The Care Quality Commission
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Archived: Dr Tahir Haffiz Also known as Barnsbury Medical Practice

Overall: Requires improvement read more about inspection ratings

Bingfield Primary Care Centre, 8 Bingfield Street, London, N1 0AL (020) 7700 9700

Provided and run by:
Dr Tahir Haffiz

All Inspections

30 October 2019

During a routine inspection

We carried out an announced comprehensive re-inspection of Dr Tahir Haffiz’s practice on 30 October 2019, to follow up concerns noted at past inspections.

We have rated this practice as Requires improvement overall and for providing an Effective, Responsive and Well-led service. We have rated it as Good for a Safe and Caring service. We rated the practice as Requires improvement in relation to the six patient population groups.

We had inspected the practice previously in May 2018 and January 2019.

In May 2018 we had rated the service as Inadequate for providing an Effective and Well-led service; Requires Improvement for providing a Safe and Responsive service; Good for providing a Caring service and consequently as Inadequate overall. The service was placed in special measures to give people who use the service the reassurance that the care they get should improve.

At our inspection in January 2019 we noted some improvements and revised some of the ratings: Inadequate for providing an Effective service; Requires Improvement for providing a Responsive and Well-led service; and Good for providing a Safe and Caring service. The overall rating for the service was revised to Requires Improvement, but it remained in special measures.

Our previous inspection reports can be found by going to https://www.cqc.org.uk/location/1-485343677 and selecting the Reports tab.

For this inspection, we based our judgement of the quality of care at this practice on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations

We have again rated this practice as Good for providing a Safe service because:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • There was an effective system for reporting and recording significant events.
  • The practice learned and made improvements when things went wrong.
  • Staff had the information they needed to deliver safe care and treatment to patients.

We have rated the practice as Requires improvement for providing an Effective service because:

At our inspection in January 2019, we rated the practice as Inadequate for providing an Effective service. We found that although the practice had taken positive action in a number of areas, the Quality Outcomes Framework (QOF) scores for 2017 / 18 showed some clinical indicators remained significantly below local and national averages. We saw that positive action had been taken to identify and implement improvement since our previous inspection in May 2018, but this had yet to have a significant impact. At this inspection we noted further action had been taken by the practice to improve performance and have revised the rating to Requires improvement.

  • The practice had taken further action to improve clinical performance by appointing additional nursing staff and increasing GP’s clinical sessions, which was likely to have a positive impact on the effectiveness of the service.
  • The QOF results for the year 2018 / 19, although remaining below average, showed an improvement in the practice’s performance over time with a reduction in exception reporting.
  • The practice’s performance in relation to caring for patients with diabetes remained low, together with its results for cervical screening and childhood immunisations.
  • There was improved monitoring of the outcomes of care and treatment. However, the provider was not familiar with revised best practice guidance relating to the monitoring process of patients prescribed Direct Oral Anticoagulants, dated June 2019.
  • The practice was able to show that all staff had the skills, knowledge and experience to carry out their roles.

We have again rated the practice as Good for providing a Caring service because:

  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice proactively identified carers and supported them.
  • Staff understood patients’ personal, cultural, social and religious needs.
  • The practice gave patients timely support and information.

We have again rated the practice as Requires improvement for providing a Responsive service because:

At our inspection in January 2019, we rated the practice as ‘Requires improvement’ for providing a Responsive service. We found the provider had taken some action to address past concerns with regard to planning and providing services to meet the needs of the local population. However, patient survey results continued to identify patient dissatisfaction with accessing the service. At this inspection, we have again rated the practice as Requires improvement.

  • We noted further action taken by the practice, but this has not been sufficient to bring about the required improvement to patient outcomes.
  • The results of the latest GP Patient Survey show some fluctuation, but most remained below local and national averages, in some cases significantly so.
  • The practice had appointed extra nursing staff and was providing more nurse appointments throughout the week. A female GP had been appointed and GPs’ weekly clinical sessions were to increase from 10 to 12 the week following our inspection.
  • Feedback from patients at the inspection and via comments cards was generally positive regarding action taken by the practice regarding access and in relation to it providing a responsive service.

