The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr UA Afser & Dr A Arif 's Practice

Overall: Requires improvement read more about inspection ratings

620 Longbridge Road, Goodmayes, Dagenham, Essex, RM8 2AJ (020) 3668 7497

Provided and run by:
Dr UA Afser & Dr A Arif 's Practice

Important: The provider of this service changed. See new profile

All Inspections

19 April 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr UA Afser and Dr A Arif’s Practice on 21 April 2016 and rated the practice as inadequate for the safe and well-led key questions, requires improvement for effective and responsive, and good for caring. This led to an overall rating of inadequate. Breaches of legal requirements were found and requirement notices were issued in relation to patient safety, inadequate governance and staffing. The provider was placed into special measures and the full comprehensive report can be found by selecting the ‘all reports’ link for Dr UA Afser and Dr A Arif’s Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection which we undertook on 19 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 21 April 2016. At this inspection we found that the requirements of the requirement notices had been met; however, a new requirement notice has been issued as we found that the arrangements for managing high risk medicines needed strengthening to keep patients safe. This has resulted in a rating of requires improvement for the safe key question. The overall rating from this visit was requires improvement.

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

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

  • The arrangements for managing high risk medicines such as warfarin and methotrexate in the practice needed significant strengthening.

  • The practice now had appropriate arrangements for identifying, recording and managing risks, issues he practice now had up to date fire risk assessment and carried out regular fire drills.

  • The practice did not deploy sufficient numbers of clinical staff to meet the needs of patients, for example, the clinical staff which included the GP, a practice nurse and a nurse prescriber worked a total of 11 clinical sessions per week.

  • The practice had updated policies, including incident policy and recruitment. All policies were practice specific and all staff had access to them on the practice computer system.

  • 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.
  • We saw clinical audits had been carried out to show patient and quality improvements.
  • Information about services and how to complain was available and improvements were made to the quality of care as a result of complaints and concerns.

  • Patients did not have access to a female GP; however, the practice told us that a female salaried GP working one session was due to commence employment in May 2017.

  • Results from the national GP patient survey highlighted concerns from patients about long waiting times and delays to appointments.

  • 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 and had systems to ensure compliance with the requirements of the duty of candour.

However, there were also areas of practice where the provider needs to make improvements.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance of high risks medicines in accordance with the fundamental standards of care.

  • Establish effective systems to improve and monitor access to appointments and waiting times as highlighted in the national GP patient survey so that it is comparable to CCG and national survey results.

  • Establish systems and processes to continually assess the needs of the service.

The areas where the provider should make improvements are:

  • Continue to ensure policies such as significant event are up to date and reflect day to day practice.

  • Review the nursing services so that they are provided in a way that meets the needs of the patient groups, particularly those unable to attend during normal opening hours.

  • Consider ways of improving access to services, for example, the provision of a website.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Thursday 21 April 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr UA Afser & Dr A Arif 's Practice on Thursday 21 April 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, there was no fire risk assessment and the fire alarm was not working on the day of inspection and the fire extinguishers had expired their servicing date. A Legionella risk assessment had not been carried out, there was no portable appliance testing conducted and improvements identified in an infection control audit carried out in 2015 had not been actioned.
  • Data showed patient outcomes were comparable to the national average. Although one audit had been carried out, we saw no evidence that audits were driving continuous improvements to patient outcomes.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity. However, patients told us appointment systems were not working well and waiting times were long.
  • Information about services was available but not everybody would be able to understand or access it. For example, the complaints procedure was in English and therefore not all patients would understand what to do.
  • The practice had a number of policies and procedures to govern activity. However the practice business continuity plan did not include a staff list or contact details.
  • Staff were clear about reporting incidents, near misses and concerns and staff told us outcomes and learning was shared at practice meetings.

The areas where the provider must make improvements are:

  • Ensure risk to patients and assessments and managed and improvements identified are implemented and actioned, including, Legionella, electrical safety, fire risks and infection control.
  • Ensure recruitment arrangements include all necessary employment checks for all staff to comply with Schedule 3 requirements, including carrying out a risk assessment for Disclosure and Barring Service (DBS) checks for staff.
  • Implement a programme of continuous improvement including audits to show improvements in patient outcomes.
  • Ensure systems are in place to keep all staff up to date with role specific training, including training in safeguarding, fire and annual basic life support, and ensure appropriate records are kept.
  • Ensure a risk assessment is carried out for managing medical emergencies if there is no defibrillator in the practice.
  • Ensure there are arrangements for managing medicines, including Patient Group Directions (PGDs) are adopted by the practice and the proper storage of medicines and an effective system to track blank prescriptions.

The areas where the provider should make improvement are:

  • Improve processes for making appointments.
  • Review systems to identify carers in the practice to ensure they receive appropriate care and support.
  • Make information more available to those with limited English.
  • The provider should review arrangements for patients to access a female GP and review the number of practice nurse sessions available.
  • Review the complaints system to be in line with the national complaints guidance.

I am placing this service in special measures. Services 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 service 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 remove this location or cancel the provider’s registration.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice