Background to this inspection
Updated
17 December 2018
Dr Zaheer Hussain, also known as Fulham Cross Medical Centre, operates from 322 Lillie Road, Fulham, London, SW6 7PP. The practice has access to three consulting rooms which are based at ground floor level.
The practice provides NHS primary care services to approximately 3100 patients and operates under a General Medical Services (GMS) contract. The practice is part of NHS North West London Clinical Commissioning Group (CCG).
The practice is registered with CQC as an individual provider, and the regulated activities provided are diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services.
The practice staff comprises a lead GP (8 sessions per week), a GP partner not currently conducting clinical sessions, two long-term female GP locums (0.2 whole time equivalent (WTE) each). The medical team are supported by a locum practice nurse (0.1 WTE) and one healthcare assistant (0.1 WTE). There is a part-time practice manager (0.4 WTE), a part-time assistant practice manager (0.5 WTE) and four administration/reception staff (1.4 WTE).
The practice population is in the fifth decile in England, on a scale of one to ten, with one being the most deprived and ten being the least deprived. People living in more deprived areas tend to have greater need for health services. Data shows that 30.4% of patients within the practice area were from Black and Minority Ethnic (BME) groups. The highest proportion of patients within the practice population were in the 15 to 44-year old age category.
The practice is open between 8am and 6.30pm Monday to Friday. Extended hours appointments are available on Monday and Tuesday from 6.30pm to 8.30pm, and on Wednesday from 6.30pm to 7.30pm. The practice does not currently have its own website, patients could request appointments and repeat prescriptions on line through the NHS website. Out of hours services are provided by London Central and West.
Updated
17 December 2018
This practice is rated as inadequate overall.
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – Good
Are services responsive? – Inadequate
Are services well-led? - Inadequate
We carried out an announced comprehensive inspection at Dr Zaheer Hussain, also known as Fulham Cross Medical Centre, on 7 October 2014 under section 60 of Health and Social Care Act 2008 as part of our regulatory functions. The overall rating for the practice was requires improvement in safe, effective, responsive and well-led domains, and good in the caring domain. A second announced comprehensive inspection was planned for 5 November 2015; however, the inspection team was refused entry by the Registered Provider, Dr Hussain. The inspection team attended the practice on 10 November 2015 and conducted a comprehensive inspection. This resulted in the practice being rated as inadequate across all domains and the practice was suspended for three months. The suspension was stayed following representations to the Judge, on condition that a repeat inspection be conducted and if found to be "good enough" the practice would be allowed to re-open. A further inspection was conducted on 4 February 2016, the practice was rated inadequate overall, inadequate in well-led, safe and effective domains and requires improvement in responsive and caring domains. The practice was placed in Special Measures. A six-month inspection following Special Measures was carried out on 15 September 2016 and the practice was rated overall as requires improvement, requires improvement in effective and well-led domains and good in safe, caring and responsive domains. The practice was taken out of special measures. A twelve-month follow-up CQC inspection took place on 17 July 2017, at which the practice was rated as being good overall, with requires improvement in well-led domain.
The full comprehensive reports of the previous inspections can be found by selecting the ‘all reports’ link for Dr Zaheer Hussain on our website at www.cqc.org.uk.
This inspection, on 24 July 2018 was an announced comprehensive inspection with a second unannounced visit on 6 August 2018 to confirm that the practice was now meeting the requirements we had identified in well led domain at our previous inspection on 17 July 2017.
At this inspection we found the practice demonstrated some improvements from previous inspections, for example, significant events, managing complaints and sharing learning with staff, and duty of candour and whistleblowing policies were in place and staff understood what is meant by those terms. However, improvement overall had not been sustained, the provider had failed to respond to issues we have previously identified and raised with them. We found breaches in regulations 12 and 17. In particular:
- The practice did not have clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice did not always learn from them. Risk assessments were not being completed; staff recruitment was not in line with requirements; improvements were required to infection control and there was no recent audit; equipment was not all calibrated; there were fewer GP sessions provided than at our last inspection when patient numbers had increased; there was no system to manage medicines and safety alerts; prescribing and the management of patients being prescribed high risk medicines was not always in line with guidance and requirements.
- There was limited evidence the practice reviewed the effectiveness and appropriateness of the care it provided. We found there was no induction for new staff, staff did not receive training needed to carry out their role, no appraisal, minimal evidence of quality improvement, no process to monitor consent. There were low numbers of women attending for a cervical smear and low child immunisations.
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Staff generally involved patients in their care and treatment and treated patients with compassion, kindness, dignity and respect.
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The practice did not respond to patient needs by providing safe and effective care and treatment. There was no evidence the practice had considered patient feedback regarding access and taken action to improve patient experience.
- There was a lack of governance and no systems in place to assess, monitor and improve quality and safety, while clinical meetings were taking place, these were not recorded so there was no evidence of discussions or actions, the practice did not work with other health and social care services to provide joined up care and treatment for patients.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 varying the terms of their registration within six months if they do not improve.
This service 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 remove this location or cancel this provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice