Archived: Dr Sharif Hossain

Updated 9 November 2017

Dr Sharif Hossain was part of Southwark Clinical Commissioning Group and served approximately 5000 patients. The practice was registered with the CQC for the following regulated activities Diagnostic and screening procedures, Family planning, Maternity and midwifery services and Treatment of disease, disorder or injury.

The practice was located within an area ranked within the second most deprived decile on the Index of Multiple deprivation. The practice had a slightly higher than average proportion of working aged patients and a significantly lower proportion of patients aged over 55 compared to the national average. The practice had almost double the level of deprivation affecting children and triple the level of deprivation affecting older people.

The practice was run by one GP principal. The practice team also included one male salaried GP and two long term locums who were male and female. The practice had four nurses. The practice offered 22 GP sessions per week with booked and emergency appointments five days per week.

At our last inspection the practice told us that they had a 1500 patient increase in the previous 18 months as a result of increased registration and the absorption of patients from a neighbouring practice which had recently been closed.

The practice was open between 8am and 7pm Monday to Friday, with the exception of Monday when the practice closed at 8pm. Dr Sharif Hossain operated from Lister Primary Care Centre, London, Southwark SE15 5LJ, which were purpose built premises rented and maintained by NHS Property Services. The health centre also hosted three other GP practices as well as other services including the district nursing team and a benefits advisory service. The practice was accessible for patients with mobility difficulties.

Practice patients were directed to contact the local out of hours provider when the surgery was closed.

The practice operated under a Personal Medical Services (PMS) contract, and was signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These were: extended hours access, facilitating timely diagnosis and support for people with dementia, improving patient online access, learning disabilities, minor surgery, patient participation, rotavirus and shingles immunisation, unplanned admissions, NHS health check, smoking cessation, holistic assessments, integrated case management, ambulatory blood pressure monitoring and population health management quality standards.

The practice was part of the GP Federation Improving Health Limited.

Updated 9 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Sharif Hossain on 22 September 2016. The overall rating for the practice was inadequate and the service was placed in special measures for a period of six months. The full comprehensive report from the inspection undertaken on 22 September 2016 can be found by selecting the ‘all reports’ link for Dr Sharif Hossain on our website at www.cqc.org.uk.

As a result of our findings from this inspection CQC issued a requirement notice for the identified breaches of Regulations 12, 18 and 19 and a warning notice for Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Specifically we found concerns related to: the processes for identification and management of significant events, the practice’s safeguarding processes, management of risks associated with infection control and fire safety, not all staff had received an internal appraisal within the previous 12 months, not all staff had completed the requisite essential training, the practice were not undertaking a regular check of staffs’ professional registrations and recruitment checks did not ensure patients were kept safe.

We also issued a requirement notice in respect of breaches in regulation 13 of CQC (Registration) Regulations 2009: the practice did not have adequate indemnity insurance in place for their nursing staff.

This inspection was undertaken within six months of the publication of the last inspection report as the practice was rated as inadequate and placed in special measures. This was an announced comprehensive inspection completed on 8 August 2017. Overall the practice is still rated as inadequate.

The concerns identified on the day of the inspection included:

• There was no effective system in place for the dissemination of patient safety alerts and no evidence that all alerts were reviewed and acted upon.
• There was no effective system in place for recording and storing controlled medicines.
• There was no effective system in place for ensuring that pathology results were reviewed actioned and archived into patient records.
• There was no effective system in place to monitor patients who were referred for urgent assessment and diagnosis.
• There was no effective system in place for recalling patients with long term conditions who required regular reviews or for those who required periodic reviews of their medication including those on high risk medicines.
• The practice was not following current clinical guidance and best practice.
• The practice did not keep an accurate, complete and contemporaneous account or record of the care provided for all patients.
• There was a failure to assess and take action in response to various risks including those related to fire safety.

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

• There were inconsistent accounts of the system in place for recording significant events and not all events had been documented. The practice policy for significant events was from another practice.
• Systems for mitigating risks associated with infection control were not clear or effective.
• Staff did not have the all the requisite training skills and knowledge to deliver effective care and treatment. For example some staff did not have a record of child safeguarding training and there was no evidence that clinical updates had been completed for all staff that administered immunisations and took samples for cervical screening.
• Results from the national GP patient survey indicated patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. However, both feedback from staff on the day and patient survey data indicated that some patients were unhappy with the attitude of the reception team.
• Information about how to complain was available. We found that some of the health promotion information in the reception area was out of date.
• Some patients we spoke with said they found it difficult to make an appointment at a convenient time or with their preferred GP. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was an absence of clear leadership in key areas. For example the management of patient safety alerts. Although staff told us they felt supported by management, we were told that staff had only recently been given contracts of employment with legal terms and conditions. We were told that the practice PPG was not currently active.
• The provider was aware of the requirements of the duty of candour.

Had the provider’s registration not been cancelled, we would have set out the following list of ‘musts’ for their action:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences

• Ensure care and treatment is provided in a safe way to patients

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

• 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.

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

We made a successful application to Camberwell Magistrate’s Court on 10 August 2017 to urgently cancel the provider’s registration under section 30 of The Health and Social Care Act 2008 on the basis that there were several breaches of the 2014 Regulations which presented serious risks to people's life, health or well-being. The provider was referred to the appropriate professional organisations and a caretaker organisation took over the management of the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 9 November 2017

The practice is rated as inadequate for providing safe, effective and well-led services and requires improvement for the provision of caring and responsive services leading to the practice being rated as inadequate overall. The issues identified impact on the care provided to this population group.

• Reviews of the patient record system raised serious concerns about the practice’s ability to identify those patients with long term conditions and questions around the quality and efficacy of the care provided. For example there were instances where patients were not correctly coded on the system limiting the practice’s ability to identify and provide the required care to those with chronic or long term illnesses. We saw patients who were not receiving regular tests and assessments required to ensure effective management of their condition; including patients on high risk medicines.

• Data indicators designed to measure the practice’s management of patients with long term conditions were mostly in line with local and national averages. However the review of records called into to question the accuracy of this data. For example there were instances of diagnostic assessments being recorded on the clinical system without any evidence of tests having been completed in secondary care. We also found instances where patients were noted as requiring medicine to enable them to manage their condition safely. In several instances we found that despite this medicine having not been issued for prolonged periods of time, clinicians had placed entries on the clinical system noting that patients had good compliance.

• Care planning was limited for patients with long term conditions. This had been identified by The Royal College of General Practitioners (RCGP) as an area where clinicians required additional training. Clinicians had completed one of three recommended courses.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP.

• There was limited evidence of effective multidisciplinary working.

Updated 9 November 2017

The practice is rated as inadequate for providing safe, effective and well-led services and requires improvement for the provision of caring and responsive services leading to the practice being rated as inadequate overall. The issues identified impact on the care provided to this population group.

• We were told that there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk however we did not see any examples of this.

• Immunisation rates were relatively high 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. We found the female toilets where the baby changing facilities were located were dirty.

• There was limited evidence of working with health visitors. We were told that the practice provided 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 9 November 2017

The practice is rated as inadequate for providing safe, effective and well-led services and requires improvement for the provision of caring and responsive services leading to the practice being rated as inadequate overall. The issues identified impact on the care provided to this population group.

• Though staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns although we noted that none of the nursing staff had any safeguarding training on file.

• The practice offered home visits and urgent appointments for those with enhanced needs and staff provided older vulnerable patients with their personal telephone number but there was no policy around remote advice no evidence of staff being trained to provide advice remotely.

• The systems around the management of palliative care patients indicated that patients who required end of life care were not referred at an early stage to local palliative care services. Discussions with the local palliative care teams did not demonstrate discussion of specific patients with palliative care needs. We were told that the latest meeting with the palliative care team had resulted in the practice reviewing their palliative care register and identifying five further patients who required end of life support but had not been referred.

• Staff at the practice had only recently begun completing care plans for patients but this was limited to those will palliative care needs.

• Health promotional advice in area was available in the reception area but we saw that some of this was out of date.

Updated 9 November 2017

The practice is rated as inadequate for providing safe, effective and well-led services and requires improvement for the provision of caring and responsive services leading to the practice being rated as inadequate overall. The issues identified impact on the care provided to this population group.

• The practice offered extended opening hours and telephone consultations. However some patient feedback indicated that access to appointments was an issue and that appointments were often not at convenient times and not with their preferred clinician.

• The practice did not have a website therefore there was no mechanism for the practice to provide online health promotion and screening information. Some of the literature in the waiting area was also out of date.

Updated 9 November 2017

The practice is rated as inadequate for providing safe, effective and well-led services and requires improvement for the provision of caring and responsive services leading to the practice being rated as inadequate overall. The issues identified impact on the care provided to this population group.

• 78% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%. Other mental health indicators were higher than local and national averages. However anomalies from a records review raised uncertainty about the accuracy of this data and whether care planning had been put in place.

• Records indicated that the practice’s system for monitoring repeat prescribing including for patients receiving medicines for mental health needs was ineffective and did not ensure patients received their medicine or ensure that regular reviews were undertaken for those on high risk medicines.

• There was little evidence of multi-disciplinary working in the case management of patients experiencing poor mental health, including those living with dementia.

• Some of the information in the practice waiting area available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations was out of date. The practice had no website which enabled patients to access information about local support services.

Updated 9 November 2017

The practice is rated as inadequate for providing safe, effective and well-led services and requires improvement for the provision of caring and responsive services leading to the practice being rated as inadequate overall. The issues identified impact on the care provided to this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. However issues identified with coding of patient records and recent reviews of patient records after multidisciplinary meetings suggested that this may not have been accurate or not used effectively.

• Homeless people were able to register at the practice.

• The practice offered longer appointments for patients with a learning disability.

• There was limited evidence that 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 though some of this information in the waiting area was several years old.

• 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. However, we saw no evidence of any safeguarding referrals and there was no evidence of safeguarding training for some staff.