Archived: Dr Hasmukhrai Makanji

Updated 14 July 2017

The Dr Hasmukhrai Makanji surgery is located in Burnt Oak, London Borough of Barnet, North London in a purpose built medical centre. The Dr Hasmukhrai Makanji surgery was formally placed in Special Measures on 28 July 2016. In November 2016, we were advised by NHS England that the two partner GPs from a local practice (Mulberry Medical Practice) would be joining to support the delivery of Dr Makanji’s NHS contract and that Dr Makanji would be retiring on 31 December 2016. We were also advised that Dr Makanji would be applying to cancel his CQC registration. On 1 January 2017, the two partner GPs from Mulberry Medical Practice assumed NHS contractual responsibilities.

Mulberry Medical Practice is based approximately one mile away and also operates from two branch locations; one of which is based in the same medical centre as the Dr Hasmukhrai Makanji surgery. We were advised that the Dr Hasmukhrai Makanji surgery’s patient list and NHS contract are separate from that of Mulberry Medical Practice.

The Dr Hasmukhrai Makanji surgery has a patient list of approximately 2,500 patients. Twenty five percent of patients are aged under 18 (compared to the national practice average of 21%) and 8% are 65 or older (compared to the national practice average of 17%). Forty five percent of patients have a long-standing health condition. 

The services provided by the practice include child health care, ante and post natal care, immunisations, sexual health and contraception advice and management of long term conditions.

The provider holds a personal medical services contract with NHS England. 

The current staff team comprises two partner GPs (one male, one female), one female long term GP locum, one part time male clinical pharmacist, one female part time practice nurse, a practice manager and administrative/reception staff. We were told that this was an interim staffing arrangement which was subject to review and change.

The practice’s opening hours are:

• Monday-Friday: 8:15am-1pm and 2pm-6.30pm

  Appointments are available at the following times:

• Monday: 9:30am-12pm and 3:30pm-5:30pm

• Tuesday: 9:30am-12pm and 3pm-6pm

• Wednesday: 09:30am - 12:00pm and 3pm-6pm

• Thursday: 9:30am-12:30pm and 3pm-6:30pm

• Friday: 9:30am-12pm and 3pm-6:30pm

The practice offers extended hours opening at the following times:

• Wednesday: 6:30pm-7:00pm

• Patients are also able to access extended opening appointments on Monday and Tuesday evenings from the supporting GPs’ main practice and one their two branch locations.

Outside of these times, cover is provided by out of hours provider Barndoc Healthcare Limited. 

At the time of our inspection Mulberry Medical Practice was in the process of applying to add the location to its CQC registration.

Updated 14 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hasmukhrai Makanji on 3 March 2016 . During the inspection we identified a range of concerns including an absence of systems in place to keep patients safe and missed opportunities to use the learning from significant events to support improvement. ( The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Hasmukhrai Makanji on our website at www.cqc.org.uk).  

The practice was rated as requires improvement for providing caring and responsive services and was rated as inadequate for providing safe, effective and well led services. Overall the practice was rated as inadequate.

Following the publication of the inspection report in July 2016, the practice was placed in special measures for a period of six months. In November 2016, we were advised by NHS England that two GPs from a local practice (Mulberry Medical Practice) would be joining and supporting the delivery of Dr Makanji’s NHS contract; and that Dr Makanji would be retiring on 31 December 2016. We were also advised that Dr Makanji would be applying to cancel his CQC registration.

Following the period of special measures, an announced comprehensive inspection was undertaken on 26 January 2017. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

• The supporting GPs had reviewed past failings and introduced clearly defined systems to minimise risks to patient safety. For example, since 1 January 2017, infection prevention and control audit, a health and safety risk assessment and a fire safety risk assessment had taken place.

• Although we saw some evidence of quality improvement activity, we did not see evidence of an overall quality improvement plan to drive and monitor improvements in patient outcomes.

• The supporting GPs had started to implement systems and protocols to monitor the effective delivery of high-quality person-centred care but it was too early to assess the results.

• We saw some evidence of actions taken to improve low satisfaction regarding how patients were involved in decisions about their care, the extent to which they were listened to and also regarding the helpfulness of reception staff.

• We observed staff to be compassionate and patients told us they were treated with dignity and respect.

• New protocols had been introduced to ensure that learning from significant events was shared and used to improve the service.

• Most patients told us it was easy to make an appointment with a named GP and that there was continuity of care with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management.

• Information about services and about how to complain were available.

• The supporting GPs demonstrated an understanding of the requirements of the duty of candour (for example its complaints policy referenced the importance of supporting complainants and of apologising when things went wrong).   

  There was also an area of practice where the provider must make improvements:    

• Ensure that there are appropriate arrangements in place to assess, monitor and improve the quality and safety of the services provided.

Importantly, the provider should also:

• Introduce cleaning schedules in accordance with the outcomes of the supporting GPs’ recent infection prevention and control audit.

• Introduce a fire evacuation plan including details of how staff will support patients with mobility problems to vacate the premises.

• Ensure that the use of chaperones is routinely recorded on the practice’s clinical system.

• Ensure that copies of the practice’s business continuity plan are kept off site.

• Monitor the impact of recent activity aimed at improving satisfaction with how patients were involved in decisions about their care, regarding the extent to which they felt they were listened to and also regarding the helpfulness of reception staff.

• Review systems in place to identify and provide support to carers.

     

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 14 July 2017

The practice is rated as requires improvement for the care of people with long-term conditions.

The provider was rated as requires improvement for providing effective, caring and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Unverified QOF data provided by the practice indicated that patient outcomes for diabetic care had improved in the period since the supporting GPs had joined the practice. For example, as of 26 January 2017, 84% of patients with diabetes had had a foot examination in the previous 12 months, compared with 82% as of 31 December 2016. We also noted that as of 26 January 2017 84% of patients with diabetes had a blood pressure reading which was in the required range compared with 81% as of 31 December 2016.   

• All these patients had a named GP and for those patients with the most complex needs, the supporting GPs told us that the named GP would be working with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 14 July 2017

The practice is rated as requires improvement for the care of families, children and young people.

The provider was rated as requires improvement for providing effective, caring and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Childhood immunisations were carried out in line with the national childhood vaccination programme. For example, unverified data we were shown on the day of the inspection indicated that rates for the vaccines given to under two year olds ranged from 84% to 91% and that performance for five year olds was 79%.

• Patients fed back to us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 14 July 2017

The practice is rated as requires improvement for the care of older people.

The provider was rated as requires improvement for providing effective, caring and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Updated 14 July 2017

The practice is rated as requires improvement for the care of working age people (including those recently retired and students).

The provider was rated as requires improvement for providing effective, caring and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The needs of this population group had been identified and the supporting GPs had recently adjusted the services offered, to ensure that they were accessible. For example, extended opening on Monday and Tuesday evenings from the supporting GPs’ main practice and one of its branch locations.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 14 July 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).

The provider was rated as requires improvement for providing effective, caring and well led services. The issues identified as requiring improvement overall affected all patients including this population group.

• 55% of patients experiencing poor mental health had an agreed care plan documented in the record (as of 26 January 2017) .

• The practice planned to regularly work with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 July 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable.

The provider was rated as requires improvement for providing effective, caring and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

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

• 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.

• When we spoke with reception staff they recognised the important role they played in recognising possible signs of abuse in children, young people and adults whose circumstances may make them vulnerable; and in forwarding this information to clinical staff. All staff with whom we spoke 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.