Archived: Dr Zahir Mughal Also known as Mughal Medical Centre

Updated 4 May 2017

Dr Zahir Mughal which is also known locally as Mughal Medical Centre provides services for 4,153 patients and is situated at 55 Ivanhoe Road, Bradford, BD7 3HY.

Dr Zahir Mughal is situated within the Bradford City Clinical Commissioning group (CCG) and provides primary medical services under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

They offer a range of enhanced services such as childhood immunisations, extended hours, and facilitating timely diagnosis and support for people with dementia. The practice also offers the circumcision of male patients.

The National General Practice Profile shows that the age of the practice population is slightly different to the national average with lower numbers of patients aged over 40 and higher numbers of patients aged below 39. This is in common with the characteristics of the Bradford City area. However, the practice also has a higher number of registered patients aged under 14 than the CCG or national average. The profile shows that 63% of the practice population is from a south Asian background with a further 9% of the population originating from black, mixed or non-white ethnic groups.

The provider and lead GP is Dr Zahir Mughal who is supported by a part time female salaried GP. The practice also employs a locum GP for three sessions per week.

The practice is staffed by one part time practice nurse and a full time advanced nurse practitioner. There are three part time health care assistants (HCA) all of whom are female and also work on reception. The practice also employs a part time pharmacist.

The clinical team is supported by the practice administrator and a team of administrative staff.

The practice catchment area is classed as being within one of the most deprived areas in England. People living in more deprived areas tend to have a greater need for health services. Male life expectancy is 76 years compared with a CCG average of 73 and a national average of 79. Female life expectancy is 82 years, CCG average 79, national average 83.

Mughal Medical Centre is situated in a purpose built building with access for less mobile patients and an interior lift.

The practice reception is open between 8am and 6.30pm every day except Thursday and appointments are available between 8.30am and 6.30pm. On a Thursday the reception is open between 8am and 8.30pm and a range of appointments are available from 8.30am until 8.30pm.

The Out of Hours walk-in service is provided by an external contractor, Local Care Direct at Hillside Bridge Health Centre. Patients are also advised of the NHS 111 service.

When we returned for this inspection, we checked and saw that the previously awarded ratings were displayed as required in the premises. 

Updated 4 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Zahir Mughal on 19 January 2016. Overall the practice was rated as requires improvement. A breach of the legal requirements was found. After the inspection the practice wrote to us to say what they would do to meet the legal requirements in relation to the safety and the leadership of the practice.

We then undertook a focussed follow up inspection at Dr Zahir Mughal on 13 October 2016 to check that the practice had met the requirements. We were not assured at that time that the practice had responded to the issues identified.

You can read the full comprehensive report which followed the inspection in January 2016 and the focused follow up inspection report from October 2016 by selecting the 'all reports' link for Dr Zahir Mughal on our website at www.cqc.org.uk .

We carried out a further announced comprehensive inspection at Dr Zahir Mughal on 14 March 2017. Overall the practice is rated as requires improvement.

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

• Staff told us they were encouraged to report and record significant events. However, these issues were not always documented and the practice did not have a comprehensive system for the management, collation and review of these events and were unable to provide a log of all the events which the inspection team were aware had taken place.
• The practice had significantly improved the systems to assess, manage and monitor the risks associated with infection prevention and control and fire. However, we found that some recruitment checks had not been undertaken during the recent recruitment of two staff members and that staff members were not offered the necessary immunisation checks including varicella and MMR.
• Staff were aware of current evidence based guidance. Staff training uptake had improved and staff felt they had the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated care and concern and most patients said they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. However, we did not see that all complaints were reviewed or discussed with the staff team.
• Patients we spoke with said they did not always find it easy to make an appointment with a named GP but urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice’s uptake for the cervical screening programme was 98%, which was significantly better than the CCG average of 76% and the national average of 81%.
• Staff had undergone Disclosure and Barring Service (DBS) checks but these were not the enhanced checks required for Nurses, Healthcare assistants, the GPs and those who had significant contact with patients, particularly children and vulnerable adults.
• There was a leadership structure and staff felt supported by management. The practice sought feedback from staff and patients. The practice had carried out a patient survey in December 2016 but had not formulated an action plan.
• The practice had a newly formed patient participation group (PPG) which had four members.

