8 August 2017
During a routine inspection
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:
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Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences
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Ensure care and treatment is provided in a safe way to patients
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Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
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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.
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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