Archived: Dr UA Afser & Dr A Arif 's Practice

Updated 10 July 2017

Dr UA Afser and Dr Arif’s Practice is a family run service providing primary medical services to approximately 4000 patients through a General Medical Services contract. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The premises is owned by Barking and Dagenham Council. Longbridge Road has a variety of local amenities including a supermarket, dentist, pharmacist and various other independent shops. The practice is well served by local buses and a little over one mile away from Barking Underground and Railway Station.

The practice is part of NHS Barking and Dagenham Clinical Commissioning Group. Data available from Public Health England shows the level of deprivation within the practice population group is rated as two on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest.

The medical team is made up of one male GP working nine clinical sessions a week, a female Nurse prescriber and a female practice nurse both working one weekly session. The clinical team are supported by a female practice manager, a reception supervisor and two reception staff. The practice’s opening times are from 8am to 6pm Monday to Friday. Surgery times are from 9.30am to 1:30pm and then 4pm to 6pm on Monday, Wednesday and Friday. There is no afternoon surgery on Thursday when the practice is closed. Extended hours are offered between 6.30pm to 8pm on Tuesday. The Out of Hours service is provided by the GP Out of Hours Hub services and NHS 111 service and can be accessed by ringing the local rate telephone number which is displayed in the practice leaflet, slips at reception and a permanent poster on the practice’s front door.

Dr UA Afser and Dr Arif’s Practice is registered as a partnership to provide the registered activities of Treatment of disease, disorder or injury; Family planning, Surgical procedures and Diagnostic and screening procedures from 620 Longbridge Road, Goodmayes, Dagenham, RM8 2AJ. An application has been submitted to register as an individual provider since the partnership ceased in October 2016.

The practice was inspected under the Care Quality Commission’s current inspection regime in April 2016 and was found to be in breach of Regulation 12 HSCA (RA) Regulations Safe care and treatment, Regulation 17 HSCA (RA) Regulations Good governance, Regulation 18 HSCA (RA) Regulations 2014 Staffing and Regulation 19 HSCA (RA) Regulations 2014 Fit and proper persons employed. This led to an overall rating of inadequate and the practice was placed in special measures (Special measures give people who use the service the reassurance that the care they get should improve).

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr UA Afser and Dr A Arif’s Practice on 21 April 2016 and rated the practice as inadequate for the safe and well-led key questions, requires improvement for effective and responsive, and good for caring. This led to an overall rating of inadequate. Breaches of legal requirements were found and requirement notices were issued in relation to patient safety, inadequate governance and staffing. The provider was placed into special measures and the full comprehensive report can be found by selecting the ‘all reports’ link for Dr UA Afser and Dr A Arif’s Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection which we undertook on 19 April 2017 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 21 April 2016. At this inspection we found that the requirements of the requirement notices had been met; however, a new requirement notice has been issued as we found that the arrangements for managing high risk medicines needed strengthening to keep patients safe. This has resulted in a rating of requires improvement for the safe key question. The overall rating from this visit was requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The arrangements for managing high risk medicines such as warfarin and methotrexate in the practice needed significant strengthening.

• The practice now had appropriate arrangements for identifying, recording and managing risks, issues he practice now had up to date fire risk assessment and carried out regular fire drills.

• The practice did not deploy sufficient numbers of clinical staff to meet the needs of patients, for example, the clinical staff which included the GP, a practice nurse and a nurse prescriber worked a total of 11 clinical sessions per week.

• The practice had updated policies, including incident policy and recruitment. All policies were practice specific and all staff had access to them on the practice computer system.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• We saw clinical audits had been carried out to show patient and quality improvements.
• Information about services and how to complain was available and improvements were made to the quality of care as a result of complaints and concerns.

• Patients did not have access to a female GP; however, the practice told us that a female salaried GP working one session was due to commence employment in May 2017.

• Results from the national GP patient survey highlighted concerns from patients about long waiting times and delays to appointments.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.

However, there were also areas of practice where the provider needs to make improvements.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance of high risks medicines in accordance with the fundamental standards of care.

• Establish effective systems to improve and monitor access to appointments and waiting times as highlighted in the national GP patient survey so that it is comparable to CCG and national survey results.

• Establish systems and processes to continually assess the needs of the service.

The areas where the provider should make improvements are:

• Continue to ensure policies such as significant event are up to date and reflect day to day practice.

• Review the nursing services so that they are provided in a way that meets the needs of the patient groups, particularly those unable to attend during normal opening hours.

• Consider ways of improving access to services, for example, the provision of a website.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 July 2017

The practice is rated as requires improvement for safe, responsive and well led and good for effective and caring . The evidence which led to these ratings affected all patients including this population group.

• The GP led in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was 86% which was higher than the local CCG average of 78%, and in line with national average of 87%.

• 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 emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• 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 10 July 2017

The practice is rated as requires improvement for safe, responsive and well led and good for effective and caring . The evidence which led to these ratings affected all patients including this population group.

• 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.

• Uptake rates for some vaccines given were lower than the CCG/national averages. For example, rates for the vaccines given to under two year olds ranged from 75% to 92% and five year olds from 64% to 92%.

• 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.

• Appointments with the practice nurse were not available outside of school hours.

• The practice worked 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.

Updated 10 July 2017

The practice is rated as requires improvement for safe, responsive and well led and good for effective and caring . The evidence which led to these ratings affected all patients including this population group.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services. The GP met with other local GPs (peer review meetings) in the locality to discuss elderly care review.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 10 July 2017

The practice is rated as requires improvement for safe, responsive and well led and good for effective and caring . The evidence which led to these ratings affected all patients including this population group.

• The practice had not adjusted the services it offered to ensure these were accessible and flexible.For example, the practice did not offer extended hours appointments with the practice nurse or nurse prescriber.

• Patients did not have access to a female GP; however, the practice told us that a female salaried GP would commence employment in May 2017.

• Appointments with the practice nurse were not available outside of normal working hours.

• The practice did not have a website; however, patients could book appointments online through NHS Choices as well as view their records and order repeat prescriptions.

Updated 10 July 2017

The practice is rated as requires improvement for safe, responsive and well led and good for effective and caring . The evidence which led to these ratings affected all patients including this population group.

• The practice carried out advance care planning for patients living with dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available such as pamphlets 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.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 July 2017

The practice is rated as requires improvement for safe, responsive and well led and good for effective and caring . The evidence which led to these ratings affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people and travellers, however they did not have any patients on the register at the time of inspection.

• The practice offered longer appointments for patients with a learning disability.

• 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, for example those with caring responsibilities.

• 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 showed us the flowchart they used to contact relevant agencies in normal working hours and out of hours.