Archived: Dr MSN Ahmed & Dr MB Ahmed Also known as Bradford Road Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Butt and partner on 25 August 2015. Overall the practice is rated as inadequate. However, we recognised that there have been considerable efforts to make improvements to the service in recent months. The practice is improving but there is still some work to do to reach the required standards in some areas.

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

• Staff were clear about reporting incidents, near misses and concerns and there was evidence of learning and communication with staff.
• Arrangements to safeguard adults and children from abuse were not adequate in relation to staff training, clarity of lead roles and identification of patients considered to be at risk. Arrangements to provide chaperones for patients were in place but staff had not received training.
• Risks to patients and others were higher than necessary as systems to assess, monitor and mitigate risks, such as, policies, procedures, and appropriate training had not been provided for all staff.
• There were procedures for the management of medicines in the practice. However, there were some shortfalls in the processes to ensure the safe storage and transport of vaccines.
• Recruitment arrangements did not include all necessary employment checks for staff in that there was no process to check nurse registration to practice was current and there was no evidence in staff files that ongoing checks had been made routinely. There were no formal induction processes for new or locum staff.
• Staff had received role specific training to improve and extend services for patients. However, they had not received training such as health and safety including fire safety, basic life support, safeguarding vulnerable adults and children and infection prevention and control.
• Non-clinical staff received regular supervision and support but there was no process for practice nurses to receive clinical supervision.
• Data showed patient outcomes were average for the locality. Audits were driving improvement in some areas of prescribing practice to reduce costs but there was no evidence audits were used to improve patient outcomes.
• Clinical records were not always adequately maintained.
• The practice had received support from the CCG and had implemented initiatives to improve care for patients and they had significantly increased the number of NHS health checks performed.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice had developed a ‘Carer’s Champion’ role to support carer’s by offering health checks and referral for social services support.
• There were some services provided for patients to meet needs such as interpreter services and information in different languages. However, there was limited access for patients with a disability and/or wheelchair users. Services and adaptations for the visually or hearing impaired were not provided. Work to build a new bespoke building was due to commence and was scheduled be completed by March 2016.
• The practice had listened to patients and had made improvements to the appointment system. Patients said they were satisfied with the appointment system and told us urgent appointments were usually available on the day they were requested.
• Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
• The practice had a leadership structure but limited formal governance arrangements.
• The practice did not have a written set of aims and objectives or improvement plan. There was no maintenance programme for the building.
• The practice acted on feedback from patients and had focused on improving the patient experience of the services provided. However, there were limited systems in place to monitor the quality of services provided.
• Records, such as patient records, training and recruitment records and health and safety monitoring records, were not always adequately maintained to ensure effective management of the practice.

The provider must make improvements in the following areas:

• Ensure systems and processes are in place to assess, monitor and mitigate risks to patient’s and others health and safety. For example, policies and procedures, staff training and risk assessments in areas such as fire safety and infection prevention and control.
• Ensure the safe storage and transport of vaccines.
• Ensure induction processes are in place for new and locum staff.
• Ensure staff receive training relevant to their role such as, health and safety including fire safety, basic life support, safeguarding vulnerable adults and children and infection prevention and control.
• Ensure practice nurses work is supervised.
• Adequately maintain clinical records.
• Ensure systems are in place to assess monitor and improve the quality and safety of the services provided.
• Ensure records used for the management of the practice are accurate, up to date and where required, held securely.

The areas where the provider should make improvement are:

• Not all staff had received safeguarding vulnerable adults and children training. Patients considered to be at risk had not been identified through the use of risk registers and system alerts.

• Staff had not received chaperone training.
• There was no process to check nurse registration to practice was current and there was no evidence in staff files that ongoing checks had been made routinely.
• There was limited access for the disabled and/or wheelchair users and services and adaptations for the visually or hearing impaired were not provided.
• There was no maintenance programme for the building.
• The practice had not developed a patient participation group (PPG).

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice