Dr Gulzar Ahmed Also known as Crompton Medical Centre

We carried out an announced comprehensive inspection at Dr Gulzar Ahmed also known as Crompton Medical Practice on 07 & 08 January 2021 to follow up on breaches of regulation identified in virtual records reviews carried out in September and December 2020 where we found:

• The provider did not have systems to ensure that care was conducted in a safe manner.

• The provider did not have governance structures that were effective.

Following a comprehensive inspection on 30 October 2019 the practice was rated “Requires Improvement” overall and issued requirement notices for breaches of Regulation 12 and 17 of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014.

In September 2020, we received information of concern. In response, we carried out an assessment of patient records through virtual access of the provider’s IT system on the 11 September 2020. This resulted in a warning notice for Regulation 17 of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014. On the 14 December 2020, we conducted a virtual records review to review this warning notice, and in view of the concerns identified we made a decision to inspect the practice in person as the requirements of the warning notice were not met.

We reviewed specific documentation including policies and audits virtually. (In light of the current Covid-19, CQC has looked at ways to fulfil our regulatory obligations, respond to risk and reduce the burden placed on practices by minimising the time inspection teams

spend on site. In order to seek assurances around potential risks to patients, we are currently piloting a process of remote working as far as practicable. This provider consented to take part in this pilot and some of the evidence in the report was gathered without entering the

practice premises).

The activity on 7, 8 and 12 January found continuing concerns in the areas previously identified despite the provider taking some actions..

We are mindful of the impact the COVID-19 pandemic has on our regulatory function. We will continue to discharge our regulatory and enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated the practice as requires improvement overall and requires improvement for all population groups except people with long term conditions and working age people (including those recently retired and students) which were rated inadequate due to the ongoing length of time concerns have been held regarding patient outcomes without sufficient improvement.

We rated the practice as requires improvement for safe services because:

• Clinical governance did not facilitate full and complete clinical records which led to concerns associated with medicines management.
• Safety alerts were not reviewed on an ongoing basis with the patient population which led to concerns.
• Safeguarding processes ensured that patients were safe and protected from potential harm.

We rated the practice as inadequate for effective services because:

• Performance data and thus outcomes for patients was below local and national averages and had been low for a significant period with limited improvement identified.
• The practice did not have evidence of appraisals and performance reviews for eligible staff working at the practice.
• Supervision of staff was not formalised and clinical supervision of staff was not documented in specific roles.
• The practice could demonstrate how they assured the competence of some staff employed in advanced clinical practice.

We rated the practice as good for caring services because:

• Patients told us that staff treated them with care and compassion.
• National GP Patient Survey results were in line with local and national averages.

We rated the practice as requires improvement for responsive services because:

• The practice did not record complaints in a suitable manner, and we did not see how these were used to improve services.
• The practice did not conduct a continuous patient survey to establish patient experience of the practice.
• Appointments were seen to be available through a variety of access routes in a timely way.
• National GP patient survey results for the practice were in line with local and national averages.

We rated the practice as requires improvement for well led services because:

• The practice did not have clear and effective processes for managing risks associated with poor clinical governance.
• Concerns raised at our virtual records review in September 2020 had not been fully addressed.
• We saw clinical management of risk was ineffective when reviewing clinical records of medication reviews, safety alerts and medication management.
• Learning from significant events and complaints was not demonstrated.
• The practice did not have clear systems and processes to keep patients safe.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Improve processes for staff appraisals and ensure that staff wellness and disciplinary policies are adhered to using documentation to demonstrate this.
• Develop quality improvement initiatives to improve patient care and experience in conjunction with continued audit activity.
• Develop a carers board for the waiting area of the practice.
• Develop a way to show the practice has evidence to support that staff are qualified to work within their designated remit.
• Improve the uptake of cervical screening and childhood immunisations so that they are in line with local and national standards.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care