Dr Yousef Rashid Also known as Shifa Medical Practice

We carried out an announced comprehensive inspection at Dr Yousef Rashid also known as Shifa Medical Practice on 30 January 2019 and rated the practice as requires improvement for the key question of responsive, good for the key question of caring and inadequate for the key questions of safe, effective and well-led. This led to an overall rating of inadequate and the service was placed in special measures.

Breaches of regulatory requirements were found, and requirement and warning notices were issued in relation to patient safety, good governance and staffing issues.

The reports of all the previous inspections can be found by selecting the ‘all reports’ link for Dr Yousef Rashid on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection which we undertook on 23 September 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 30 January 2019.

This report covers our findings in relation to those requirements. We found that there had been improvement since our last comprehensive inspection in January 2019. These improvements included an increase in staffing, better awareness, understanding and compliance in relation to issues that could affect patient safety and, finally an improvement in the way the provider was using governance to deliver efficient services at this location.

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, patients and the public.

We have now rated this provider as requires improvement overall.

We rated the practice as good for providing caring and responsive services because:

• The provider provided care in a way that treated patients with dignity and respect.
• The provider supported carers registered at the practice through providing seasonal vaccines and signposting them to appropriate organisations.
• GP patient survey results were comparable to local and national averages.

We rated this provider as requires improvement for safe and well-led services because:-

• The provider had improved some record keeping but not sufficiently in relation to the monitoring of patients who had been prescribed high-risk medication.
• Childhood immunisation rates were below the national target in three out of the four indicators.
• The provider had increased staffing through the recruitment of new administration staff and a part-time practice manager, however it was too early to fully assess any positive impact on services provided.
• The nursing provision at provider was not sufficient to address the need of the population groups.
• The practice had a vision but the vision was not supported by a credible strategy.
• Governance arrangements had improved evidence through updated policies and procedures, however it was too early to fully assess any positive impact on services provided.

We rated this provider as inadequate for effective services because:-

• Uptake rates for the cervical screening programme were below the national target.
• Childhood immunisation rates were below the national target in three out of the four indicators.
• The practice did not have embedded recall systems in place for cytology and childhood immunisations to ensure that patients were followed up when they did not attend the practice when invited to.
• The nursing provision at provider was not sufficient to address the needs of some of the population groups.

These areas affected all population groups, so we rated all population groups as requires improvement.

The areas where the provider must make improvements are:-

• Ensure care and treatment is provide in a safe way to patients.
• Ensure effective systems and processes to ensure good governance in accordance.

The areas where the provider should make improvements are:-

• To provide training to administrative staff regarding the signs of sepsis.
• To identify whether the premises landlord has conducted a recent security risk assessment.
• To obtain and retain multi-disciplinary team meeting minutes.

This service will remain in special measures. Services 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.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Dr Yousef Rashid is a provider registered with CQC.

We carried out an inspection of the provider on 14 May 2019 to follow up concerns raised at our inspection on 30 January 2019.

At the inspection in January 2019 we found that:

• Patients on high-risk medication were not having appropriate monitoring completed in line with guidelines for safe prescribing and we found that the system for reviewing uncollected prescriptions was not effective.
• Systems for staff training, appraisal and recruitment were not effective.
• Emergency medicines were not all stored correctly, in date and the practice did not have all recommended emergency medicines or a risk assessment which explained their absence.
• Equipment had not been PAT tested or calibrated.
• Patient records were not always updated with information from secondary care services after discharge.
• The practice had not effectively monitored and made significant improvements in diabetes, HbA1c performance.
• The practice did not maintain an at-risk register for vulnerable adults and children. In addition, there was no process in place to identify carers.
• Governance systems were lacking. For example; practice policies had not been reviewed since 2016, verbal complaints remained unrecorded, staff were not aware of a clear governance structure and the practice did not hold regular practice meetings that were minuted.
• The practice did not have a programme in place to monitor quality improvements and subsequently make improvements.

