Archived: Dr Raphael Rasooly

Updated 4 January 2023

Dr Raphael Rasooly's practice is located at 21 Tanfield Avenue, London, NW2 7SA and is known locally as Neasden Medical Centre. The provider also runs a branch practice at Greenhill Park, London, NW10 9AR. The practice provides NHS services through two General Medical Services (GMS) contracts to around 12,000 patients living in the areas of Harlesden and Neasden in North West London. The practice is part of the North West London Integrated Care Board and part of both the North Brent Primary Care Network and the South Brent Primary Care Network.

The practice is run by a principal male GP and employs a salaried female GP, four sessional GPs, two practice nurses and two clinical pharmacists. The administration team is led by a practice manager and includes several administrators and reception staff. Two receptionists are trained to carry out phlebotomy duties and one is a trained healthcare assistant. The practice also has access to associated staff through its membership of the primary care network, for example an additional clinical pharmacist and a social prescriber.

The practice population is in the seventh most deprived decile in England. Public Health England rates the level of deprivation within the practice population group as three, on a scale of one to ten. Level one represents the highest level of deprivation and level ten the lowest. There is a higher than the national average proportion of patients between 15 and 44 years of age. The population is ethnically diverse with around a third of patients identifying as white.

The practice reception is open at the main and branch sites Monday to Friday between 8.00am and 6.30pm. Patients may book appointments by telephone, online or in person. The practice offers extended hours appointments on a Tuesday evening and on Sunday and evening and weekend primary care appointments are also available at other sites in Brent.

When the practice is closed, patients are directed to contact the local out of hours service via NHS 111. This information can be accessed on the practice website.

The practice is registered with CQC to carry out the following regulated activities: diagnostic and screening procedures; treatment of disease, disorder or injury and surgical procedures.

Updated 4 January 2023

Dr Raphael Rasooly is a provider registered with CQC. Following a comprehensive inspection on 5 March 2020, we rated the practice inadequate overall and in safe, effective and well-led and across all population groups. Responsive and caring were rated requires improvement.

At the inspection, we found concerns in relation to systems and processes to keep people safe, the safe management of medicines, systems for learning and making improvements when things went wrong, monitoring of the outcomes of care and treatment, staff training, leadership and overall governance. The practice was placed in special measures and issued warning notices for breaches of Regulation 12 and 17 of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014.

We carried out an unannounced focused inspection of Dr Raphael Rasooly on 3 August 2020 to follow-up on information of concern we received, and the warning notices issued following the March 2020 inspection.

At this inspection, we found the provider had made some improvement in providing safe, effective and well-led services. However, we identified further concerns in relation to structured reviews of people with long-term conditions and general governance systems. The practice was issued Requirement notices for breaches of Regulation 12 and 17 of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014.

We carried out a comprehensive inspection of the practice on 7 December 2020. Following this inspection, we rated this practice requires improvement overall. Safe, effective, caring, responsive and well-led key questions were rated requires improvement along with all the population groups.

We also reviewed remotely specific documentation including policies and audits. (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 report of the previous inspections can be found by selecting the 'all reports' link for Dr Raphael Rasooly on our website at www.cqc.org.uk.

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 providers, patients, the public and other organisations

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

• Although some improvement was evident since the previous inspections. We found continuing concerns in relation to medicine reviews, the effectiveness of the monitoring system for people on Direct Oral Anticoagulants (DOACs) and compliance with safety alerts.

We rated the practice requires improvement for providing effective services because:

• We found continuing concerns in relation to structured medicine reviews for people with asthma.
• Cervical screening and childhood immunisation achievement rates were below national targets although there was some improvement since the last inspection.
• The provider did not monitor the clinical practice of sessional GPs.
• The provider did not monitor the process for seeking consent.

We rated the practice requires improvement for providing caring services because:

• National GP Patient Survey results for caring indicators were below local and national averages.
• Feedback we received from people who used the service showed that people were not always treated with kindness and respect and their privacy upheld.

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

• Although nurse capacity had been increased, and there had been some improvement in uptake, cervical screening and childhood immunisation achievement rates remained below national targets.
• Feedback we received from people who used the service was predominantly negative in relation to access to the service.

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

• The provider demonstrated some improvement in leadership and overall governance. However, concerns remained particularly in relation to clinical governance and leadership capacity to sustain improvement.

The areas where the practice 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.

(Please see the specific details on action required at the end of this report).

The areas where the practice should make improvements are:

• Ensure safeguarding policies consider people accessing online services and relevant safeguarding information is shared with the Out of Hours service.
• Develop a comprehensive program of quality improvement including clinical audit to drive improvement in care and treatment outcomes.
• Improve patient satisfaction with the caring aspects of the service provided and continue to improve the identification and support of patients with carer responsibilities.
• Improve confidentiality arrangements at the reception desk.
• Improve patient satisfaction with access to the service.
• Further develop systems to ensure compliance with the requirements of the duty of candour.
• Take steps to improve patient engagement and involvement in the development of the services provided.

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

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care