Archived: Peel Precinct Surgery

Updated 9 June 2020

Dr Abubakr Shaikh is an individual GP who provides NHS primary care services through a General Medical Services (GMS) contract from Peel Precinct Surgery located at Carlton House, Canterbury Terrace, London, NW6 5DX to approximately 1170 patients in the Kilburn area of Brent in North West London. The practice is part of NHS Brent Clinical Commissioning Group (CCG).

The provider is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder or injury, maternity and midwifery services, family planning and surgical procedures. Following our inspection on 29 May 2019, we suspended the provider’s CQC registration, having identified significant concerns, which put patients’ safety at risk. The period of suspension was from 1 June 2019 to 14 November 2019. At an announced, unrated, follow-up inspection undertaken on 5 November 2019 we further extended the practice suspension from 15 November until 2 May 2020.

At the time of our desk-based inspection on 16 April 2020, there was no patient activity at the provider’s location. Following the suspension on 1 June 2019, the provider’s patient list was transferred a caretaker practice put in place by NHSE (London) commissioners to provide the service. This caretaker arrangement remains in place.

The practice serves a multi-ethnic mix of population who have varied socio-cultural and religious needs. The information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

Updated 9 June 2020

We carried out an announced comprehensive inspection at Dr Abubakr Shaikh (Peel Precinct Surgery) on 5 November 2014. The overall rating for the practice was requires improvement.

We carried out an announced comprehensive inspection on 31 March 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. In addition, we issued a warning notice to the provider in respect of safe care and treatment and informed them that they must become complaint with the law by 15 July 2016.

We carried out an announced comprehensive inspection on 8 December 2016 following the period of special measures. Overall the practice remained rated as inadequate as they had not met the requirements of the warning notice and, as a result, further enforcement action was taken in respect of safe care and treatment and good governance.

We carried out an unannounced focused inspection on 4 July 2017 to follow-up on the warning notice and to check that the necessary improvements had been made, or whether further enforcement action was required. At the inspection we found significant improvements had been made to prevent enforcement action although we still found continuing areas of non-compliance in respect of safe care and treatment and good governance.

We carried out an announced comprehensive inspection on 14 December 2017 to review in detail the actions taken by the practice since our December 2016 and July 2017 inspections to improve the quality of care and to confirm that the practice was now meeting legal requirements. At the inspection, we found further improvements had been made and the practice were rated good overall. However, we still found continuing areas of non-compliance in respect of good governance. The practice was taken out of special measures.

The full comprehensive reports on the November 2014, March and December 2016 inspections, the focused follow-up inspection in July 2017 and the comprehensive inspection report of December 2017 can be found by selecting the ‘all reports’ link for Dr Abubakr Shaikh on our website at .

This inspection, carried out on 29 May 2019, was an announced comprehensive inspection to follow-up on the breaches of regulation identified at our previous inspection on 14 December 2017. In addition, the practice moved location in August 2018 and failed to inform and submit registration paperwork to CQC until prompted. Completed paperwork was received in December 2018 and the new location, registered as Peel Precinct Surgery, was inspected by the registration team in March 2019 and formally registered.

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 the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The provider did not have clear systems and processes in place to keep patients safe and safeguarded from abuse.
• The provider did not carry out recruitment checks in accordance with regulations.
• The provider had not addressed the findings of some premises risk assessments.
• The provider did not have a process in place to ensure electronic patient-related correspondence was reviewed and actioned in a timely manner.
• The provider did not have systems and processes in place to monitor and safety-net urgent two-week wait referrals.
• The provider did not have systems and processes in place to manage and monitor cervical smear screening.
• The provider did not have a consistent process for monitoring patients’ health in relation to the use of high-risk medicines prior to prescribing.
• The provider did not monitor the prescribing of controlled drugs, for example, investigation of unusual prescribing, quantities, dose, formulations and strength.
• The provider had not taken steps to ensure appropriate antimicrobial use to optimise patient outcomes and reduce the risk of adverse events and antimicrobial resistance.
• The provider did not have effective systems in place to ensure that safety alerts were appropriately actioned.

We rated the practice as inadequate for providing effective services because:

• There was no effective process in place to ensure that clinicians were aware of relevant and current evidence-based guidance and standards and were practising in line with guidance.
• There was limited monitoring of the outcomes of care and treatment. The provider did not have a systematic process in place for patient recall.
• The provider was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.

These areas affected all population groups, so we rated all population groups as inadequate.

We rated the practice as inadequate for providing responsive services because:

• The practice was unable to demonstrate the responsive and proactive identification and management of vulnerable patients such as homeless and drug-dependant patients.
• The provider could not demonstrate that care was consistently delivered and coordinated with other services, including multi-disciplinary reviews, for some patient population groups.
• Patients were unable to access the surgery in person during normal core working hours of 8am to 8.30am.
• Feedback from patients was positive about accessing care and treatment in a timely way.

These areas affected all population groups, so we rated all population groups as inadequate.

We rated the practice as inadequate for providing well-led services because:

• The provider could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The overall governance arrangements were ineffective.
• The provider did not have clear and effective processes for managing risks, issues and performance.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

We rated the practice as good for providing caring services because:

• Staff treated patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people.
• Staff helped patients to be involved in decisions about care and treatment.
• The practice respected patients’ privacy and dignity.

The areas where the provider 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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed and specified information is available regarding each person employed.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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.

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

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Updated 6 August 2019

Updated 6 August 2019

Updated 6 August 2019

Updated 6 August 2019

Updated 6 August 2019

Updated 6 August 2019