We have again rated the practice as Requires improvement for providing a Well-led service because:

At our inspection in January 2019, we rated the practice as ‘Requires improvement’ for providing a Well-led service. We found the provider had taken some action to address previous concerns, but further improvement was still needed. The practice’s systems and processes for improving clinical indicators for patients had not been embedded and Quality and Outcomes Framework (QOF) scores for some clinical indicators remained significantly below local and national averages. In addition, a review of practice policies and protocols was ongoing. At this inspection, we have again rated the practice as Requires improvement.

  • Although further action had been taken since our last inspection, it had not yet been fully effective to bring about the necessary improvements to performance and patients’ outcomes. The changes made remain to be fully embedded and should be monitored to ensure they bring about improvement.
  • Some processes should be formalised by implementing formal written policies. These include a system to ensure correspondence was dealt with speedily and effectively in the absence of the provider, and in relation to monitoring the care of older patients discharged from hospital and for following up patients experiencing poor mental health who failed to collect prescriptions for long term medication. During the factual accuracy process, the issue relating to correspondence was addressed by the provider.

The areas where the practice must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, to bring about the necessary improvement in clinical performance and patient outcomes and to sustain the improvement.

(Please see the specific details on action required at the end of this report).

The areas where the practice should make improvements are:

  • Maintain complete and accurate records of staff training on sepsis awareness.
  • Maintain a full range of easy read and pictorial healthcare guidance materials for patient with learning disabilities.

I am taking the practice out of special measures in recognition of the improvements made since our previous inspections. However, further improvement is required in relation to the practice providing effective and well-led services and regarding the care provided to People with long-term conditions, Families, children and young people and Working age people (including those recently retired and students).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

16 January 2019

During a routine inspection

We carried out an announced comprehensive re-inspection at Dr Tahir Haffiz, Barnsbury Medical Practice, on 16 January 2019. At this inspection we followed up on breaches of regulations identified at a previous inspection on 30 May 2018. At the 30 May 2018 inspection the practice was rated ‘Requires Improvement’ for providing a Safe and Responsive service; ‘Inadequate’ for providing an Effective and Well Led service; ‘Good’ for providing a Caring service and rated ‘Inadequate’ overall. Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published.

A copy of our previous inspection report can be found by going to https://www.cqc.org.uk/location/1-485343677 and selecting the Reports tab.

We have rated this practice as ‘Requires Improvement’ overall.

At the last inspection on 30 May 2018 we rated the practice as ‘Requires Improvement’ for providing Safe services because:

  • Systems to keep patients safe and safeguarded from abuse were not effective.
  • Recruitment systems were not effective.
  • There was no management oversight of clinical staff training.
  • Systems to share learning were not effective.

At this inspection, we found the provider had satisfactorily addressed these areas. We have rated this practice as ‘Good’ for providing Safe services because:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • There was an effective system for reporting and recording significant events.
  • The practice learned and made improvements when things went wrong.
  • Staff had the information they needed to deliver safe care and treatment to patients.
  • The arrangements for managing medicines in the practice helped keep patients safe.

At the last inspection on 30 May 2018 we rated the practice as ‘Inadequate’ for providing Effective services because:

  • The practice had no assurance that clinical staff members had completed clinical updates.
  • There was no system to monitor the process for seeking consent.
  • Although there had been improvement in QOF further improvement was still necessary.
  • Cytology uptake was below the local and national averages.

At this inspection we have again rated this practice as ‘Inadequate’ for providing Effective services because:

  • We found that although the practice had taken positive action in a number of areas, the Quality Outcomes Framework (QOF) scores for some clinical indicators remained significantly below local and national averages.
  • We noted that positive action had been taken to identify and implement improvement since our last inspection but this had yet to have a significant impact.

At our previous inspection on 30 May 2018 we rated the practice as ‘Good’ for providing Caring services. At this inspection we have continued to rate the practice as ‘Good’ for providing Caring services because:

  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice proactively identified carers and supported them.
  • Staff understood patients’ personal, cultural, social and religious needs.
  • The practice gave patients timely support and information.

At our last inspection on 30 May 2018 we rated the practice as ‘Requires Improvement’ for providing a Responsive service because:

  • Arrangements in respect of planning and providing services to meet the needs of the local population and appointment timings needed improving.

