9 January 2017
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Rashid Kadhim on 10 May 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rashid Kadhim on our website at www.cqc.org.uk.
This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 9 January 2017. Overall the practice remains rated as Inadequate.
Our key findings were as follows:
- A programme of continuous clinical and internal audit to monitor quality and to make improvements had been commenced however audits had not yet been completed therefore it was not possible to determine what, if any, improvements to patient care had occurred as a result.
- The practice was still in the process of developing an overarching governance framework to support the delivery of the strategy and good quality care. We saw that structures and procedures had been put into place; however, there was insufficient evidence to indicate that the improvements made were substantial enough or sustainable.
- The practice did not offer online appointment booking although it was working to resolve this. It did provide electronic repeat prescriptions.
- The practice provided a nurse for just one day each week which impacted on patient access as it limited the day they could attend. The nurse offered appointments up to 5pm on alternate weeks to accommodate working people and school age children. Following the inspection the practice told us that the local extended primary care service also offered weekend nursing appointments which were available to this practice and bookable in advance.
- Record keeping in general had significantly improved; however, there were still some gaps identified – for example equipment cleaning, staff files and GP call backs to patients.
- The practice had an up to date fire risk assessment and carried out regular fire drills and monthly testing of fire alarms. We noted that the fire risk assessment had highlighted a considerable number of areas of concern. We were told that the practice was taking steps to address these; however, these actions had not been documented.
- Neither the cleaner, who handled clinical waste bags, nor the lead GP had up to date hepatitis B immunisation.
- Data from the Quality and Outcomes Framework (QOF) showed patient outcomes had improved since the inspection in May 2016, but were still 3% below the CCG average and 4% below the England average.
- Childhood immunisation rates for the vaccinations given to two year olds were between 3% and 21% below the 90% national target.
- Almost all of the 46 patient Care Quality Commission comment cards we received were positive about the service experienced; however, some commented on areas they felt needed to be improved. Predominant amongst these comments was the need to reduce the waiting time once patients had arrived for their appointment. This was reiterated by patients we spoke with on the day, who also commented on the need for more clinical staff and the difficulty in getting an appointment with a female doctor.
- Data from the 2016 national GP patient survey published in July 2016 showed patients rated the practice substantially lower than others for some aspects of care including how well the GP listened; how much time they gave them and how well the GP explained tests and treatment. Patients’ satisfaction with how they could access care and treatment were also, in many instances, considerably below local and national averages even though some had improved from the data published in January 2016.
- Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. We saw that meetings now took place with other health care professionals on a regular basis.
- There was now a system in place for reporting and recording significant events.
- Lessons were shared to make sure action was taken to improve safety in the practice.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- The practice had recently appointed a salaried GP although this had not led to an increase in GP capacity as the number of locum sessions had reduced since our May 2016 inspection.
- Information about how to complain was available. The practice now maintained a complaints log. This had been updated to include three complaints from early 2016, but there had not been any complaints since then so we were unable to assess how well the new system had been embedded.
- Since the last inspection the practice had put a recruitment policy and procedure into place.
There were areas of practice where the provider needs to make improvements.
Importantly, the provider must:
- Ensure there are an adequate number of practice nurse sessions so as to meet patient demand.
- Demonstrate there is an effective quality improvement programme in place, for example two cycle, completed audits.
- Ensure accurate records are maintained in relation to, for example, fire safety, cleaning of clinical equipment, staff records and the action taken in regard to GP call backs to patients.
- Provide patients with access to online booking.
- Monitor the practice performance and its adherence to guidance; and take action on evidence of poor or deteriorating performance, and to improve performance.
In addition the provider should:
- Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
- Enable staff, where appropriate, to obtain hepatitis B immunisation.
- Revise the chaperone policy, and continue to review the practice’s policies and procedures.
- Ensure that locum GPs are provided with information relevant to working at this practice.
- Continue to review the staffing levels at the practice, particularly with regard to the availability of a practice nurse, so that the needs of the practice patient list can be met.
- Review and implement strategies to improve the practice child immunisation performance.
- Continue to develop a governance framework to enable recent improvements to be sustained.
- Continue to review the outcomes of the national patient survey and implement measures to improve the patient experience.
- Monitor the punctuality of appointments and patient waiting times.
- Monitor that people who express a preference get adequate access to a GP of the gender of their preference.
- Consider developing a practice website and a practice leaflet.
This service was placed in special measures in July 2016. Insufficient improvements have been made such that there remains a rating of inadequate for caring, responsive and well led. The service will therefore remain in special measures and kept under review. 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.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice