Archived: Dr Shabir Bhatti Also known as Bermondsey Spa Medical Practice

Updated 21 January 2016

The practice operates from a single location in Bermondsey, South east London. It is one of 49 GP practices in the Southwark Clinical Commissioning Group (CCG) area. There are approximately 8512 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services, family planning services and diagnostic and screening procedures.

The practice has a personal medical services (PMS) contract with the NHS and is signed up to a number of enhanced services. Enhanced services require an increased level of service provision above what is normally required under the core GP contract. These enhanced services include childhood vaccination and immunisation, flu and pneumococcal immunisations, extended hours and minor surgery.

The practice has a larger than average population of patients aged between 20 and 40 years, and a higher than national and CCG average representation of income deprived children and older people.

The practice clinical team is made up of a male principal GP, two male and two female salaried GPs, a female practice nurse (PN), a female health care assistant (HCA), a phlebotomist, osteopath and counsellor.

The clinical team is supported by ten reception/administrative staff members and a medical secretary. At the time of our inspection, the practice did not have a practice manager but they told us one was due to begin employment in November 2015. The practice is a teaching practice, and has medical students attached to the practice for short periods.

The practice is open between 8.00am and 6.30pm Monday to Friday. It offers extended hours from 7.00am to 8.00am Monday and Wednesday and from 6.30pm to 7.30pm on Tuesday for patients who are not able to access appointments at the practice during normal opening hours. Routine and urgent appointments are available throughout the day. The practice is closed at weekends and on bank holidays.

The practice has opted out of providing out-of-hours (OOH) services and directs their patients to a contracted out-of-hours service.

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Shabir Bhatti on 15 October 2015. Overall the practice is rated as inadequate.

We previously inspected Dr Shabir Bhatti in February 2014 and it was found to be non-compliant with safeguarding people from abuse, care and welfare of people using the service, cleanliness and infection control and management of medicines. We found it to be compliant in all areas at a subsequent inspection in September 2014. They had practice managers in post at both of these inspections.

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. Appropriate recruitment checks on staff had not been undertaken prior to their employment, there were insufficient arrangements to safeguard people from abuse and medicines management arrangements needed improvement

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• There was insufficient assurance to demonstrate people received effective care and treatment. For example, the practice did not engage in regular clinical and multi-disciplinary meetings to discuss and make decisions about the care of their patients with complex needs. The practice did not routinely monitor their quality performance and make plans to improve.

• Whilst some patients were positive about their interactions with staff, some patients did raise concerns about a lack of care and concern and rude attitude shown by reception staff and clinical staff at times.

• Patients said that they sometimes had to wait a long time for non-urgent appointments and that it was very difficult to get through the practice when phoning to make an appointment. Patients also told us they experienced long delays waiting for their booked appointments

• The practice had insufficient leadership capacity and lacked formal governance arrangements.

The areas where the provider must make improvements are:

• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Take action to address identified concerns with infection prevention and control practice.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.

• 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.

• Ensure staff have appropriate training and appraisals for their roles

• Ensure complaints are dealt with in line with the practice policy

The areas where the provider should make improvement are:

• Improve processes for making appointments.
• Actively seek to involve patients in developing and improving the service through the development of a patient participation group
• Ensure online services are available for patients in line with their service contract obligations
• Ensure there is a system for the management of prescription pads so they are properly accounted for
• Develop systems to provide information and support to patients who are also carers.

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. 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

Updated 21 January 2016

The practice is rated as inadequate for the care of people with long term conditions. We found the practice to be inadequate for providing safe, effective, responsive and well led services and that these findings affect people in this population group.

Nursing staff had lead roles in chronic disease management. However the practice could not demonstrate how they ensured role-specific training and updates for these staff, for example on topics relating to the review of patients with long-term conditions, administering vaccinations, and taking on lead roles such as for infection prevention and control.

Nationally reported data showed that the practice achieved high scores for its performance for many indicators relating to the care of people with various long term conditions. For example, all of the patients on their chronic kidney disease register with hypertension and proteinuria were being treated according to the recommended protocols of Angiotensin-converting enzyme inhibitors (ACE-1) and Angiotensin receptor blockers (ARB). Of their patients with chronic obstructive pulmonary disease (COPD), 88% had the diagnosis confirmed by post bronchodilator spirometry between 3 months before and 12 months after entering on to the register. All of the patients on their heart failure register with a current diagnosis of heart failure due to left ventricular systolic dysfunction, were being currently treated with an ACE-I or ARB, as well as being additionally currently treated with a beta-blocker licensed for heart failure.

Structured annual reviews were undertaken to check that their health and medicines needs were being met. For example, 78% of their patients with asthma had had an asthma review in the preceding 12 months that included an assessment of asthma control. Also, 71% of their patients with a new diagnosis of depression in the preceding year had been reviewed within recommended timeframes.

However for those people with the most complex needs, the GPs did not routinely work with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 21 January 2016

The practice is rated as inadequate for the care of families, children and young people. We found the practice to be inadequate for providing safe, effective, responsive and well led services and that these findings affect people in this population group.

Immunisation rates were relatively high for all standard childhood immunisations.

The practice carried out six week post-natal checks for mothers and new baby health checks. The practice hosted baby clinics run by the community health visitors.

Access to a GP was available through telephone consultations, urgent and pre-booked appointments, although patient feedback we received was that they had difficulties getting appointments when they needed them. Appointments were available outside of school hours and the premises were suitable for children and babies.

At the time of our inspection, the principal GP in the practice carried out male circumcision procedures under private treatment.  However there were no peer reviews of these procedures being carried out. We also found that there were no arrangements for the principal GP to carry out follow ups of the patients who had had circumcisions at the practice.

Updated 21 January 2016

The practice is rated as inadequate for the care of older people. We found the practice to be inadequate for providing safe, effective, responsive and well led services and that these findings affect people in this population group.

Nationally reported data showed that the practice achieved high scores in relation to their interventions for conditions commonly found in older people. For example 86% of their cancer patients diagnosed within the preceding 15 months, had a patient review recorded as occurring within 6 months of the date of diagnosis. Of patients with rheumatoid arthritis on the register, 90% had had a face-to-face annual review in the preceding 12 months. For the management of osteoporosis in respect of patients aged 50 and over, all their patients within this register were currently being treated with an appropriate bone-sparing agent.

Patients in the recommended groups, including older people, are invited for annual seasonal flu vaccinations. The percentage of people aged 65 or over who received a seasonal flu vaccination was 69%, which was lower than the national average of 73%.

Prescription requests can be made online via the practice website. However appointments could not be made online and patients did not have online access to any parts of their medical records.

Updated 21 January 2016

The practice is rated as inadequate for the care of working age people (including those recently retired and students). We found the practice to be inadequate for providing safe, effective, responsive and well led services and that these findings affect people in this population group.

The age profile of patients at the practice is mainly those of working age, students and very young children, but the services available did not fully reflect the needs of this group. Although the practice offered extended opening hours for early morning appointments from 7.00am to 8.00am Mondays and Wednesdays, and late evening appointments from 6.30pm to 7:30pm on Tuesdays, patients could not book appointments online. Appointments could only be booked by telephone or in person at the practice.

Health promotion advice was offered but there was limited accessible health promotion material available through the practice.

The practice’s uptake for both health checks and health screening was similar to other practices in the local area.

Updated 21 January 2016

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). We found the practice to be inadequate for providing safe, effective, responsive and well led services and that these findings affect people in this population group.

In the preceding 12 months, 82% of people experiencing poor mental health had a documented care plan recorded in their records. The practice also carried out checks relating to the physical health of these patients. For example, 77% had had a record of their blood pressure, and 82% had had a record of their alcohol consumption, in the preceding 12 months.

However the practice did not work with multi-disciplinary teams in the case management of people experiencing poor mental health.

Updated 21 January 2016

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The practice did not hold a register of patients living in vulnerable circumstances. It was unable to identify the percentage of patients who had received annual health checks.

The practice had not worked with multi-disciplinary teams in the case management of vulnerable people. Some staff knew how to recognise signs of abuse in vulnerable adults and children, but they were not aware of their responsibilities regarding information sharing, and documenting of safeguarding concerns.

The practice told us they maintained a carers’ register and that their patient records system highlighted carers who had been identified. However the practice was not able to provide us with figures for their total numbers of carers, and there was no system in place for offering carers additional support.