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, patients, the public and other organisations.

At this inspection we found that:

• Systems for monitoring patients prescribed high risk medicines continued to be not safe or effective.
• Emergency medicines were checked and in date and the practice’s box of uncollected prescriptions was regularly reviewed.
• Hospital discharges reviewed showed that the practice was taking appropriate action in response to requests from other health services.
• Data for 2019/20 indicated that performance against targets for diabetes had improved year to date but that the proportion of the patient list identified as having diabetes had reduced considerably.
• A programme of clinical audit had been considered but not yet initiated.
• Governance arrangements had improved as there was a up to date policy framework in place covering most areas of operation; including systems to record verbal complaints yet some newly appointed staff were unclear about leadership roles. Regular practice meeting had also been initiated.
• Recruitment, training and appraisal processes had improved and the practice were in the process of setting up systems to oversee staff training.
• Risks associated with the premises had been assessed and had either been addressed or were in the process of being addressed.
• The practice had identified those with caring responsibilities and adults who were vulnerable. However, the practice had not identified any at-risk children on their patient list.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

The areas where the provider should make improvements are:

• Review the practice’s patient list to ensure that those with diabetes and at-risk children are being identified and supported.
• Clarify leadership roles for newly appointed staff working at the practice.
• Continue with work to monitor staff training and upgrade the premises in light of infection control audits.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.

We carried out an announced comprehensive inspection at Dr Yousef Rashid also known as Shifa Medical Practice on 29 December 2017 and rated the practice as requires improvement for the safe, effective and well-led key questions. This led to an overall rating of requires improvement. Breaches of legal requirements were found and requirement notices were issued in relation to patient safety and governance.

The reports of all the previous inspections can be found by selecting the ‘all reports’ link for Dr Yousef Rashid on our website at www.cqc.org.uk.

This inspection was an announced focused inspection which we undertook on 30 January 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 12 December 2017. This report covers our findings in relation to those requirements. We found that there had not been an improvement and the practice is now rated as inadequate overall and has been placed in special measures for a period of six months.

We have rated this practice as inadequate overall.

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, patients and the public.

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

• The practice had still failed to carry out Disclosure and Barring Service (DBS) checks on staff who acted as chaperones.
• Checks of medicines and related equipment stored in the practice were not carried out consistently to ensure that they remained safe and effective. We found some expired medical emergency equipment.
• The practice’s performance remained below local and national averages for management of diabetes.
• Verbal complaints were not formally recorded and we did not see evidence that they had been discussed with staff. The practice did not carry out formal, minuted staff meetings.
• Practice policies had not been updated annually.
• Staff did not have all the required training and recruitment files did not contain the appropriate recruitment checks.
• There was no evidence that the practice nurse had medical indemnity insurance.
• Patient’s medication reviews were not formalised and did not contain the required information.
• There was a lack of governance arrangements to ensure that quality assurance processes were in place which led to improvements in patient outcomes.

The areas where the provider must make improvements 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.
• Ensure that persons employed at the practice have received appropriate training.

(Please see the specific details on action required at the end of this report). Note: Warning notices were issued to the provider following the inspection undertaken on 30 January 2019. This was to ensure that the provider was aware of our concerns and that action was taken quickly to address these concerns and mitigate risks to patients.

Requirement notices were issued for the additional concerns which related to breaches identified. The level of risk stemming from these concerns was not deemed to be sufficient to require additional enforcement action.

The areas where the provider should make improvements are:

• Take steps to improve the uptake of childhood immunisations rates.
• Develop a process aimed at identifying patients with caring responsibilities to be able to provide appropriate support and signposting.
• Review staffing levels at the practice to ensure that there is sufficient capacity to complete all necessary tasks.
• Consider developing a structure for minuted staff meetings to take place, to facilitate lessons learned and improvements to be made.
• Take steps to develop and maintain care plans for patients with learning disabilities.

I am placing this service in special measures. Services 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 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. 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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care