The areas where the provider must make improvement are:

• The provider must establish systems and processes to ensure that all significant events and complaints which occur are recorded, collated, managed and reviewed as appropriate.
• The provider must ensure that the appropriate level of DBS checks are undertaken for all employed persons and that recruitment arrangements include the necessary employment and immunisation checks for all staff. The process of appraisal must be embedded into the culture of the practice.
• The provider must establish a system to support clinical audit within the practice which will assess, monitor and improve outcomes for patients.

The areas where the provider should make improvement are

• The provider should continue to review the results of the national GP patient survey, including where patients experienced difficulty with making and getting appointments and the overall satisfaction of the patients registered at the practice. The provider should continue to explore ways to engage patients in the governance of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 May 2017

The provider was rated as requires improvement for safe and for well-led care. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as requires improvement for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• We saw that outcomes for diabetes related indicators were comparable to other practices. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading, in the preceding 12 months was 140/80mmHg or less was 77% compared to the CCG average of 73% and the national average of 78%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were management plans in place for patients with long-term conditions who experienced a sudden deterioration in health.
• Patients with multiple health issues had synchronised recalls so that these could be reviewed at one appointment.
• Patients were offered input from a dietician and a Health Care Assistant (HCA) had attended additional training regarding diabetes. The practice also offered weight management advice and guidance with nursing staff or the HCA.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 4 May 2017

The provider was rated as requires improvement for safe and for well-led care. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as requires improvement for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances. The practice told us they would also liaise with the school nursing service where concerns were raised about developmental or mental health concerns in older children.
• Immunisation rates were relatively high for childhood immunisations with the exception of the first dose of the MMR vaccine for five year olds which at 63% was slightly higher than the CCG average.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice communicated with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. The practice held dedicated baby clinics once a week with a nurse and GP. Safeguarding concerns involving children were shared with the Health visiting team.
• The practice had emergency processes to see acutely ill children and young people and for acute pregnancy complications and the premises were suitable for children and babies
• The practice was able to respond to the local demand for the non-therapeutic circumcision of male children.
• The practice offered an in house contraception clinic for patients.

Updated 4 May 2017

The provider was rated as requires improvement for safe and for well-led care. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as requires improvement for the care of older people.

• 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 pharmacist would carry out home visits to elderly patients to review their medications. Nurses and Health Care Assistants (HCAs) would also carry out home visits as necessary, for example, when bloods were required.
• Scheduled tasks were sent to reception staff prior to medications being needed by older patients and staff would call the patient and assist them to order their repeat medication if necessary.
• The practice was responsive to the needs of older patients, and offered home visits and urgent same day appointments for those with enhanced needs.
• Older patients all had a named GP and a care plan where required.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 4 May 2017

The provider was rated as requires improvement for safe and for well-led care. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as requires improvement for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, the practice offered telephone consultations and an evening surgery until 8.30pm on a Thursday.
• The practice offered online services which included the ability to book appointments, request prescriptions and leave messages as well as a full range of health promotion and screening that reflected the needs for this age group.
• When necessary the practice arranged flu clinics during the evening, outside school hours and at weekends.

Updated 4 May 2017

The provider was rated as requires improvement for safe and for well-led care. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.
• The practice supported small numbers of patients with dementia. However, 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG average of 86% and the national average of 84%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. Reception staff told us they undertook a weekly check to ensure that prescriptions were collected.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 93% which was comparable to the CCG average of 94% and better than the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice offered physical health checks for patients discharged from secondary care as part of the local incentive scheme.
• The practice would support patients with mental health issues to make contact with the community First Response team by assisting them to do this in a private room within the surgery.
• 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.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 4 May 2017

The provider was rated as requires improvement for safe and for well-led care. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice also operated a ‘worry list’. This was a list of patients who the practice were concerned about for a number of reasons and their needs would be prioritised and urgent appointments given.
• The practice offered longer appointments for patients with a learning disability, patients with mental health needs and those who required an interpreter.
• 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. The practice hosted a session run by a voluntary care advisor who visited one day per week to assist patients with benefit claims, immigration issues and other social needs.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.