At this inspection, we found the provider had taken some action to address these areas however, patient survey results continued to identify patient dissatisfaction with accessing the service. We have again rated the practice as ‘Requires Improvement’ for providing a Responsive service because:

  • Patients were not always able to access care and treatment from the practice within an acceptable timescale for their needs.
  • The practice organised and delivered services to meet patients’ needs and had changed its working practices. The practice was no longer closed at lunchtimes and was open until 6.30pm as opposed to 6.00pm in order to improve patient access; and plans were in place to recruit a Healthcare Assistant and increase the nursing hours offered at the practice.

At our last inspection on 30 May 2018 we rated the practice as ‘Inadequate’ for providing a Well Led service because:

  • Leaders did not all have the capacity or knowledge to monitor and govern activity.
  • There was no documented vision or strategy to achieve goals.
  • Not all staff members knew how to access practice polices and were not confident with their content.
  • There were no processes to identify and act on future risks.
  • Equality and diversity was not actively promoted.

At this inspection, we found the provider had taken positive action to address these areas, however improvements were still required. We have rated the practice as ‘Requires Improvement’ for providing a Well Led service because:

  • The practice’s systems and processes for improving clinical indicators for patients had not been embedded and Quality and Outcomes Framework (QOF) scores for some clinical indicators remained significantly below local and national averages.
  • The review of practice policies and protocols was ongoing.

The areas where the provider must make improvements are:

  • Develop and embed effective systems and processes to improve the quality of care and outcomes for patients.

In addition to the areas which were identified for improvement under the key questions of providing effective and well-led services relating to that inspection, we also said the practice should make improvements in the following area:

  • Ensure the action plan developed as a result of the infection prevention and control audit is updated and documented when action points have been reviewed.
  • Appoint a deputy safeguarding lead and ensure this member of staff is trained to safeguarding child protection Level 3.
  • Ensure spirometry results are directly transcribed from the spirometry machine rather than manually entered into patient records.
  • Monitor and audit the prescribing of controlled drugs.
  • Develop an audit process to monitor clinicians are seeking consent for patients appropriately.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, its staff, patients, the public and other organisations.

We have rated this practice as ‘Requires Improvement’ overall and ‘Requires Improvement’ for all population groups.

This service remains in special measures. Where a service is rated as Inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as Inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 varying the terms of their registration within six months if they do not improve.

The service 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.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

30/05/2018

During a routine inspection

This practice is rated as inadequate overall. (Previous inspection 10 2017 – Inadequate)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Dr Tahir Haffiz on 30 May 2018 to follow up on breaches of regulations identified in a previous inspection on 10 October 2017. There were breaches in infection control, emergency processes, quality improvement and safety systems. The full comprehensive report from the inspection on 10 October 2017 can be found by selecting the ‘all reports’ link for Dr Tahir Haffiz on our website at .

A focussed inspection was carried out on 26 February 2018, this inspection was not rated and took place to ensure the practice was complying with the breaches in regulations as identified by the warning notices they were issued in their previous inspection. This report can be found by selecting the ‘all reports’ link for Dr Tahir Haffiz on our website at . This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection in May 2018 we found:

  • Processes to keep patients safe and safeguarded from abuse were not effective.
  • Systems for learning from significant events and complaints were not effective.
  • Not all staff members knew how to access practice policies and procedures which were saved on the practices computer system.
  • There was no comprehensive management oversight of clinical training and training updates.
  • Information required to prescribe high risk medicines was not effectively documented.
  • Learning and changes made as a result of patient safety alerts were not effectively shared with all relevant staff members.
  • There were flaws in recruitment processes; references and evidence of membership with a professional body were not always obtained.
  • Although the practice demonstrated improvement in the Quality and Outcomes Framework (QOF) further improvements were required to bring the practice in line with local and national averages.
  • Low cytology uptake had not been adequately addressed.
  • There was no documented vision and values with a strategy to address them.
  • Portable appliance testing was out of date.
  • There was evidence of quality improvement including a completed clinical audit cycle.
  • Emergency equipment was routinely checked to ensure it was in date and fit for use.
  • Childhood immunisation rates were above the 90% national targets.

The areas where the provider must make improvements as they are in breach of regulations are:

  • 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.

The areas where the provider should make improvements are:

  • Ensure systems are in place to improve cytology uptake.
  • Consider ways to improve confidentiality at the reception desk.
  • Review the practices recruitment processes to ensure legal requirements are being met.

The service 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 remove this location or cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

26 February 2018

During an inspection looking at part of the service

We had previously carried out an announced comprehensive inspection of Dr Tahir Haffiz’s practice, known as the Barnsbury Medical Practice, on 10 October 2017. We rated the practice as inadequate and it was placed in special measures with effect from 14 December 2017. We identified concerns over governance at the practice and served a warning notice under regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also served a requirement notice under regulation 12, relating to safety at the practice, due to concerns over sharing learning from significant events and cleaning and safety checks. The report of the comprehensive inspection can be found by selecting the ‘reports’ link for the practice on our website at http://www.cqc.org.uk/location/1-485343677. Following the inspection, the practice sent us a plan of the action it intended to take to meet the requirements of the regulation.

We carried out this focussed inspection on 26 February 2018, to review the practice’s action plan, looking at the identified breaches set out in the warning notice, under the key question Well-led and at the issues relating to safety at the practice. We found that the practice had made some improvements sufficient for us to withdraw the warning notice. However, further improvement needs to be made in relation to clinical performance and it needs to be sustained. Up to date Quality and Outcomes Framework (QOF) data showed improved performance, but also increased exception reporting, which was above average and was a concern. Accordingly, we have served a further requirement notice, under regulation 9. We found that the requirement notice served under regulation 12 in relation to safety at the practice had been met.

We have not reviewed the ratings for the key questions or for the practice overall. We will consider the practice’s ratings when we carry out a full comprehensive inspection at the end of the period of special measures.

Our key findings were as follows:

  • The practice had taken appropriate action in relation to monitoring general cleaning, the cleaning of medical equipment, and safety checks of emergency equipment and medication, so that care was delivered in a safe way.
  • The practice had introduced systems to ensure that significant events and safety alerts were reviewed and appropriately actioned.
  • Relevant and current evidence-based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines, were reviewed and discussed at clinical meetings.
  • There was evidence that clinical performance had improved, but at the date of the inspection there was a significant increase in QOF exception reporting.

There were areas of practice where the provider needs to make improvements. Importantly, the provider must:

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

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

10 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We previously inspected Dr Tahir Haffiz’s practice, known as the Barnsbury Medical Practice, in April 2015. We rated the practice as good overall and requires improvement for providing effective services. This was because published data showed that patient outcomes were below local and national averages.

We carried out this announced comprehensive inspection on 10 October 2017. Overall the practice is now rated as inadequate.

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

  • The delivery of high quality care is not assured by the leadership, governance and culture in place.
  • Data from the Quality and Outcomes Framework showed patient outcomes were significantly below local and national averages and had not improved. There were no detailed or realistic plans in place to bring about improvement.
  • Patient feedback indicated there were frequent delays with appointments.
  • Although risks to patients were assessed, the systems to address these risks were not implemented well enough to ensure patients were kept safe.
  • There were shortfalls in planning and providing services to meet the needs of the local population.
  • There was insufficient evidence that learning from significant events and other relevant information was shared appropriately.
  • There was a limited programme of clinical audit to drive improvement.

The areas where the practice must make improvement are:

  • Ensure care and treatment is provided in a safe way to patients. For example, by sharing with all staff learning from significant events, safety alerts and clinical guidance; maintaining cleaning logs and records of safety checks.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For example, systems and processes to assess, monitor and improve the quality and safety of the services provided.

The areas were the practice should make improvement are:

  • Inform patients of the availability of chaperones and translation services.
  • Review the current system to ensure that all staff members receive annual appraisals.
  • Review the current system of recording clinical and practice meetings, so that relevant information is shared appropriately.
  • Record verbal as well as written complaints.
  • Consider how patients who wish to see a female practitioner at the practice can do so.
  • Establish a process to contact patients who do not attend for their cervical screening test.

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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

22 April 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on the 22nd April 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Data showed that some patient outcomes were below average for the locality.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it 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 were areas of practice where the provider needs to make improvements.

The provider should

  • Continue in its efforts to engage with patients and improve the uptake of annual reviews, health checks and screening for eligible patients to improve patient outcomes.
  • Make arrangements to enable patients to book appointments and order repeat prescriptions online, via the practice website.
  • Continue with plans to re-establish regular meetings of the patient participation group, to help gather feedback and comments from patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice