and record any action taken.
• The practice had identified 62 patients as carers (2% of the practice list) and they had a designated member of staff who acted as a carers champion, they also held quarterly carers meetings. They sign posted carers to local support groups.
• The practice had a complaints and comments leaflet which outlined the reporting process, where to get advocacy help and routes for escalation.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect, but they could be more involved in planning and making decisions about their care and treatment.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• Although the results are improving the practice should continue to assess, monitor and improve the access to and satisfaction with appointments in view of the low National GP patient survey results.
• Improving the uptake of the bowel screening programme.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 2018

The practice is rated as requires improvement for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 89% compared to the CCG average 80% and the national average of 78%.
• The practice ran diabetes clinics every week with the GP and the practice nurse ran pre-diabetes, chronic obstructive pulmonary disease (COPD) and Asthma clinics.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care

Updated 12 January 2018

The practice is rated as requires improvement for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
• Immunisation rates were comparable to local averages for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 12 January 2018

The practice is rated as requires improvement for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Where older patients had complex needs, the practice shared summary care records with local care services, the practice hosted Multi-Disciplinary Meetings (MDT) on the first Tuesday of every month.

Updated 12 January 2018

The practice is rated as requires improvement for the care of working age people (including those recently retired and students).

• The practice offered extended opening hours on Wednesday evenings.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice had developed its own dedicated website for patients.
• The practice offered telephone consultations.
• NHS health checks were available for this group.

Updated 12 January 2018

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.
• All of the three patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national averages of 87%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia by giving all mental health patients an annual review.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months was 100% compared to the CCG average of 81% and the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 12 January 2018

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.