Archived: Dr Amir Mir Also known as Cornwallis surgery

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection of Dr Amir Mir on 14 and 23 July 2015. Overall the practice is rated as inadequate.

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

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

• Regulation 12 (1) (2) (a) (b) (c) (d) (f) (g) (h): Safe Care and Treatment
• Regulation 13 (1) (2): Safeguarding service users from abuse and improper treatment
• Regulation 18 (1) (2) (a): Staffing
• Regulation 19 (1) (a) (b) (2) (a) (3) (a): Fit and proper persons employed
• Regulation 17 (1) (2) (a) (b) (c) (d) (e) (f): Good governance

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, the review of patients’ laboratory tests results were subject to significant delays and appropriate recruitment checks on staff had not been undertaken prior to their employment.
• Patients were unable to access care when they needed to due to insufficient staffing levels and inconsistent arrangements for ensuring access to GP and nurse appointments.
• Medicines were not appropriately managed within the practice. There were no supplies of emergency medicines and the temperature of a refrigerator used to store vaccinations was not routinely monitored.
• There was a lack safeguarding arrangements in place to protect vulnerable adults and children. The GP lead for safeguarding within the practice was absent and no alternative arrangements had been implemented. Staff had not received training in the safeguarding of vulnerable adults and children.
• Staff had not been supported in accessing training to meet their needs. For example staff had not received training in health and safety, infection control or chaperoning.
• Staff had not received appropriate supervision or appraisal. There were no team meetings held within the practice.
• There was a lack of openness and transparency within the management team and a lack of reporting of incidents, near misses and concerns. There was no evidence of learning and communication with staff.
• The practice did not have a patient participation group. They had not gathered feedback from patients to implement changes to service provision and promote continuous improvement.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
• Patients with long term conditions had received appropriate review of their care and treatment.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

If the provider had continued to be registered, the areas where the provider must have made improvements are:

• Implement processes to ensure the timely review of all patient laboratory test results.
• Ensure staffing levels and appointment access arrangements enable patients to access care to meet their urgent and routine healthcare needs.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure a supply of emergency medicines is available within the practice and that medicines are appropriately stored and monitored.
• Ensure arrangements are in place to safeguard vulnerable adults and children from abuse.
• Implement systems to ensure all clinicians are kept up to date with national guidance and guidelines.
• Ensure audits of practice are undertaken, including completed clinical audit cycles.
• Ensure clear processes for the recording, review and learning from significant events and incidents.
• Ensure there are formal governance arrangements in place, including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure assessment of risk is undertaken and monitoring recommendations are implemented, in order to reduce the risk of exposure of staff and patients to legionella bacteria.
• Ensure staff undertake training to meet their needs, including training in the safeguarding of vulnerable adults and children, health and safety, chaperoning and infection control processes.
• Provide opportunities for staff to receive regular supervision and appraisal.
• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements
• Ensure the practice establishes a patient participation group and implements processes and procedures to gather feedback from patients.

If the provider had continued to be registered, the areas where the provider should have made improvements are:

• Develop an action plan to ensure findings from the infection control audit are reviewed and actions completed.
• Ensure protocols for repeat prescribing and the initiation of new prescriptions are in line with national guidance.

On the basis of the concerns identified at this inspection we took action to enforce urgent suspension of the provider’s registration, under Section 31 of the Health and Social Care Act 2008. This enforcement action is subject to appeal by the provider. Following our inspection visit, Dr Amir Mir submitted an application to cancel their registration and this application was accepted. We subsequently received an application from another provider to provide services from the same location. This application was accepted and patients previously registered with Dr Amir Mir are able to access care from the new provider. The service provided at Cornwallis Surgery will be put into special measures. The new provider will be responsible for ensuring that improvements are made.

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. 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice