The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Ijaz Hayat Also known as Hayat Medical Centre

Overall: Inadequate read more about inspection ratings

273 Boundary Road, Walthamstow, London, E17 8NE (020) 8521 7086

Provided and run by:
Dr Ijaz Hayat

All Inspections

17 June 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of this practice in October 2014 where we found the practice to be inadequate for providing safe, effective, caring, responsive and well-led services. It was also inadequate for providing services for the care provided to older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia). You can view the full report by selecting the 'all reports' link for Hayat Medical Centre on our website at www.cqc.org.uk

We undertook this focussed inspection on 17 June 2015 to check that the provider had made improvements and now met legal requirements. This report only covers our findings in relation to those requirements.

We found some minor improvements had been made:

  • Staff had attended child protection and adult safeguarding training
  • Staff had been trained to carry out chaperone duties
  • Suitable arrangements were in place to ensure medicines were appropriately stored and that fridge temperatures were recorded in line with recognised guidance.

However, we found that overall the practice was still providing inadequate care that was not safe, caring, effective, responsive or well-led.

We found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulations breached were:

  • Regulation 7 – Requirements relating to registered managers
  • Regulation 17 – Good governance
  • Regulation 12 – Safe Care and treatment
  • Regulation 18 – Staffing
  • Regulation 15 – Premises and equipment
  • Regulation 16- Receiving and acting on complaints

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

  • The practice had no clear leadership structure and limited formal governance arrangements.
  • Suitable arrangements for leadership, training and implementation of effective infection control measures were not in place
  • There were no systems in place to manage risk, including procedures and audit to monitor effective risk assessment of any actions that had been taken to mitigate the risks
  • Clinical audit cycles were not completed undertaken.
  • There were no systems to ensure that patients received treatment and care relevant to their condition, including routine reviews of patients with long term conditions.
  • Appropriate arrangements were not in place to respond to medical emergencies
  • Patients receiving repeat prescriptions were not regularly reviewed by the GP
  • There were no arrangements in place for working with other health and social care professionals to ensure patients with complex needs or priority conditions were discussed and appropriate action taken
  • Patients felt they were not able to make or participate in decisions relating to their care or treatment.
  • Recruitment checks were not carried out for all staff prior to employment.
  • Staff were not appropriately trained, supervised and appraised.
  • There were no arrangements in place for annual testing of electrical equipment.
  • There were no systems in place to audit, manage, respond to and learn from incidents, complaints and occasions when things went wrong

If the provider had continued to be registered with the Care Quality Commission, the provider would have been placed into special measures. The areas where the provider must have made improvements are:

  • Put in place systems to audit, manage, respond to and learn from incidents, complaints and occasions when things go wrong.
  • Ensure that recruitment checks are carried out for all staff prior to employment.
  • Ensure that patients receiving repeat prescriptions are regularly reviewed by the GP.
  • Make suitable arrangements for leadership, training and implementation of effective infection control measures.
  • Ensure arrangements are in place for annual testing of all electrical equipment.
  • Ensure appropriate arrangements are in place to respond to emergencies.
  • Put in place systems to ensure that patients receive the treatment and care relevant to their condition, including routine reviews of patients with long term conditions.
  • Ensure that all staff are appropriately trained, supervised and appraised.
  • Put in place systems to manage risk, including procedures and audit to monitor effective assessment and implementation of actions identified.
  • Ensure audit cycles are undertaken.
  • Implement clear leadership structures and ensure staff are made aware of governance arrangements.
  • Ensure patients are enabled to make or participate in decisions relating to their care or treatment.
  • Make suitable arrangements for working with other health and social care professionals to ensure patients with complex needs or priority conditions are discussed, and agreed appropriate action taken

We believed that there was a serious risk to patients’ lives, health or wellbeing so we took immediate enforcement action. The registration of Dr Hayat to provide Diagnostic and Screening Procedures and Treatment of Disease Disorder or Injury, at this location, was cancelled with immediate effect by an order of the Court on 19th June 2015.

As part of this action CQC liaised with NHS England to ensure measures were put in place to provide support, care and treatment for the patients affected by this closure. Patients previously registered with Hayat Medical Centre were transferred to another local practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

22nd and 23rd October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Hayat Medical Centre on 22 and 23 October 2014. In addition to asking the five questions the inspection followed up on serious concerns highlighted at previous inspections. Overall the practice is rated as inadequate.

Specifically, we found the practice to be inadequate for providing safe, effective, caring, responsive and well-led services.  It was also inadequate for providing services for the care provided to older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. Staff were not clear about reporting incidents, near misses and concerns and there was no processes in place to learn from significant events.
  • Data showed that care and treatment was not delivered in line with recognised professional standards and guidelines.
  • We found treatment and care of patients was variable and patients were not satisfied with the overall quality of care and support offered by the practice from both clinical and non-clinical staff.
  • The practice failed to engage with commissioners and other agencies to improve its services and promote the care and welfare of patients.
  • Access to the surgery by telephone and wait times for appointments were poor and patients reported delays in being seen for booked appointments.
  • There was no clear leadership structure and administrative and governance systems were significantly lacking. 
  •   Staff were not clear about their responsibilities and did not feel supported by management.
  • There were areas of practice where the provider needs to make improvements

Importantly, the provider must:

  • Make suitable arrangements for training relevant staff in safeguarding and child protection.
  • Put in place systems to audit, manage, respond to and learn from incidents, complaints and occasions when things go wrong.
  • Ensure that patients records kept securely and can be located promptly when required.
  • Ensure that recruitment checks are carried out for all staff prior to employment
  • Ensure that any staff that carry out chaperone responsibilities have been trained and can evidence a satisfactory DBS disclosure.
  • Ensure that patients receiving repeat prescriptions are regularly reviewed by the GP.
  • Ensure that prescription forms are handled in accordance with national guidance and stored safely.
  • Make suitable arrangements to ensure medicines are appropriately stored and that  fridge temperatures are taken and recorded in line with recognised guidance. 
  • Make suitable arrangements for leadership, training and implementation of effective infection control measures.
  • Ensure arrangements are in place for annual testing of all electrical equipment.
  • Ensure appropriate arrangements are in place to respond to emergencies.
  • Put in place systems to ensure that patients receive the treatment and care relevant to their condition, including routine reviews of patients with long term conditions.
  • Ensure that all staff are appropriately trained, supervised and appraised.
  • Put in place systems to manage risk, including procedures and audit to monitor effective assessment and implementation of actions identified.
  • Ensure audit cycles are undertaken.
  • Implement clear leadership structures and ensure staff are made aware of governance arrangements.
  • Ensure patients are enabled to make or participate in decisions relating to their care or treatment.

In addition the provider should:

  • Make suitable arrangements for working with other health and social care professionals to ensure patients with complex needs or priority conditions are discussed, and agreed appropriate action taken.
  • Make appropriate arrangements in place to protect patients privacy and dignity.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

21 March 2014

During an inspection looking at part of the service

At the inspections carried out in October 2013 we asked the provider to implement changes as we had concerns regarding safeguarding, training of staff and the complaints system. The provider sent us an action plan of steps they intended to take to address these issues by February 2014. This was a follow-up inspection to check if the issues had been effectively dealt with and also to look at further areas of the practice.

Care and treatment did not always ensure patients' safety and welfare. We found evidence which indicated unauthorised and unqualified staff were carrying out patient assessments and ineffective systems to monitor patients based on their latest test results.

Staff still had a limited understanding of safeguarding and the acting clinical safeguarding lead had not undergone training in the safeguarding of vulnerable adults. Staff recruitment and selection processes were inadequate. We found that staff did receive appropriate professional development.

At this inspection we found that there was sufficiently detailed information on the noticeboard in the patient waiting area which explained how to make a complaint.

Patients' medical records were not accurate and fit for purpose. There was a significant failure in the medical record database which meant that some documents attached to patient records were not able to be accessed by healthcare staff. We found medical records and had missing information and anomalies in what was recorded.

11 February 2014

During an inspection in response to concerns

We carried out this inspection of Hayat Medical Centre in response to serious concerns we had received about the practice. At our last inspections we found that patients were not able to access care and treatment in a timely manner. They found it was not easy to book appointments and obtain follow-up results of medical tests that had been carried out. Despite the fact that the surgery had introduced a new appointments system, we found that this was still the case. The provider needs to review the number of GPs or the number of appointments available in order to provide an adequate service to patients.

People's health, safety and welfare was not protected when they moved to another healthcare provider because significant information was missing from their patient records. The provider did not work in cooperation with the integrated care services team because they no longer had regular meetings to discuss and coordinate the care of patients with long term medical conditions.

During the last inspection we found that although there had been a problem with repeat prescriptions not being ready on time, this situation had improved. However, this improvement had not been sustained and we found that there were again delays with patients getting repeat prescriptions on time.

We found there was still no effective quality assurance system in place which identified, assessed and managed risks to the health, safety and welfare of the people who used the service and others.

3, 13 January 2014

During an inspection looking at part of the service

At our inspections of Hayat Medical Practice in October 2013 we identified that patients were not able to easily access the service and did not experience care, treatment and support which met their needs. We found that repeat prescriptions were not ready when people needed them. There was no clinical governance of the practice because the provider had been suspended by the General Medical Council (GMC) and was unable to take decisions in relation to the care and treatment of patients. There was no overall system to identify, assess, monitor and manage risks to the health, safety and welfare of patients.

We judged that this had a moderate impact on patients who used the service and we served three warning notices on the provider in November 2013, relating to patient care and welfare, management of medicines and systems to assess and monitor the quality of service provision.

We carried out follow up inspections on 3 and 13 January 2014 to check compliance with these warning notices and found that the provider was still not compliant with two of the three warning notices. We found that the provider had made some improvements and was now compliant with regard to the management of medicines. However, patients were still at risk of receiving unsafe or inappropriate care. No person had been appointed to clinically govern the practice and there were no systems in place to identify, assess and manage health, welfare and safety risks to the patients.

23, 24, 31 October 2013

During a routine inspection

Hayat Medical Centre was a GP practice run by Dr I Hayat as an individual provider. Due to the provider's recent suspension by the General Medical Council he was unable to practice as a GP or to take decisions in relation to the care and treatment of patients. This meant that locum doctors who all worked on a part-time basis were employed to attend surgery sessions and cover the clinical work of the practice.

People who use the service had access to some information and support regarding their care or treatment. One person told us that when they saw the doctor 'I feel that I am respected and listened to.'

We found that patients could not reasonably access the service. People told us 'my biggest frustration is trying to get an appointment. You can be holding on for as long as 30 minutes before someone answers' and "it's hard to get an appointment". Patients' treatment plans and examination records had not always been fully recorded.

Staff had not received formal training in safeguarding vulnerable adults and children. When we spoke to staff we found their knowledge and awareness of this issue was limited.

The arrangements in place for patients to obtain their repeat medicines were not safe or appropriate. Patients had been without their medicines for a period of time before they were able to get their prescriptions.

There was no overall plan to regularly assess and monitor the quality of care and treatment of the patients.