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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Dr Abul Kashem Mohammed Zakaria on 17 November 2016. Overall the practice is rated as inadequate.

This inspection was a follow up to earlier inspections carried out on 17 June 2015 and 25 February 2016.

Following the inspection on 17 June 2015 the practice was rated inadequate overall and placed in special measures. There were breaches in legal requirements relating to the provision of safe and well-led services and these key questions were rated inadequate. Effective was rated requires improvement because there were no completed clinical audits. Caring and responsive were rated good. After the inspection the provider submitted an action plan detailing how it would make improvements and when the practice would be meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Following the inspection on 25 February 2016, which we carried out to consider whether sufficient improvements had been made and to identify if the provider was now meeting legal requirements and associated regulations, the practice was rated requires improvement overall and remained in special measures. The provider had made improvements; however there continued to be a breach in the legal requirement relating to the provision of well-led services in the areas of medical record keeping and clinical audit, and this key question was rated inadequate. Safe, effective, caring, and responsive were rated requires improvement. After the inspection the provider submitted an action plan detailing how it would make further improvements and when the practice would be meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At our inspection on 17 November 2016 we found some further improvement had been made, however there continued to be shortfalls in medical record keeping and we also found medicines were not always properly and safely managed. The provider had enlisted external help and support to enable it to strengthen leadership and governance and to address shortcomings in medical record keeping. An action plan was in place and progress was being made. However, until processes to maintain complete medical records were embedded people were at high risk of avoidable harm; and until effective governance and performance management arrangements are embedded, the delivery of high–quality person-centred care cannot be assured.

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

• There continued to be shortcomings in medical record keeping and we found shortfalls in prescribing practice.
• National GP patient survey results showed patients rated the practice lower than others for aspect of care and access to the service. The provider had a patient survey action plan to address this but was not checking that the plan was working.
• Improvements were made to the quality of care as a result of complaints and concerns, however, information about alternatives to complaining to the provider, or about taking a complaint further was not readily available.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment, and further training was ongoing as required.
• The provider had enlisted external help and support from NHS England and the Royal College of General Practitioners (RCGP) to strengthen leadership and governance, and progress was being made on an action plan to address skills deficits and embed practice processes.
• Staff felt supported and enthused to make changes to improve patient care. The practice proactively sought feedback from staff and patients, which it acted on.
• There was an open and transparent approach to safety and a system was in place for reporting and recording significant events.
• The provider had increased the number of appointments available, and was promoting the uptake of online booking to make it easier for patients to make an appointment.
• Patients said there was continuity of care, with urgent appointments available the same day. Patients were pleased that a female GP was working at the practice.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Action was being taken to strengthen leadership capacity and governance arrangements.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure processes are in place to maintain a complete record 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.

• Ensure the proper and safe management of medicines.

The areas where the provider should make improvement are:

• Continue to implement the NHS England Support for Vulnerable GP Practices Programme action plan.

• Review the practice’s system for recording action taken on patient safety alerts.

• Review arrangements for the identification and support of carers amongst its patient list.

• Provide appropriate information about the complaints process, advocacy help and routes for escalation.

This service was placed in special measures in August 2015 and for a second period following our inspection on 25 February 2016. Following our most recent inspection on 17 November 2016 insufficient improvements have been made such that there remain ratings of inadequate for safe and well-led. The service remains in special measures and will be inspected again within three months, and if there is not enough improvement we will move to close the service. The service will be kept under review and if needed could be escalated to urgent enforcement action.

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 follow-up inspection of Dr Abul Kashem Mohammed Zakaria on 25 February 2016. Overall the practice is rated as requires improvement.

This inspection was a follow-up to our earlier inspection on 17 June 2015 when the practice was rated inadequate overall. There were breaches in legal requirements relating to the provision of safe and well-led services and these key questions were rated inadequate. Effective was rated requires improvement because there were no completed clinical audits. The practice was placed into special measures in August 2015. Subsequent to this the provider submitted an action plan detailing how it would make improvements and when the practice would be meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At our inspection on 25 February 2016 we found the provider had made improvements, however further improvements are required in the areas of medical record keeping in particular and clinical audit.

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

• There was an open and transparent approach to safety and a system was in place for reporting, recording and learning from significant events. The provider did not have policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour, however.
• Risks to patients were assessed and well managed, with the exception of those relating to medical record keeping.
• Data showed patient outcomes were comparable with national averages.
• Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. However, national GP patient survey results showed comparatively few felt they were treated with care and concern and there was no action plan in place to improve the results.
• Most patients said they were able to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available the same day.
• Arrangements to access a female GP were limited. The provider had attempted to recruit a female GP to work at the practice but had not been successful.
• Information about services and how to complain was available and easy to understand however no complaints had been recorded at the practice in the last 12 months.
• 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.
• A governance framework was in place although processes to maintain a complete medical record in respect of each patient’s treatment and care, and systems to drive improvement in patient outcomes were not embedded.

The areas where the provider must make improvements are:

• Ensure a complete record is maintained for each patient of the care and treatment provided to them.

• Ensure adequate systems are in place that effectively assess, monitor and improve the quality of care provided and patient outcomes.

The areas where the provider should make improvement are:

• Put in place policy and procedures to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.
• Take action to address the national GP patient survey results published in January 2016 where the practice was significantly below the national average. The percentage of respondents saying the GP and nurse were good at treating them with care and concern was low.
• Review access to a female GP for patients at the practice.
• Review the complaints procedure to ensure that patient complaints are captured and the practice learns from these.

The practice was placed into special measures in August 2015. While improvements have been made since then, the practice continues to be rated as inadequate for one of the five key questions and so remains in special measures for a further six months. 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice